Descending necrotizing mediastinitis due to odontogenic infections. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. [Oral Surg Oral Med Oral Pathol Oral Radiol Endod] Journal article

Title	Descending necrotizing mediastinitis due to odontogenic infections.
Author(s)	Sakamoto H, Aoki T, Kise Y, Watanabe D, Sasaki J
Institution	Tokai University, Department of Oral Surgery, School of Medicine, Kanagawa, Japan.
Source	Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000 Apr; 89(4):412-9.
MeSH	Acute Disease Adult Bacteria Bacterial Infections Combined Modality Therapy Focal Infection, Dental Humans Male Mediastinitis Mediastinum Middle Aged Necrosis
Abstract	OBJECTIVE: Acute purulent mediastinitis caused by oropharyngeal infection is termed descending necrotizing mediastinitis. Such infections usually have a fulminate course, leading to sepsis and frequently to death. The purpose of this study is to show the importance of early diagnosis, aggressive surgical intervention, and optimal antibiotics chemotherapy in controlling this fatal infectious disease. STUDY DESIGN: Two patients with descending necrotizing mediastinitis due to odontogenic infection who were treated at our institution are described. RESULTS: Both patients survived. CONCLUSIONS: From the patients, 23 different aerobic and anaerobic bacteria were isolated. All of the isolates were susceptible to carbapenem. Early evaluation by means of cervicothoracic computed tomography scanning was extremely useful for diagnosis and surgical planning. Knowledge of anatomic pathways from the mouth to the mediastinum is essential. We believe that tracheostomy is not always necessary. In both of the cases presented, mediastinal drainage was completed through use of a transcervical approach. However, a more aggressive drainage including tracheostomy might be necessary when the infection extends below the carina.
Language	eng
Pub Type(s)	Case Reports Journal Article Review
PubMed ID	10760723

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