Management of descending necrotizing mediastinitis

Mihos, Petros; Potaris, Konstantinos; Gakidis, Ioannis; Papadakis, Dimitrios; Rallis, Georgios

doi:10.1016/j.joms.2003.08.039

Cited by 104 publications

(86 citation statements)

References 17 publications

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“…In a country like India where healthcare providers are inadequate in number and facilities are less, ignorance to a dental problem adds to the worsening condition. Complications such as retropharyngeal spread and intracranial extension or mediastinal spread and airway obstruction indicate the potentially serious nature of these infections [1,[13][14][15][16][17][18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Management of Odontogenic Space Infection with Microbiology Study

Singh

Kambalimath

Gupta

2014

J. Maxillofac. Oral Surg.

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Introduction Dental infection has plagued humankind for as long as our civilization has been a fight against microorganisms by man dates back to ancient civilization. The discoveries of antibiotics are encouraging trends towards conquest of the microbial infection. Materials and Methods This study emphasizes the detection of pathogenic microorganisms by microbiological examination and culture of specimens representative of the infection, importance of early and correct diagnosis of infections, prompt treatment and supportive care. Results The age group most commonly involved was in the third and fourth decades of life. Extraction followed by incision and drainage was done. The most commonly involved space was submandibular followed by buccal space. Thirty isolates were obtained. 43 % of the strains were strict anaerobes and 39 % were aerobes, with mixed growth was seen in 18.52 %. Amongst aerobes alpha hemolytic Streptococcus aureus and Peptostreptococcus as anaerobes were the most predominant followed by Bacteroides and Prevotella. Mixed aerobic and anaerobic isolates were obtained from 18.52 % of total cases. Overall resistance to Penicillin was 22 %, amongst aerobes. Conclusion Amoxicillin and Clavulanic acid combination performed better, as 100 % strains were sensitive to it. The results of this study saw a changing trend in terms of predominance of anaerobic bacteria over aerobic ones.

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Section: Discussionmentioning

confidence: 99%

Management of Odontogenic Space Infection with Microbiology Study

Singh

Kambalimath

Gupta

2014

J. Maxillofac. Oral Surg.

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“…Despite modern therapy, the mortality rate remains high, with reports ranging from 14% to 50% [1,2]. The lethality arises from tissue damage as the infection descends down cervical fascial planes into the mediastinum [3,4]. The term descending necrotising mediastinitis implies the infection …”

Section: Overviewmentioning

confidence: 99%

“…started from a head and neck source, most commonly an oropharyngeal or odontogenic focus [4][5][6]. Other reported initial infections that have led to DNM include acute epiglottitis, cervical lymphadenitis, parotitis, thyroiditis, jugular intravenous drug abuse and traumatic endotracheal intubation [7].…”

Section: Review: Descending Necrotising Mediastinitis E Weaver Et Almentioning

confidence: 99%

Descending necrotising mediastinitis: two case reports and review of the literature

Weaver¹,

Nguyen²,

Brooks³

2010

Eur Respir Rev

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Descending necrotising mediastinitis is a rare and serious infection with a high mortality rate, which complicates pharyngeal or odontogenic infection. Early recognition and treatment are essential in order to minimise morbidity. Evaluation with computed tomography is necessary to confirm the diagnosis and facilitate surgical planning. In addition to prompt empirical antiobiotic therapy, surgical intervention is necessary in nearly all cases. Surgical drainage and debridement may be performed through cervicotomy alone, or through combined cervicotomy and thoracotomy, depending upon the extent of disease. Hyperbaric oxygen therapy may play an auxiliary role. We present two recent cases with characteristic imaging findings, and review the relevant literature. KEYWORDS: Computed tomography, mediastinitis CASE ONEA 60-yr-old male presenting with neck swelling, dysphagia and hoarseness had been extubated 2 days previously following a pneumonia. He had a past medical history of laryngeal cancer treated 10 yrs ago with external beam radiation and chemotherapy. On examination he had bilateral diffuse neck erythema, oedema and right-sided induration. Fibre-optic laryngoscopy showed scabbing of the right hypopharynx and erythematous swelling of the false vocal folds, aryepiglottic folds, and epiglottis. Over the course of 12 h, he developed septic shock with a blood pressure of 70/ 30 mmHg, heart rate of 135 beats?min, and a temperature of 103uF. He was started empirically on vancomycin and piperacillin/tazobactam. After stabilisation in the intensive care unit (ICU), computed tomography (CT) imaging of the neck and chest was performed. There was a large amount of subcutaneous air tracking into the deep fascial planes of the anterior neck, oedematous laryngeal mucosa, and bilateral loculated fluid collections tracking throughout the anterior neck extending to the superior mediastinum ( fig. 1). CT imaging of the chest showed a complex air and fluid collection in the anterior mediastinum extending to the base of the neck ( fig. 2). After review of the images, the patient was taken to the operating room for a combined procedure performed by both head and neck surgeons and thoracic surgeons. Bilateral anterior neck dissections were performed, and blunt dissection, irrigation and debridement were carried out to several centimeters below the sternal manubrium. Penrose drains were left in place. Then, left anterior thoracotomy with debridement of the anterior mediastinum, left pleural decortication and a pericardial window were performed by the thoracic surgeons. Microbiology of the anterior mediastinal fluid grew multiple organisms including Fusobacterium, Prevotella, Bacteroides fragilis, Peptostreptococcus, and a heavy growth of Streptococcus intermedius. Pathology of the pharyngeal lesions showed necrosis and granulation tissue. No neoplasm was identified. The patient later received a tracheostomy and pectoralis myocutaneous flap repair of the neck without sequelae. His total ICU length of stay was 32 days, and hi...

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“…Once DNM is diagnosed, antibiotic treatment should be initiated. The responsible pathogens for DNM are primarily a mixture of aerobic and anaerobic bacteria of the oral microflora (7,10). In the present case, no agents were isolated in the specimen obtained by mediastinal drainage due to previous anti-biotherapy.…”

Section: Discussionmentioning

confidence: 51%

Fatal Dental Abscess: Descending Necrotising Mediastinitis

Şahin¹,

Meteroğlu²,

Toptancı³

et al. 2013

Respir Case Rep

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Mediastinitis is a rare infectious disease around the vital organs in the mediastinum. Descending necrotizing mediastinitis (DNM) is caused by odontogenic, pharyngeal, cervical infections, sternotomy or diagnostic and therapeutic instrumentation. Unless it is diagnosed in a timely manner and properly treated, the outcome is fatal. Delay in treatment leads to the spread of the infection down to the mediatinum. We present a case of DNM in 17-year-old girl suffering from a dental abscess.

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Management of descending necrotizing mediastinitis

Cited by 104 publications

References 17 publications

Management of Odontogenic Space Infection with Microbiology Study

Management of Odontogenic Space Infection with Microbiology Study

Descending necrotising mediastinitis: two case reports and review of the literature

Fatal Dental Abscess: Descending Necrotising Mediastinitis

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