Descending Necrotizing Mediastinitis with Dental Caries: One case report.
- Author:
Hyeon Jae LEE
;
Won Mo KOO
;
Gun LEE
;
Chang Young LIM
- Publication Type:Case Report
- MeSH:
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
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2000;33(8):688-692
- CountryRepublic of Korea
- Language:Korean
-
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.
