Korean J Thorac Cardiovasc Surg.  2000 Aug;33(8):688-692.

Descending Necrotizing Mediastinitis with Dental Caries: One case report

• Lee HJ
• Koo WM
• Lee G
• Lim CY

Abstract

Descending Necrotizing Mediastinitis (DNM) is a complication of oropharyngeal infections that can spread to the mediastinum. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. late diagnosis is the principal reason for the high mortality in DNM. An 18-year-old female admitted with Ludwig's angina from dental caries. Despite of combined antibiotics, dental extraction and drainge of submental abscess, infection spread to the cervical area. Chest computed tomogram revealed extension of the abscess to the pretracheal and periaortic space and development of bilateral pleural empyema. We performed bilateral cervical mediastinotomy and thoracotomy for drainage and debridement. Tracheostomy to secure the airway and postoperative pleural irrigation were performed. Postoperative course was uneventful and patient was discharged on the 40th postoperative day. It is important to perform chest CT scanning for early diagnosis of DNM when oropharyngeal infection spreads to the cervical area. Improved survival of patients with DNM implies early and radical surgical drainage and debridement via a cervical mediastinomy and thoracotomy.

MeSH Terms

Abscess
Adolescent
Anti-Bacterial Agents
Debridement
Delayed Diagnosis
Dental Caries*
Drainage
Early Diagnosis
Empyema, Pleural
Female
Humans
Ludwig's Angina
Mediastinitis*
Mediastinum
Mortality
Thoracotomy
Thorax
Tomography, X-Ray Computed
Tracheostomy
Anti-Bacterial Agents