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Surgical Excision of Unusual Sacked Neck and Mediastinum Abscess of Odontogenic Origin. Antibiotics (Basel) 2022; 11:antibiotics11121757. [PMID: 36551414 PMCID: PMC9774090 DOI: 10.3390/antibiotics11121757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
The most common cause of neck infections is odontogenic abscesses that can often be life-threatening and require a surgical drain associated with antibiotic therapy. We present a case of the surgical management of an odontogenic sack-shaped and walled abscess arising from elements 3.6, 3.7 and 3.8 that reached the laterocervical spaces and anterior mediastinum in a 28-year-old healthy woman. Typical signs and symptoms of cervical complications of dental origin are fever, a neck mass, lymphadenopathy, trismus and odynophagia. The gold standard treatment in these situations is a multidisciplinary approach involving an oral surgeon, ENT specialist and thoracic surgeon to drain the infected material. To the best of our knowledge, this is the first described case report of a dental abscess enclosed in a sack in the deep space of the neck and in the anterior space of the mediastinum.
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Lira J, Santos J, Capela M, Rodrigues J, Cunha O, Carvalho I. Descending Mediastinitis in a Child: Diagnostic Challenges and a Different Treatment Approach. Clin Pract 2021; 11:505-508. [PMID: 34449574 PMCID: PMC8395469 DOI: 10.3390/clinpract11030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/12/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
In children, spontaneous mediastinitis is a rare, severe and commonly misdiagnosed disease. Although standard of care treatment frequently involves surgery, we report a case of mediastinitis in a five-year-old child, successfully treated with 4 weeks of intravenous antibiotics. Ultrasound imaging was used to monitor patient response to conservative treatment while reducing radiation exposure.
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Lin J, Jimenez CA. Acute mediastinitis, mediastinal granuloma, and chronic fibrosing mediastinitis: A review. Semin Diagn Pathol 2021; 39:113-119. [PMID: 34176697 DOI: 10.1053/j.semdp.2021.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 11/11/2022]
Abstract
Acute mediastinitis is a rare infection that carries high morbidity and mortality. They are complications seen most often with deep sternal wound infections from surgeries with median sternotomies, oropharyngeal and odontogenic infections and esophageal perforations. These conditions should be promptly recognized and treated. Mediastinal granulomas are focal, mass-like lesions commonly resulting from prior granulomatous infections. They are regarded as benign, self-resolving lesions however can cause complications by compression of adjacent mediastinal structures. Chronic fibrosing mediastinitis is a rare, diffuse fibroinflammatory process most often seen with granulomatous infections and carries a worse prognosis than mediastinal granulomas especially when adjacent mediastinal structures are compromised. In this review, we discuss the epidemiology, etiology, clinical presentation, treatment and prognosis of acute mediastinitis, mediastinal granulomas, and chronic fibrosing mediastinitis.
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Affiliation(s)
- Julie Lin
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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4
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Mediastinitis necrosante descendente: reporte de caso y revisión de la literatura. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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5
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Feng CC, Lin CS. Descending Necrotizing Mediastinitis Mimics Upper Respiratory Tract Infection. J Acute Med 2017; 7:177-178. [PMID: 32995194 PMCID: PMC7517945 DOI: 10.6705/j.jacme.2017.0704.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/15/2017] [Accepted: 08/18/2017] [Indexed: 06/11/2023]
Affiliation(s)
- Cho-Chao Feng
- Hsinchu Cathay General Hospital Department of Emergency Medicine Hsinchu Taiwan
| | - Chaou-Shune Lin
- Hsinchu Cathay General Hospital Department of Emergency Medicine Hsinchu Taiwan
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Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982–2016). REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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7
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Iwanaga J, Kamura Y, Tanaka T, Watanabe K, Kusukawa J, Oskouian RJ, Tubbs RS. A new space of the face: The bucco-mandibular space. Clin Anat 2017; 30:958-962. [PMID: 28762568 DOI: 10.1002/ca.22964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 11/09/2022]
Abstract
Our previous studies based on intraoral dissection of fresh cadavers demonstrated the fissure and loose connective tissues behind the mucosa between the incisivus labii inferioris (ILI) and buccinator (BM) muscles. However, this raised new questions about the relationship among these muscles, the fissure and the buccal space. To our knowledge, no pathway to the oral cavity from the buccal space has been previously demonstrated, although such a pathway would better explain some routes of infection. Therefore, the aim of this study was to clarify the relationship among the mimetic muscles attached to the mandible, the fissure, and the buccal space. Twenty sides from 10 fresh frozen adult cadaveric Caucasian heads were used. The relationships among the ILI, BM, mandible, and buccal space were investigated with dissection and fluoroscopy. In all specimens, the fissure between the lateral border of the ILI and the anterior border of the BM formed the entrance of a space (here termed the bucco-mandibular space), which corresponded to the buccal mucosa in the premolar region. The superior border of this space was formed by the platysma and associated fascia, which was continuous with the masseteric fascia. This fascia clearly separated this space from the buccal space, which was located lateral to the BM and superior to this space. Clin. Anat. 30:958-962, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA.,Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | | | - Tsuyoshi Tanaka
- Department of Restorative Dental Sciences, Division of Prosthodontics, University of Florida, College of Dentistry, Gainesville, Florida, USA
| | - Koichi Watanabe
- Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington, USA.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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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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Sumi Y. Descending necrotizing mediastinitis: 5 years of published data in Japan. Acute Med Surg 2014; 2:1-12. [PMID: 29123684 DOI: 10.1002/ams2.56] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/25/2014] [Indexed: 12/29/2022] Open
Abstract
Descending necrotizing mediastinitis implies infection originating from the neck, most commonly an oropharyngeal or odontogenic focus, that spreads in the cervical fascial spaces and descends into the mediastinum. Early diagnosis is essential because descending necrotizing mediastinitis can rapidly progress to septic shock and organ failure. A comprehensive review of the current data of descending necrotizing mediastinitis in Japan was carried out using PubMed and ICHUSHI from the last 5 years. The symptoms, origins, comorbid conditions, treatment modalities, complications, and survival rates were analyzed. Tonsillar and pharyngeal origin was more identified compared to odontogenic origin. More than one-third of patients were diabetic and 28% of them were not identified as having any comorbidity. Streptococcus sp. and anaerobes were most isolated, reflecting the microflora of the oral cavity. Of the broad antibiotics, carbapenem was the most used as treatment, and clindamycin was the most co-given. Mediastinal drainage approach varied widely and the optimal approach is controversial. Twenty-one patients were treated with video-assisted thoracic surgical drainage and 15 cases by percutaneous catheter drainage, whereas transcervical approach was applied in 25 patients and thoracotomy was carried out in 21 patients. The overall mortality was 5.6%. Many authors advocated that the most effective management tool is a high degree of clinical suspicion followed by prompt and adequate drainage with intensive care including hemodynamic and nutritional support and repeat computer tomographic monitoring.
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Affiliation(s)
- Yuka Sumi
- Department of Emergency and Critical Care Medicine Juntendo University, Urayasu Hospital Chiba Japan
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Olsen I, van Winkelhoff AJ. Acute focal infections of dental origin. Periodontol 2000 2014; 65:178-89. [DOI: 10.1111/prd.12018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE The purpose of this article is to depict the anatomic pathways along which transphrenic spread of diseases and entities can disseminate. CONCLUSION The abdomen and thorax form a continuum on which the diaphragm is an important but incomplete barrier to disease migration.
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Kocher GJ, Hoksch B, Caversaccio M, Wiegand J, Schmid RA. Diffuse descending necrotizing mediastinitis: surgical therapy and outcome in a single-centre series. Eur J Cardiothorac Surg 2012; 42:e66-72. [DOI: 10.1093/ejcts/ezs385] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bas B, Ozden B, Bekcioglu B, Sanal K, Yilmaz S, Celik B, Basoglu A, Celenk C. Descending necrotizing mediastinitis associated with an infected dentigerous cyst. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e15-8. [PMID: 22862987 DOI: 10.1016/j.oooo.2011.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 08/26/2011] [Accepted: 09/03/2011] [Indexed: 11/17/2022]
Abstract
Descending necrotizing mediastinitis (DNM) is a rare condition in which an infection from the head and neck propagates into the mediastinum. The most common cause of DNM is odontogenic infection. DNM is spread by the fascial planes from the neck into the mediastinum and requires an aggressive surgical drainage through cervical and thoracic approaches. We report on a 67-year-old male patient, who had acute mediastinitis related to an infected dentigerous cyst in the left parasymphyseal region. A multidisciplinary team approach was used to treat the patient. The team consisted of thoracic surgeons, maxillofacial surgeons, and a radiologist. After the drainage of the mediastinum and pleural cavity, the cyst was enucleated. The patient was discharged at the 42nd day of hospitalization. The aim of this article is to present diagnosis, management, and follow-up of an infected dentigerous cyst that caused DNM.
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Affiliation(s)
- Burcu Bas
- Ondokuz Mayıs University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kurupelit, Samsun, Turkey.
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Martínez Vallina P, Espinosa Jiménez D, Hernández Pérez L, Triviño Ramírez A. [Mediastinitis]. Arch Bronconeumol 2011; 47 Suppl 8:32-6. [PMID: 23351519 DOI: 10.1016/s0300-2896(11)70065-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mediastinitis is defined as acute or chronic inflammation of the mediastinal structures and generally has a low incidence. The most frequent acute cause is sternotomy following cardiac revascularization surgery with both internal mammary arteries, with an incidence of 0.4% to 5% and a mortality of 16.5% to 47%. The most frequent vector is Staphylococcus aureus. Esophageal perforation, usually iatrogenic, is the second most frequent cause of acute mediastinitis, produced by common oropharyngeal flora, with a mortality rate of 20% to 60%, depending on the time of diagnosis. The third most frequent cause is descending necrotizing mediastinitis, the origin being an odontogenous focus in 60% and beta-hemolytic streptococcus the causative agent in 71.5% of cases. The most accurate diagnostic imaging technique is computed tomography. Treatment is almost always surgical and survival depends on its early performance. The worst postsurgical prognostic factor is septic shock.
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Parker KL, Bizekis CS, Zervos MD. Severe mediastinal infection with abscess formation after endobronchial ultrasound-guided transbrochial needle aspiration. Ann Thorac Surg 2010; 89:1271-2. [PMID: 20338352 DOI: 10.1016/j.athoracsur.2009.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 07/29/2009] [Accepted: 09/01/2009] [Indexed: 10/19/2022]
Abstract
Endobronchial, ultrasound-guided, transbronchial needle aspiration has recently been introduced as an alternative to mediastinoscopy for lymph node staging of lung cancer and the diagnosis of respiratory diseases. This procedure is less invasive and more cost-effective, and multiple large studies have reported no associated complications. In this case, an individual presented with descending mediastinitis after having this minimally invasive procedure for mediastinal lymphadenopathy.
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Affiliation(s)
- Kathryn L Parker
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York City, New York 10016, USA
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Deu-Martín M, Saez-Barba M, Sanz IL, Peñarrocha RA, Vielva LR, Montserrat JS. Mortality Risk Factors in Descending Necrotising Mediastinitis. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1579-2129(10)70046-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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[Mortality risk factors in descending necrotizing mediastinitis]. Arch Bronconeumol 2010; 46:182-7. [PMID: 20227809 DOI: 10.1016/j.arbres.2010.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 01/12/2010] [Accepted: 01/16/2010] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The term descending necrotizing mediastinitis (MND) refers to an infection that begins in the oropharyngeal region and spreads through the fascial planes into the mediastinum. This study aims to estimate the incidence of MND in our centre, the epidemiology and clinical features of the disease and to evaluate prognostic factors influencing mortality. PATIENTS AND METHODS We performed a retrospective study on 43 consecutive patients diagnosed at the Hospital Universitari Vall d'Hebron in Barcelona from January 1996 to December 2006. We performed a descriptive study and a bivariate and a multivariate analysis of variables collected. RESULTS Overall mortality was 21%, but when we subdivided the study into two periods (1996-2000 and 2001-2006) it shows a significant decrease (40% versus 4.3%). Risk factors identified in the bivariate analysis were: diagnosis period 1996-2000, diabetes mellitus, comorbidity, number of surgeries, left lateral surgery, postoperative morbidity and septic shock. In multivariate analysis, only the presence of septic shock proved to be an independent predictor of mortality. CONCLUSIONS MND is a disease of low incidence and should be suspected clinically and confirmed immediately with a computed tomography (CT). Multidisciplinary and early treatment has allowed us to reduce mortality by 40% in the first initial period to 4.3% today.
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Baikoussis NG, Siminelakis SN, Tzimas P, Papadopoulos GS. Maltreated dental abscess complicated with chest wall necrotizing fasciitis, empyema thorax and cardiac tamponade. Interact Cardiovasc Thorac Surg 2010; 10:485. [PMID: 20185855 DOI: 10.1510/icvts.2009.222323b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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