Severe deep neck space infections and mediastinitis of odontogenic origin: clinical relevance and implications for diagnosis and treatment.
CONCLUSIONS
Early diagnosis and aggressive antimicrobial and surgical treatment are essential to successfully treat extensive cervico-mediastinal abscesses of odontogenic origin. Patient management should be performed by experienced clinicians well trained in managing possible complications. We recommend close clinical and radiological postoperative follow-up investigations with early surgical re-intervention if necessary.


OBJECTIVE
While neck infections affecting the perimandibular space have a high prevalence and their clinical aspects have repeatedly been discussed, further spread of the inflammation and life-threatening situations have rarely been described. The objective was to determine clinical, diagnostic, and therapeutic aspects of severe neck infections of odontogenic origin. Emphasis was placed on grave descending deep neck space infections, sometimes resulting in mediastinitis as a life-threatening complication.


METHODS
We reviewed 10 patients with severe odontogenic abscesses treated during an 8-year interval in a single center.


RESULTS
The submandibular space was the most frequently encountered location of deep neck space infections. Mediastinitis was found in five patients. The most frequent causative bacteria were Streptococcus and Bacteroides species. All patients underwent intravenous antibiotic treatment and surgical therapy. Mediastinotomy was inevitable in five cases and thoracotomy in one case. All patients survived.
Kinzer
Susanne
S
Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Killianstrasse 5, Freiburg, Germany.
Pfeiffer
Jens
J
Becker
Silke
S
Ridder
Gerd Jürgen
GJ
D000038:Abscess / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001442:Bacteroides Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D003131:Combined Modality Therapy; D017266:Dental Prosthesis; D004939:Esophageal Perforation / Q000150:complications*; D004947:Esophagus; D005260:Female; D005491:Focal Infection, Dental / Q000150:complications* / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D008158:Ludwig's Angina / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D009333:Neck; D010038:Otorhinolaryngologic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D010508:Periodontal Abscess / Q000150:complications*; D010518:Periodontitis / Q000150:complications*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D036542:Tomography, Spiral Computed
D000900:Anti-Bacterial Agents