Descending Necrotizing Mediastinitis: Complication of a Simple Dental Infection☆,☆☆,★
Section snippets
INTRODUCTION
Dental infections and abscesses are common in the general population. Although dental infections are usually benign, they can lead to serious complications. Two major complications are Ludwig's angina and descending necrotizing mediastinitis (DNM). These rare but life threatening conditions must not be overlooked by a physician during the assessment of tooth pain. In this report we describe a case of DNM due to a dental infection and discuss diagnosis and management.
CASE REPORT
A previously healthy 23-year-old man presented to the urgent care center with the complaint of tooth pain of 5 days' duration. He described pain in the right submandibular area that radiated to his right ear. The patient denied fever, chills, and neck or chest pain but did have some difficulty swallowing, although he was able to handle his secretions and his speech was normal. The patient denied nausea and vomiting but had decreased his fluid intake because of pain. Physical examination
DISCUSSION
Patients who present with dental abscesses usually respond well to antibiotics and outpatient referral and generally have an uncomplicated course. We report a case of DNM that developed in an otherwise healthy individual who had no signs at initial presentation of the fulminating course to come.
The two most dangerous complications of a simple dental infection are DNM and Ludwig's angina. Ludwig's angina can lead to DNM, but the converse is not true. Although both conditions can originate from a
References (11)
- et al.
Descending necrotizing mediastinitis
J Thorac Cardiovasc Surg
(1994) - et al.
Odontogenic infection leading to cervical emphysema and fatal mediastinitis
J Oral Maxillofac Surg
(1982) - et al.
Life-threatening deep fascial space infections of the head and neck
Infect Dis Clin
(1988) - et al.
Descending necrotizing mediastinitis: Trans-cervical drainage is not enough
Ann Thorac Surg
(1990) - et al.
Descending necrotizing mediastinitis
Surg Gynecol Obstet
(1983)
Cited by (18)
Increasing frequency and severity of odontogenic infection requiring hospital admission and surgical management
2020, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Odontogenic infections that spread beyond the confines of the jawbone pose a serious threat to the airway and have the propensity to cause deep neck infections.9 Severe complications have been reported, including cerebral abscess,10 descending mediastinitis,11 toxic shock syndrome,12 necrotising fasciitis,13 foetal distress requiring urgent delivery,14 and the development of methicillin-resistant Staphylococcus aureus (MRSA) while in the ICU.2 These adverse outcomes could have been avoided if the patient had sought early dental treatment at the onset of the symptoms.
Mediastinitis caused by an infected mandibular cyst
2004, International Journal of Oral and Maxillofacial SurgeryDiagnostic imaging of maxillofacial infections
2003, Oral and Maxillofacial Surgery Clinics of North AmericaDescending necrotizing mediastinitis due to odontogenic infections
2000, Oral surgery, oral medicine, oral pathology, oral radiology, and endodonticsLudwig's angina [2] (multiple letters)
1997, Annals of Emergency Medicine
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From the Department of Medicine* and the Emergency Department,‡ Jewish Hospital at Washington University Medical Center, Washington University School of Medicine, St Louis, MO.
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Address for reprints: Frank L Zwemer Jr, MD Emergency Department Jewish Hospital at Washington University Medical Center 216 South Kingshighway St. Louis, MO 63110 314-454-7905 Fax 314-454 -7998 E-mail [email protected]
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Reprint no. 47/1/81215