Cervical Necrotizing Fasciitis With Descending Mediastinitis: Literature Review and Case Report

Descending Necrotizing Mediastinitis due to Odontogenic Infection: An unusual Case Report

“…These findings are present in the described case report, and the net collection present in the interpleural space evidenced by chest CT resulted in approximately 1000mL in the right thorax. Corroborating current literature [1,4,8,9], cases of Mediastinitis arise mainly when odontogenic infection affects more than one cervical space and submandibular space. In the present case, the composite feature of the involved cervical spaces is evident, since the right cervical, sublingual, left buccal and left submandibular spaces were drained simultaneously with the extraction of the right lower first molar compromised tooth.…”

“…It is important to emphasize odontogenic infection as an etiological factor and its interaction with cervicofacial spaces. The mortality rate for Necrotizing Fasciitis ranges from 7% to 20% [1]; however, when there is an association with DNM, the mortality rate increases to 41%, with a high probability that the patient will die if there is a delay in diagnosis and improper drainage. In the presented case report, the patient required early surgical intervention due to the imminent risk of septic shock.…”

“…This is the most recommended surgical approach for deep surgical treatment in cases of DNM [2,5], although there are other options such as bithoracotomy and median sternotomy, which present the disadvantage of high risk of suture dehiscence and osteomyelitis [9,10]. The clinical-surgical therapy should include maintenance of the airways, elimination of the etiological factor, drainage of the deep cervical/thoracic spaces and broadspectrum antibiotic therapy [1,8]. Regarding the interdisciplinary conduct of the presented case report, the patient did not present critical condition as to respiratory activity, reason why no airway management surgical procedure was performed.…”

“…The posterior mediastinum is an anatomical region that can be reached by these infectious proliferations due to the proximity of the oropharyngeal area with the retropharyngeal and parapharyngeal spaces [1]. DNM may initiate clinical alterations such as: edema in the submandibular region conferring "bull's neck" aspect, trismus, cervical extension limitation, redness, fever, dysphasia, dyspnea besides pleural and pericardial effusion [1,2]. The history of recent tooth extractions and odontogenic infections is common since dental infections usually present a wide microbiological variety [3].…”

Descending necrotizing mediastinitis secondary to cervical necrotizing fasciitis: Two case reports and contemporary literature

“…[2][3][4][5] Servikal nekrotizan fasiit olgularının %40-45'inde negatif göğüs içi basınç nedeniyle mediastinal yayılım (desendan nekrotizan mediastinit; DNM) saptanır. [6,7] İlk kez Pearse tarafından 1938 yılında tanımlanan DNM'de SNF retrofarengeal alandan alar fasya aracılığıyla doğrudan arka mediastene veya karotis kılıf aracılığıyla ön mediastene ve perikarda yayılır. [8][9][10][11] Klinik olarak göğüs ağrısı, solunum sıkıntısı, sepsis bulguları ile ortaya çıkar ve tedaviye rağ-men %25-40 oranında ölümcül seyreder.…”