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

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.