Descending Necrotizing Mediastinitis of Odontogenic Origin in a Young Male Patient: Case Report and Discussion

Sarmad Said¹, Chad J. Cooper¹, Mohamed Teleb¹ and German T. Hernandez^2,

¹Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA

²Department of Internal Medicine, Paul L. Foster School of Medicine, Division of Nephrology & Hypertension, Texas Tech University Health Sciences Center, El Paso, Texas, USA

Cite this paper

Sarmad Said, Chad J. Cooper, Mohamed Teleb and German T. Hernandez. Descending Necrotizing Mediastinitis of Odontogenic Origin in a Young Male Patient: Case Report and Discussion. American Journal of Medical Case Reports. 2014; 2(2):44-47. doi: 10.12691/AJMCR-2-2-5

Abstract

Background: Mediastinitis is an inflammatory process that can be presented acute or chronic. Acute mediastinitis occurs secondary due to esophagus perforation or induced by infections of odontogenic or retrapharyngealorigins. The most common form is the postsurgical mediastinitis after cardiovascular interventions. Descending necrotizing mediastinitis and acute infectious mediastinitis has often a fulminate and fatal course. Chronic mediastinitis (or sclerosing fibrosing mediastinitis) appears to be associated with long standing mediastinitis, which induces collagenous and fibrous overgrowth. Case Report: Forty-one year-old male patient without significant past medical history presented with 2-weeks history of progressive shortness of breath, productive cough, generalized dental pain and, facial swelling. In the further workup he was found to have an acute odontogenic mediastinitis complicated by deep neck abscess after recent history of dental extraction. Hospital course included respiratory failure induced by sepsis and possible airway compression from the deep neck abscess. He was intubated, placed on mechanical ventilation, and required multiple surgical interventions including but not limited to drainage, chest tubes, and thoracentesis. Intravenous antibiotic treatment with Metronidazole and Ceftriaxone was initiated. After long-standing treatment his condition improved and was discharged home. Conclusion: Odonotogenic mediastinitis with deep neck abscess should be considered in patients with recent tooth aches/infection or dental surgery. Early recognition, surgical, and antimicrobial treatment are implemented with good prognosis and outcome.

Keywords

mediastinitis, odontogenic infection, pneumomediastinum, descecing-necrotizing mediastinitis

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Deu-Martín M, Saez-Barba M, Sanz IL, Peñarrocha RA, Vielva LR, Montserrat MR. Mortality risk factors in descending necrotizing mediastinitis. Arch Bronconeumol 2010; 46: 182-7.
[2]	Sarna T, Sengupta T, Miloro M, Kolokythas A. Cervical necrotizing fasciitis with descendingmediastinitis: literature review and case report. J Oral Maxillofac Surg. 2012 Jun; 70(6): 1342-50.
[3]	Levitt GW. Cervical fascia and deep neck infections. Laryngoscope 1970; 80: 409-35.
[4]	Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983; 157: 545-52.
[5]	Basoglu A, Celik B, Sengul AT, Kaya S. Descending necrotizing mediastinitis with bilateral pleural empyema. Turk Respir J 2004; 5: 56-8.
[6]	Pearse HE Jr. Mediastinitis following cervical suppuration. Ann Surg 1938; 107: 588-611.
[7]	Mathieu D, Neviere R, Teillon C, Chagnon JL, Lebleu N, Wattel F. Cervical necrotizing fasciitis: clinical manifestations and management. Clin Infect Dis 1995; 21: 51-6.
[8]	Roccia F, Pecorari GC, Oliaro A, Passet E, Rossi P, Nadalin J, et al. Ten years of descending necrotizing mediastinitis: management of 23 cases. J Oral MaxillofacSurg 2007; 65: 1716-24.
[9]	Scaglione M, Pezzullo MG, Pinto A, Sica G, Bocchini G, Rotondo A. Usefulness of multidetector row computed tomography in the assessment of the pathways of spreading of neck infections to the mediastinum. Semin Ultrasound CT MR 2009; 30: 221-30.
[10]	Cirino LMI, Elias FM, Almeida JLJ. Descending mediastinitis: a review. Sao Paulo Med J 2006; 124: 285-90.
[11]	González-García R, Risco-Rojas R, Román-Romero L, Moreno-García C, López García C. Descending necrotizing mediastinitis following dental extraction. Radiological features and surgical treatment considerations. J Craniomaxillofac Surg 2011; 39: 335-9.