Mediastinitis and bilateral pleural empyema caused by an odontogenic infection

Abstract

Background. Although odontogenic infections are relatively frequent in the general population, intrathoracic dissemination is a rare complication. Acute purulent mediastinitis, known as descending necrotizing mediastinitis (DNM), causes high mortality rate, even up to 40%, despite high efficacy of antibiotic therapy and surgical interventions. In rare cases, unilateral or bilateral pleural empyema develops as a complication of DNM. Case report. This case report presents the treatment of a young, previously healthy patient with mediastinitis and bilateral pleural empyema caused by an odontogenic infection. After a neck and pharynx re-incision, and as CT confirmed propagation of the abscess to the thorax, thoracotomy was performed followed by CT-controlled thoracic drainage with continued antibiotic therapy. The patient was cured, although the recognition of these complications was relatively delayed. Conclusions. Early diagnosis of DNM can save the patient, so if this severe complication is suspected, thoracic CT should be performed.

Empyema thoracis of odontogenic origin: experience from a maxillofacial unit

“…reported [1]. The volume of pus aspirated is an indication of severity of infection, and the fact that two of our patients were malnourished could explain the higher median volume of aspirate in our study.…”

“…Cervicofacial odontogenic infections are serious conditions that can spread upwards to the brain or downwards into the pleural and mediastinal cavities. Downwards spread through the cervical spaces into the pleural cavity with pus collection known as empyema thoracis is exceedingly rare [1], even though, em-pyema was firstly diagnosed by Hippocrates over 2,000 years ago.…”

Fatal Dental Abscess: Descending Necrotising Mediastinitis

“…Once DNM is diagnosed, antibiotic treatment should be initiated. The responsible pathogens for DNM are primarily a mixture of aerobic and anaerobic bacteria of the oral microflora (7,10). In the present case, no agents were isolated in the specimen obtained by mediastinal drainage due to previous anti-biotherapy.…”

A fatal case of empyema thoracis: the price for underestimating odontogenic infections

“…In most cases of odontogenic infection involving the deep neck spaces, the submandibular space is frequently involved [16,17]. Direct spread of odontogenic infections into the submandibular space commonly arises from either the second or third mandibular molar [18][19][20], or from the sublingual space. Indirect involvement of the submandibular space commonly follows lymphatic spread.…”