title: Descending necrotizing mediastinitis following dental extraction. Radiological features and surgical treatment considerations.
abstract: Descending necrotizing mediastinitis (DNM) following dental extraction is an extremely serious infection with a high mortality rate. Oral infection may rapidly descend into the mediastinum across the retropharyngeal and retrovisceral spaces. Once established, mediastinitis is rapidly followed by sepsis and death. If DNM is suspected cervical and thoracic CT must be carried out urgently. After this, prompt control of the upper airway with tracheostomy, aggressive surgical debridement of the deep cervical spaces and mediastinum, and intravenous broad spectrum antibiotic therapy are mandatory. The present paper reports two new cases of DNM following dental extraction, and focuses on radiological features of abscess progression through the cervical spaces down into the mediastinum.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Infanta Cristina, Badajoz, Spain. raulmaxilo@gmail.com
authors.forename: Raúl
authors.initials: R
authors.lastname: González-García
authors.forename: Roberto
authors.initials: R
authors.lastname: Risco-Rojas
authors.forename: Leticia
authors.initials: L
authors.lastname: Román-Romero
authors.forename: Carlos
authors.initials: C
authors.lastname: Moreno-García
authors.forename: Cipriano
authors.initials: C
authors.lastname: López García
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D000328:Adult; D058109:Airway Management; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003646:Debridement; D004322:Drainage; D019115:Fasciitis, Necrotizing / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005260:Female; D005491:Focal Infection, Dental / Q000150:complications*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery; D009333:Neck / Q000000981:diagnostic imaging / Q000601:surgery; D009336:Necrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed; D014081:Tooth Extraction / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents