A case of descending necrotizing mediastinitis due to severe odontogenic infection successfully treated by thoracoscopic drainage

  • ARAKAWA Mikiko
    Department of Dentistry and Oral Surgery, Nagoya Medical Center Department of Dentistry and Oral Surgery, Komaki City Hospital
  • HATTORI Hisashi
    Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine
  • TOH Taketomo
    Department of Dentistry and Oral Surgery, Komaki City Hospital
  • TAKAHASHI Makoto
    Department of Dentistry and Oral Surgery, Nakatsugawa Municipal General Hospita
  • YAMBE Makoto
    Department of Dentistry and Oral Surgery, Komaki City Hospital
  • UEDA Minoru
    Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine

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Other Title
  • 重症歯性感染による降下性壊死性縦隔炎に対し胸腔鏡下ドレナージにて救命し得た1例
  • 重症菌性感染による降下性壊死性縦隔炎に対し胸腔鏡下ドレナージにて救命し得た1例
  • ジュウショウキン セイカンゾメ ニ ヨル コウカセイ エシセイ ジュウカクエン ニ タイシ キョウコウキョウ カ ドレナージ ニテ キュウメイ シエタ 1レイ

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Abstract

We report a case of descending necrotizing mediastinitis due to severe odontogenic infection successfully treated by thoracoscopic drainage. A 24-year-old man was referred to our hospital emergency center because of bilateral submandibular swelling and was hospitalized on the same day. He had diffuse swelling and redness from the submandible to neck bilaterally and had difficulty in swallowing. He had spontaneous pain at the third right mandibular molar, but no tenderness, swelling, or pus discharge around the buccal gingiva. Panoramic X-ray images showed a radiolucent area at the root apex of the right mandibular third molar. Enhanced computed tomography revealed a diffuse abscess spreading to the sublingual, submental, and submandibular spaces. The patient underwent a laryngotracheotomy and cervical drainage because he had laryngeal edema. However, an abscess had formed in the anterior mediastinum through the left intercarotic space, and hydrothorax was found. Then, surgical drainage for the deep cervical abscess and endoscopic transthoracic drainage for the descending necrotizing mediastinitis were performed. The treatment succeeded, and he was discharged.

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