[Critical odontogenic infection involving the mediastinum. Case report].
BACKGROUND
Occasionally, trivial odontogenic infections may develop into complex diseases. This may even result in an unrestrained phlegmonous spread causing life-threatening complications. These problems have decreased since the introduction of antibiotics and also due to improved oral hygiene and improved diagnostic measures resulting in optimized medical treatment. However, life-threatening forms are still seen, in particular if infections spread along the cervical fascial sheaths down towards to the mediastinum. Over the past decade the number of critical infections has increased in other medical specialties. This is usually explained by the development of multiresistant pathogens in the context of nosocomial infections.


METHODS
We reviewed the patients' records of the past 15 years at the Department of Oral and Maxillofacial Surgery of the University Hospital Kiel to assess a possible increase of odontogenic infections with life-threatening complications. From 1990 to 2004, four patients with odontogenic infections exhibiting critical phlegmonous spread were treated in the intensive care unit. Two patients developed bacterial mediastinitis which could be controlled by intravenous antibiotics only. One patient progressed to general septic mediastinitis and eventually died of cardiorespiratory arrest. The last patient also had septic mediastinitis and developed right pleural empyema. Several operations were necessary before the disease could be controlled. This patient's case report is presented in detail.


CONCLUSIONS
The prognosis of patients with mediastinitis crucially depends on (a) early diagnosis including computed tomography of the neck and thorax, (b) early radical surgical intervention, and (c) optimized pathogen-oriented antibiotic treatment.
Bartsch
M S
MS
Klinik für Mund-, Kiefer- und Gesichtschirurgie, Christian-Albrechts-Universität zu Kiel. bartsch@mkg.uni-kiel.de
von Bernstorff
W
W
Schäfer
F K W
FK
Wiltfang
J
J
Warnke
P H
PH
D000038:Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D000667:Ampicillin / Q000627:therapeutic use; D002439:Cefotaxime / Q000627:therapeutic use; D002481:Cellulitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D003422:Critical Care; D018450:Disease Progression; D016724:Empyema, Pleural / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D012086:Reoperation; D012772:Shock, Septic / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D013212:Staphylococcus epidermidis; D013290:Streptococcal Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D013407:Sulbactam / Q000627:therapeutic use; D007507:Therapeutic Irrigation; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D014640:Vancomycin / Q000627:therapeutic use
C035444:sultamicillin; D014640:Vancomycin; D000667:Ampicillin; D002439:Cefotaxime; D013407:Sulbactam