title: Descending Necrotizing Mediastinitis Treated with Tooth Extractions following Mediastinal and Cervical Drainage.
abstract: Descending necrotizing mediastinitis (DNM) is a rare condition in which oropharyngeal infection spreads to the mediastinum via the cervical fascia. Delayed diagnosis and surgery result in a high mortality rate among patients with DNM. We present a case of DNM resulting from odontogenic infection treated successfully with tooth extraction following mediastinal and cervical drainage. A 43-year-old, previously healthy Japanese man was admitted to our hospital for treatment of acute mediastinitis. Computed tomography revealed gas collection around the mid-thoracic esophagus and bilateral pleural effusion. We performed mediastinal drainage via right thoracotomy. Cervicotomy was performed on postoperative day 14 to drain a residual cervical abscess. The patient required the extraction of ten teeth over three procedures to address primary odontogenic infection before his fever resolved on postoperative day 40. Prompt diagnosis, aggressive drainage and removal of the source of infection can improve survival among patients with this life-threatening disease.
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Fukuchi
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Okihide
authors.initials: O
authors.lastname: Suzuki
authors.affiliation: Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nasu
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Koizumi
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Muta
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Hideko
authors.initials: H
authors.lastname: Imaizumi
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Ishiguro
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kumagai
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Ishibashi
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Erito
authors.initials: E
authors.lastname: Mochiki
authors.affiliation: Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ishida
keywords: Descending necrotizing mediastinitis; Drainage; Tooth extraction