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References

Prado-Calleros HM, Jiménez-Fuentes E, Jiménez-Escobar I. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck. 2016; 38:E2275-2283 https://doi.org/10.1002/hed.24183
Pappa H, Jones DC. Mediastinitis from odontogenic infection. A case report. Br Dent J. 2005; 198:547-548 https://doi.org/10.1038/sj.bdj.4812302
Diamantis S, Giannakopoulos H, Chou J, Foote J. Descending necrotizing mediastinitis as a complication of odontogenic infection. Int J Surg Case Rep. 2011; 2:65-67 https://doi.org/10.1016/j.ijscr.2011.01.004
Basa S, Arslan A, Metin M Mediastinitis caused by an infected mandibular cyst. Int J Oral Maxillofac Surg. 2004; 33:618-620 https://doi.org/10.1016/j.ijom.2003.09.008
Kang SK, Lee S, Oh HK Clinical features of deep neck infections and predisposing factors for mediastinal extension. Korean J Thorac Cardiovasc Surg. 2012; 45:171-176 https://doi.org/10.5090/kjtcs.2012.45.3.171
Mediastinum image. https://commons.wikimedia.org/wiki/File:Mediastinum.jpg (accessed February 2022)
Pett S. Mediastinal infections. In: Fry DE (ed). Boston: Little Brown; 1995
Abu-Omar Y, Kocher GJ, Bosco P European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg. 2017; 51:10-29 https://doi.org/10.1093/ejcts/ezw326
Misthos P, Katsaragakis S, Kakaris S Descending necrotizing anterior mediastinitis: analysis of survival and surgical treatment modalities. J Oral Maxillofac Surg. 2007; 65:635-639 https://doi.org/10.1016/j.joms.2006.06.287
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Descending Necrotizing Mediastinitis: A Potential Consequence of Odontogenic Infection

From Volume 49, Issue 3, March 2022 | Pages 262-265

Authors

Emma G Walshaw

BDS, MJDF, RCS(Eng), PgCert (MedEd)

Medical Student, Department of Oral and Maxillofacial Surgery, University of Leeds School of Medicine

Articles by Emma G Walshaw

Email Emma G Walshaw

Richard Taylor

BDS (Hons, ) MFDS RCPSG

Medical Student, University of Leeds School of Medicine

Articles by Richard Taylor

Jiten Parmar

Consultant in Oral and Maxillofacial Surgery, Leeds Teaching Hospitals NHS Trust

Articles by Jiten Parmar

Abstract

Descending necrotizing mediastinitis is a potential consequence of cervicofacial infection, which can promptly progress into a life-threatening disease, with the sequelae of severe sepsis, organ failure and death. This article highlights the importance of this pathology and discusses key signs and symptoms that may be identified when performing an assessment on a patient with a large cervicofacial swelling. This article also describes the case of a young and healthy patient who experienced this pathology from an odontogenic source.

CPD/Clinical Relevance: Descending necrotizing mediastinitis, although rare, is a potentially life threatening consequence of odontogenic infection and awareness of it is imperative for dental professionals.

Article

This article discusses the presentation of descending necrotizing mediastinitis (DNM) arising from an odontogenic infection. Once established, DNM poses a significant threat to life and can lead to sepsis, organ failure and death.1 It is imperative that dental care professionals have an appreciation of DNM as a risk of odontogenic infection, and are able to escalate a patient's care to the appropriate specialist centre should they suspect that a patient is experiencing this pathology.

While there are numerous case reports published regarding mediastinitis associated with odontogenic infections,2,3,4 this case highlights that even young patients, with no underlying health conditions, are at risk of DNM.

The term mediastinitis refers to either acute or chronic inflammation of the tissues within the middle thoracic cavity (mediastinum). The mediastinum contains important anatomical structures such as the thymus gland, the pericardial sac, the heart, aorta, oesophagus, trachea and major blood vessels. The mediastinum is continuous with fascial spaces in the neck. This anatomical relation explains the possibility of spread of infection from the fascial spaces of the neck into the chest, particularly from the parapharyngeal, prevertebral and retropharyngeal (danger) spaces.5

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