Mediastinitis and bilateral pleural empyema caused by an odontogenic infection

Mirna Juretic 1 , Margita Belusic-Gobic 1 , Melita Kukuljan 3 , Robert Cerovic 1 , Vesna Golubovic 2  and David Gobic 4
  • 1 Clinic for Oral and Maxillofacial Surgery, Clinical hospital, Rijeka, Croatia
  • 2 Clinic for Anaesthesiology and Reanimatology, Clinical hospital, Rijeka, Croatia
  • 3 Department of Radiology, Clinical hospital, Rijeka, Croatia
  • 4 Clinic for Internal Medicine, Clinical hospital, Rijeka, Croatia

Mediastinitis and bilateral pleural empyema caused by an odontogenic infection

Background. Although odontogenic infections are relatively frequent in the general population, intrathoracic dissemination is a rare complication. Acute purulent mediastinitis, known as descending necrotizing mediastinitis (DNM), causes high mortality rate, even up to 40%, despite high efficacy of antibiotic therapy and surgical interventions. In rare cases, unilateral or bilateral pleural empyema develops as a complication of DNM.

Case report. This case report presents the treatment of a young, previously healthy patient with mediastinitis and bilateral pleural empyema caused by an odontogenic infection. After a neck and pharynx re-incision, and as CT confirmed propagation of the abscess to the thorax, thoracotomy was performed followed by CT-controlled thoracic drainage with continued antibiotic therapy. The patient was cured, although the recognition of these complications was relatively delayed.

Conclusions. Early diagnosis of DNM can save the patient, so if this severe complication is suspected, thoracic CT should be performed.

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  • Balkan ME, Oktar GL, Oktar MA. Descending necrotizing mediastinitis: a case report and review of the literature. Int Surg 2001; 86: 62-6.

  • Izadi K, Lazow SK, Berger JR. Mediastinitis secondary to an odontogenic infection. A case report. N Y State Dent J 2003; 69: 28-30.

  • Tung-Yiu W, Jehn-Shyun H, Ching-Hung C, Hung-An C. Cervical necrotizing fasciitis of odontogenic origin: a report of 11 cases. J Oral Maxillofac Surg 2000; 58: 1347-53.

  • Sobolewska E, Skokowski J, Jadezuk E. Pleural empyema as a complication of the descending necrotizing mediastinitis. Pneumonol Alergol Pol 1997; 65: 364-9.

  • Bonapart IE, Stevens HP, Kerver AJ, Rietveld AP. Rare complications of an odontogenic abscess: mediastinitis, thoracic empyema and cardiac tamponade. J Oral Maxillofac Surg 1995; 53: 610-3.

  • Biasotto M, Pellis T, Cadenaro M, Bevilacqua L, Berlot G, Di Leonarda R. Odontogenic infections and descending mediastinitis: case report and review of the literature. Int Dent J 2004; 54: 97-102.

  • Economopoulos GC, Scherzer HH, GryboskiWA. Successful management of mediastinitis, pleural empyema, and aortopulmonary fistula from odontogenic infection. Ann Thorac Surg 1983; 35: 184-7.

  • Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983; 157: 545-52.

  • Miller WD, Furst IM, Sandor GK, Keller A. A prospective blinded comparison of clinical exam and computed tomography in deep neck infections. Laryngoscope 1999; 109: 1873-9.

  • Tsunoda R, Suda S, Fukaya T, Saito K. Descending necrotizing mediastinitis caused by an odontogenic infection: a case report. J Oral Maxillofac Surg 2000; 58: 240-2.

  • Garcia-Consuegra L, Junquera-Gutierrez L, Albertos-Castro JM, Llorente-Pendas S. Descending necrootizing mediastinitis caused by odontogenic infections. Rev Stomatol Chir Maxillofac 1998; 99: 199-202.

  • Marty-Ane CH, Alauzen M, Alric P, Serres-Cousine O, Mary H. Descending necrotizing mediastinitis: avantage of mediastinal drainage with thoracotomy. J Thorac Cardiovasc Surg 1994; 107: 55-61.

  • Iyoda A, Yusa T, Fujisawa T, Mabashi T, Hiroshima K, Ohwada H. Descending necrotizing mediastinitis: report of a case. Surg Today 1999; 29: 1209-12.

  • Labriola JD, Mascaro J, Alpert B. The microbiologic flora of orofacial abscesses. J Oral Maxillofac Surg 1983; 41: 711-4.

  • Pynn BR, Sands T, Pharoah MJ. Odontogenic infections: Part one. Anatomy and radiology. Oral Health 1995; 85: 7-10, 13-4, 17-8.

  • Sands T, Pynn BR, Katsikeris N. Odontogenic infections: Part two. Microbiology, antibiotics and management. Oral Health 1995; 85: 11-4, 17-23.

  • Sandor GK, Low DE, Judd PL, Davidson RJ. Antimicrobial treatment options in the management of odontogenic infections. J Can Dent Assoc 1998; 64: 508-14.

  • Maisel RH, Karlen R. Cervical necrotising fascitis. Laryngoscope 1994; 104: 795-8.

  • Wheatley MJ, Stirling MC, Kirsh MM, Gago O, Orringer MB. Descending necrotizing mediastinitis: transcervical drainage is not enough. Ann Thorac Surg 1990; 49: 780-4.

  • Brunelli A, Sabbatini A, Catalini G, Fianchini A. Descending necrotizing mediastinitis. Surgical drainage and tracheostomy. Arch Otolaryngol Head Neck Surg 1996; 122: 1326-9.

  • Cordero L, Torre W, Freire D. Descending necrotizing mediastinitis and respiratory distress syndrome treated by aggressive surgical treatment. J Cardiovasc Surg 1996; 37: 87-8.

  • Sakamoto H, Aoki T, Kise Y, Watanabe D, Sasaki J. Descending necrotising mediastinitis due to odontogenic infections. Oral Surg Oral Med Oral Path Radiol Endod 2000; 89: 412-9.

  • Mathieu D, Neviere R, Teillon C, Chagnon JL, Lebleu N, Wattel F. Cervical necrotizing fascitis: clinical manifestations and management. Clin Infect Dis 1995; 21: 51-6.

  • Sugata T, Fujita Y, Myoken Y, Fujioka Y. Cervical cellulitis with mediastinitis from an odontogenic infection complicated by diabetes mellitus: report of a case. J Oral Maxillofac Surg 1997; 55: 864-9.

  • Rubin MM, Cozzi GM. Fatal necrotizing mediastinitis as a complication of an odontogenic infection. J Oral Maxillofac Surg 1987; 45: 529-33.


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