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Stathopoulos P, Rallis G. Poorly controlled diabetes mellitus is strongly associated with descending necrotizing mediastinitis of odontogenic origin. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:113-118. [PMID: 38155017 DOI: 10.1016/j.oooo.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We hypothesized that poorly controlled diabetic status may be a negative prognostic factor for acute mediastinitis of odontogenic origin, and we conducted a cohort study to verify this hypothesis. STUDY DESIGN Data were collected on all consecutive patients diagnosed with maxillofacial infections of odontogenic origin who received surgical treatment in the Oral and Maxillofacial Surgery Department. All patients included in the study were divided into 4 groups based on the presence or absence of diabetes and mediastinitis. Poorly controlled diabetic status constituted our primary predictor variable, and the occurrence of descending necrotizing mediastinitis was the outcome variable. RESULTS All 7 patients with poorly controlled diabetes mellitus were complicated with descending necrotizing mediastinitis. An exact Fischer test was conducted to investigate the association of poorly controlled diabetes mellitus with descending necrotizing mediastinitis in patients admitted for surgical treatment of their maxillofacial collection. The result was significant at P < .01. CONCLUSION This study represents the first scientific attempt to associate poorly controlled diabetes mellitus with descending necrotizing mediastinitis of odontogenic origin. Our results show evidently that these patients are more susceptible to deep space infections, which subsequently spread faster and are much more difficult to control.
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Parara E, Krasadakis C, Toursounidis I, Tsekoura K, Mourouzis C, Rallis G. Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine. J Craniomaxillofac Surg 2021; 49:1182-1186. [PMID: 34246538 PMCID: PMC8254394 DOI: 10.1016/j.jcms.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/05/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Abstract
To present five patients with DNM, who were treated during the first quarantine for Coronavirus disease 2019 (Covid-19). Five patients with DNM were treated in our department during the first lockdown. The mean age of the patients was 42,2 years and four were male. Two patients were immunocompromised. Repeated surgical drainage was performed in all patients, whereas four were also subjected to elective tracheostomy during their first operation. The mean hospitalization duration was 55,4 days and mortality was 40%. During the first lockdown for the Covid-19, a rise in the ratio of DNM cases to the overall incidence of cervicofacial infections was observed in our department. All patients with DNM were operated on an emergency basis and were subsequently admitted to the ICU. We consider the effect of the quarantine as a decisive factor for this escalation, because according to the department archives, there had not been any cases of DNM originating from a dental infection, for the past 5 years. Additionally, past studies from the same department reported no more than 6 cases over a 10 year period.
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Affiliation(s)
- Eleni Parara
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece.
| | - Christos Krasadakis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - Iordanis Toursounidis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - Konstantina Tsekoura
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - Constantinos Mourouzis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - George Rallis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
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Lanfear AT, Hamandi M, Fan J, Bolin ML, Williams M, DiMaio JM, Waters J. Lemierre's syndrome treated operatively. Proc AMIA Symp 2020; 33:671-673. [PMID: 33100566 DOI: 10.1080/08998280.2020.1772011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Lemierre's syndrome (LS) is a pharyngeal infection complicated by infectious jugular vein thrombosis and septic emboli. Most commonly caused by Fusobacterium necrophorum, it may result in metastatic infection, especially when antibiotic treatment is delayed. Patients with LS are often healthy adults between 16 and 30 years who present with prolonged symptoms of pharyngitis, lateral neck pain, and fever. Other symptoms may include shortness of breath, tachycardia, and hypotension. When administered promptly, antibiotics can act as an effective treatment. However, complications may arise that require additional intervention. Herein, we report a case of LS in a young adult, complicated by severe pleural effusions that required surgical decortication.
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Affiliation(s)
| | | | - Joy Fan
- Baylor Scott and White-The Heart Hospital, Plano, Texas
| | | | | | | | - John Waters
- Baylor Scott and White-The Heart Hospital, Plano, Texas
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Rohowetz LJ, Gratton SM, Dansdill D, Miller CJ, Dubin S. Cavernous sinus thrombosis caused by Streptococcus constellatus-associated Lemierre syndrome presenting as an isolated abducens nerve palsy. Am J Ophthalmol Case Rep 2020; 18:100592. [PMID: 32123771 PMCID: PMC7037586 DOI: 10.1016/j.ajoc.2020.100592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe a patient with Streptococcus constellatus-associated Lemierre syndrome complicated by eventual cavernous sinus thrombosis (CST) that manifested as an isolated abducens nerve palsy. Observations A patient with a history of heavy alcohol use presented with Lemierre syndrome caused by an odontogenic infection due to Streptococcus constellatus. Despite initiation of intravenous antibiotics and eventual eradication of her bacteremia, she developed an isolated abducens nerve palsy on hospital day 7 due to associated CST. Conclusions and Importance CST is a rare complication of odontogenic infection and Lemierre syndrome. This case demonstrates the potential for primary odontogenic infections to progress to life- and sight-threatening diseases. This case also illustrates the importance of considering uncommon pathogens as the etiology of CST based on the suspected source of primary infection.
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Affiliation(s)
| | | | | | | | - Sarah Dubin
- Corresponding author. Department of Internal Medicine University of Missouri, Kansas City 2411 Holmes St, Kansas City, MO, 64108, USA.
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Scopel Costa B, Filipe da Paz Scardua E, Loss dos Reis W, Nascimento Silva D, Rangel Pereira TC, Vaz SL, Grão Velloso TR. Thoracic pain associated with an odontogenic infection: An unusual Lemierre's syndrome. SPECIAL CARE IN DENTISTRY 2019; 39:441-445. [DOI: 10.1111/scd.12399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/12/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Wyllyam Loss dos Reis
- Intensive care physician of the Cassiano Antônio Moraes University Hospital Vitória Brazil
| | | | | | - Sergio Lins Vaz
- Department of Dental ClinicEspírito Santo Federal University Vitória Brazil
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Omura T, Mori H, Matsuoka M, Hori Y. Surgical Management of Descending Necrotizing Mediastinitis Complicated by Purulent Pericarditis and Lemierre's Syndrome. Am Surg 2019. [DOI: 10.1177/000313481908500124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Takeshi Omura
- Department of Surgery Tokushima Prefectural Central Hospital Tokushima, Japan
| | - Hayato Mori
- Department of Surgery Tokushima Prefectural Central Hospital Tokushima, Japan
| | - Momoyo Matsuoka
- Department of ENT Tokushima Prefectural Central Hospital Tokushima, Japan
| | - Yohji Hori
- Department of ENT Tokushima Prefectural Central Hospital Tokushima, Japan
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Noy D, Rachmiel A, Levy-Faber D, Emodi O. Lemierre's syndrome from odontogenic infection: Review of the literature and case description. Ann Maxillofac Surg 2016; 5:219-25. [PMID: 26981474 PMCID: PMC4772564 DOI: 10.4103/2231-0746.175746] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lemierre's syndrome (LS) is a rare potentially fatal sequel of head and neck infection, classically described as thrombophlebitis of the internal jugular vein (IJV) with cervical space infection extending into the thorax. Our objective was to answer the clinical question: "Does Lemierre syndrome (LS) from odontogenic infection differ from nonodontogenic LS in regard to clinical sequence, treatment, and survival." We reviewed the literature on the management of LS over the last two decades, with a focus on LS from odontogenic infection. Such a case is presented in order to portray the clinical sequence. Only 10 cases met the inclusion criteria (including the case presented). The recorded data were analyzed in comparison to large case series reviewing LS. Our data reflect the moderate differences in regard to IJV thrombosis and bacteriogram. There is an overall rise in published LS cases in the last 20 years. Odontogenic infection leading to LS is scarce, yet with survival rates similar to nonodontogenic LS. Repeated surgical interventions and aggressive wide spectrum antibiotic therapy remain the treatment of choice.
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Affiliation(s)
- Dani Noy
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Dan Levy-Faber
- Department of Cardio-thoracic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Omri Emodi
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
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Fukuchi M, Suzuki O, Nasu D, Koizumi K, Muta Y, Imaizumi H, Ishiguro T, Kumagai Y, Ishibashi K, Mochiki E, Ishida H. Descending Necrotizing Mediastinitis Treated with Tooth Extractions following Mediastinal and Cervical Drainage. Case Rep Gastroenterol 2015; 9:311-6. [PMID: 26600767 PMCID: PMC4649729 DOI: 10.1159/000441386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Descending necrotizing mediastinitis (DNM) is a rare condition in which oropharyngeal infection spreads to the mediastinum via the cervical fascia. Delayed diagnosis and surgery result in a high mortality rate among patients with DNM. We present a case of DNM resulting from odontogenic infection treated successfully with tooth extraction following mediastinal and cervical drainage. A 43-year-old, previously healthy Japanese man was admitted to our hospital for treatment of acute mediastinitis. Computed tomography revealed gas collection around the mid-thoracic esophagus and bilateral pleural effusion. We performed mediastinal drainage via right thoracotomy. Cervicotomy was performed on postoperative day 14 to drain a residual cervical abscess. The patient required the extraction of ten teeth over three procedures to address primary odontogenic infection before his fever resolved on postoperative day 40. Prompt diagnosis, aggressive drainage and removal of the source of infection can improve survival among patients with this life-threatening disease.
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Affiliation(s)
- Minoru Fukuchi
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
| | - Okihide Suzuki
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
| | - Daisuke Nasu
- Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kazue Koizumi
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
| | - Yu Muta
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
| | - Hideko Imaizumi
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
| | - Toru Ishiguro
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
| | - Youichi Kumagai
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
| | - Keiichiro Ishibashi
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
| | - Erito Mochiki
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical University, Kawagoe, Japan
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Rahhal H, de Campos FPF, Ferreira CR, Felipe-Silva A. Lemierre's syndrome due to intratumoral abscess of the uvula. AUTOPSY AND CASE REPORTS 2015; 5:11-20. [PMID: 26558242 PMCID: PMC4636101 DOI: 10.4322/acr.2015.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/20/2015] [Indexed: 11/23/2022] Open
Abstract
Lemierre’s syndrome (LS), described in detail in 1936, used to be a life-threatening entity until the advent of antibiotics. Tonsillitis or pharyngitis are the main primary infections and oropharyngeal anaerobic flora is the predominant etiology. However, other primary site infections, as well as other microbiological agents have been reported since the first description. Inflammatory symptoms in the neck and marked findings on physical examination predominate the majority of cases. Nonetheless, the authors report the case of a 54-year-old man with a history of dysphagia followed by cough, purulent expectoration, and fever. The bad condition of his dentition was noteworthy. During the diagnostic work-up, an ulcerated lesion in the uvula and a middle lobe pneumonia were disclosed. Streptococcus viridans was isolated from blood culture. On the fifth day of hospitalization, the patient died after a copious episode of hemoptysis. The autopsy findings depicted an abscess within a squamous cell carcinoma of the uvula, pharyngitis with carotid sheath spreading accompanied by pylephlebitis and thrombosis of the internal jugular vein up to the innominate vein, surrounded by an abscess in the mediastinum. Alveolar hemorrhage and pneumonia were also present. We conclude that the ulcerated carcinoma of the uvula housed an abscess, facilitated by the poor oral hygiene, which triggered LS and the descending mediastinitis. Pulmonary involvement was due to the septic embolism from the internal jugular vein. We would like to highlight the uvula abscess as the primary site of infection in this case of LS with S. viridans as the causative agent.
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Affiliation(s)
- Hassan Rahhal
- Department of Internal Medicine - Hospital das Clínicas - University of São Paulo, São Paulo/SP - Brazil
| | | | - Cristiane Rubia Ferreira
- Anatomy Pathology Service - Hospital Universitário - University of São Paulo, São Paulo/SP - Brazil
| | - Aloisio Felipe-Silva
- Anatomy Pathology Service - Hospital Universitário - University of São Paulo, São Paulo/SP - Brazil
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Boyd D, Paterson P, Dunphy L, Carton A, Hammersley N. A case report of Lemierre's Syndrome associated with dental sepsis. Scott Med J 2013; 58:e24-7. [PMID: 23596035 DOI: 10.1177/0036933012474609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Lemierre's syndrome is a potentially fatal condition characterised by spread of an oropharyngeal infection, resulting in thrombosis of the internal jugular vein. This leads to septicaemia and possible metastatic abscesses. CASE PRESENTATION We discuss the case of a previously healthy 17-year-old male who developed Lemierre's syndrome following dental sepsis. He presented with bilateral submandibular and submental swelling extending into the neck and chest. His management included a tracheostomy; incision and drainage of the abscesses; drainage of a pleural effusion and prolonged anticoagulant therapy. CONCLUSION The incidence of Lemierre's disease appears to be increasing and early diagnosis is essential. A high index of suspicion is needed in cases of oropharyngeal infection followed by fever, tender swelling of the neck and dysphagia - especially in young patients.
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Affiliation(s)
- D Boyd
- Oral and Maxillofacial Surgery Department, Monklands Hospital, UK
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Murray M, Stevens T, Herford A, Roberts J. Lemierre syndrome: two cases requiring surgical intervention. J Oral Maxillofac Surg 2012; 71:310-5. [PMID: 22835986 DOI: 10.1016/j.joms.2012.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Matthew Murray
- Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA 92350, USA.
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13
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González-García R, Risco-Rojas R, Román-Romero L, Moreno-García C, López García C. Descending necrotizing mediastinitis following dental extraction. Radiological features and surgical treatment considerations. J Craniomaxillofac Surg 2011; 39:335-9. [DOI: 10.1016/j.jcms.2010.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/21/2010] [Accepted: 10/04/2010] [Indexed: 11/16/2022] Open
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Kim JH, Ryu DM, Jee YJ, Lee JW, Lee DW. Mediastinitis: a case report. J Korean Assoc Oral Maxillofac Surg 2010. [DOI: 10.5125/jkaoms.2010.36.6.538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jae Hwan Kim
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Dong-Mok Ryu
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Yu-Jin Jee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Deok-Won Lee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
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