Descending necrotizing mediastinitis following dental extraction. Radiological features and surgical treatment considerations

González-García, Raúl; Risco-Rojas, Roberto; Román-Romero, Leticia; Moreno-García, Carlos; García, Cipriano López

doi:10.1016/j.jcms.2010.10.001

Cited by 25 publications

(29 citation statements)

References 15 publications

(18 reference statements)

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“…González-García et al 6 recommend a multidisciplinary approach to patients with DNM, with early input from maxillofacial and cardiothoracic teams. Tracheostomy is recommended for patients with deep cervical infection, to facilitate airway management.…”

Section: Discussionmentioning

confidence: 99%

Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection

Mark¹,

Song

Mark

2018

BMJ Case Reports

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Descending necrotising mediastinitis (DNM) is an uncommon clinical entity which may arise secondary to primary odontogenic or neck infection in susceptible patients. Infection may spread contiguously via the alar or 'danger' space, a potential anatomical space posterior to the true retropharyngeal space. Spread of infection to the mediastinum almost always necessitates urgent cardiothoracic surgical intervention. This case report describes a male patient whose clinical deterioration following the diagnosis of submandibular abscess was investigated with CT imaging of the chest, where a diagnosis of DNM was made. Diagnosis was confirmed following surgical intervention and aspiration of pus from the mediastinum.

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Section: Discussionmentioning

confidence: 99%

Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection

Mark¹,

Song

Mark

2018

BMJ Case Reports

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“…12 To our knowledge, from the neck to the mediastinum, there exist 3 potential major pathways for the infection to spread along the fascial spaces in DNM. Because an extensive fascial communication exists between the gums, the neck, and the mediastinum, odontogenic infections can rapidly spread to the mediastinum facilitated by gravity, respiration, and negative intrathoracic pressure.…”

Section: Discussionmentioning

confidence: 99%

Facial Paralysis and Mediastinitis Due to Odontogenic Infection and Poor Prognosis

Bucak

Ulu²,

Kokulu³

et al. 2013

Journal of Craniofacial Surgery

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Cervical necrotizing fasciitis (CNF) is a rare, rapidly advancing infection that involves the skin, the subcutaneous fibrofatty tissue, as well as the superficial and deep fascia and can cause life-threatening complications. The most frequent initiating factors in the head and neck region are a primary odontogenic infection, a peritonsillar infection, as well as posttraumatic or iatrogenic skin and mucosal injuries. Necrotizing fasciitis (NF) can expand within hours, and the reported mortality rate is up to 75% with delay interference. If the patients have any risk factors, poor prognosis can be seen. In this study, 1 patient with CNF with a history of peritonsillar infection and 2 patients with CNF who had a history of odontogenic infection with spreading to the temporal region and the mediastinum were described, with information of the literature and a clinical experience that was gained from 5 patients with NF who were seen at our clinic in the recent year, despite the fact that CNF was not seen up to last year. None of the patients had any risk factors. One of them had a worse clinical state with ascending infection to the temporal region, cranial nerve paralysis, and descending necrotizing mediastinitis, but he recovered from NF. After the oral intake began, dyspnea due to aspiration was seen and he died because of sepsis and multiorgan dysfunction. We aimed to attract attention to the importance of dental pathologies and increased mortality in a healthy patient.

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“…This makes mediastinotomy essential to management. An infection originating from the head and neck region may spread downward through the facial spaces or deep planes of the neck into the mediastinum, pleural cavities, and pericardium, due to gravity and negative intrathoracic pressure (4,5). The suggested criterion for the diagnosis of DNM is as follows: 1) severe oropharyngeal infection, 2) radiographic evidence of mediastinitis, 3) perioperative confirmation of both infections, and 4) the establishment of a relation between oropharyngeal infection and mediastinitis (6).…”

Section: Discussionmentioning

confidence: 99%

“…CT not only determines the spread of the inflammatory-necrotic process into the cervical and mediastinal area, but also allows for the determination of the optimal surgical drainage approach (5,7). Treatment of DNM consists of broad-spectrum antibiotic therapy and early drainage of the mediastinum and pleural cavity to remove the cause of infection (5,8,9). Once DNM is diagnosed, antibiotic treatment should be initiated.…”

Section: Discussionmentioning

confidence: 99%

Fatal Dental Abscess: Descending Necrotising Mediastinitis

Şahin¹,

Meteroğlu²,

Toptancı³

et al. 2013

Respir Case Rep

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Mediastinitis is a rare infectious disease around the vital organs in the mediastinum. Descending necrotizing mediastinitis (DNM) is caused by odontogenic, pharyngeal, cervical infections, sternotomy or diagnostic and therapeutic instrumentation. Unless it is diagnosed in a timely manner and properly treated, the outcome is fatal. Delay in treatment leads to the spread of the infection down to the mediatinum. We present a case of DNM in 17-year-old girl suffering from a dental abscess.

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Descending necrotizing mediastinitis following dental extraction. Radiological features and surgical treatment considerations

Cited by 25 publications

References 15 publications

Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection

Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection

Facial Paralysis and Mediastinitis Due to Odontogenic Infection and Poor Prognosis

Fatal Dental Abscess: Descending Necrotising Mediastinitis

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