Mediastinitis of odontogenic origin. A serious complication with 80 years of history

Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine

“…The mean hospitalization duration for our patients with DNM was similar to that found by other studies ( Qu et al., 2018 ; Escobedo et al., 2020 ). All the patients were re-operated an average of three times, which was in agreement with the general clinical practice ( Freeman et al., 2000 ; González-García et al., 2011 ; Escobedo et al., 2020 ). In their systematic classification of the factors affecting the duration of hospitalization in cases of head-and-neck odontogenic infection, Heim et al.…”

“…The prevertebral space is also called the ‘danger space’, mainly because its involvement practically renders the infection thoracic, as the lower border of this space is the diaphragm. DNM is a rare critical condition and requires immediate drainage via thoracotomy ( Mihos et al., 2004 ; Wang et al., 2005 ; Malis et al., 2008 ; Escobedo et al., 2020 ). Importantly, DNM may be indefinable in a patient with cervical cellulitis or abscess.…”

“…The diagnosis of DNM was established with clinical examination and CT of the face, neck, and thoracic cavity. All patients presented were diagnosed according to the Estrera's diagnostic criteria of for DNM: 1) clinical manifestations of severe infection (pyrexia, tachycardia, tachypnea); 2) characteristic radiological features of mediastinitis on CT scan; 3) identification of necrotizing infection at surgery; 4) preexisting oral or cervical infection ( Wang et al., 2005 ; Escobedo et al., 2020 ). For patients 1, 2, and 3, OMFS consultation was the initial step.…”

“…Other authors argue that DNM is under-reported and that there has been a rise in the occurrence of this condition ( Cai et al., 2006 ; Escobedo et al., 2020 ). Indeed, large series of patients with DNM have been reported over the last 5 years, compared with limited numbers in the previous decades ( Ruiz et al., 1993 ; Freeman et al., 2000 ; Roccia et al., 2007 ; Huang et al., 2015 ; Qu et al., 2018 , 2020 ; Pucci et al., 2020 ).…”

“…Tracheostomy was performed in four patients, either during the initial drainage and debridement, or following a prolonged intubation period in the ICU. Indeed, the current evidence does not justify the application of a single treatment algorithm regarding tracheostomy in the management of DNM ( Ruiz et al., 1993 ; Freeman et al., 2000 ; Roccia et al., 2007 ; González-García et al., 2011 ; Escobedo et al., 2020 ). The surgical drainage undertaken for each patient was dictated by the type of DNM and the effusion pattern in the thoracic cavity.…”