Descending necrotizing mediastinitis due to odontogenic infections.
OBJECTIVE
Acute purulent mediastinitis caused by oropharyngeal infection is termed descending necrotizing mediastinitis. Such infections usually have a fulminate course, leading to sepsis and frequently to death. The purpose of this study is to show the importance of early diagnosis, aggressive surgical intervention, and optimal antibiotics chemotherapy in controlling this fatal infectious disease.


METHODS
Two patients with descending necrotizing mediastinitis due to odontogenic infection who were treated at our institution are described.


RESULTS
Both patients survived.


CONCLUSIONS
From the patients, 23 different aerobic and anaerobic bacteria were isolated. All of the isolates were susceptible to carbapenem. Early evaluation by means of cervicothoracic computed tomography scanning was extremely useful for diagnosis and surgical planning. Knowledge of anatomic pathways from the mouth to the mediastinum is essential. We believe that tracheostomy is not always necessary. In both of the cases presented, mediastinal drainage was completed through use of a transcervical approach. However, a more aggressive drainage including tracheostomy might be necessary when the infection extends below the carina.
Sakamoto
H
H
Tokai University, Department of Oral Surgery, School of Medicine, Kanagawa, Japan.
Aoki
T
T
Kise
Y
Y
Watanabe
D
D
Sasaki
J
J
D000208:Acute Disease; D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D003131:Combined Modality Therapy; D005491:Focal Infection, Dental / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis