Mediastinitis: a case report

Jae Hwan Kim; Dong-Mok Ryu; Yu-Jin Jee; Jung-Woo Lee; Deok-Won Lee

doi:10.5125/jkaoms.2010.36.6.538

Journal List > J Korean Assoc Oral Maxillofac Surg > v.36(6) > 1032443

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Kim, Ryu, Jee, Lee, and Lee: Mediastinitis: a case report

Original Article

J Korean Assoc Oral Maxillofac Surg 2010;36(6):538-542.

Published online: 7 January 2010

DOI: https://doi.org/10.5125/jkaoms.2010.36.6.538

Mediastinitis: a case report

Jae Hwan Kim^1,², Dong-Mok Ryu^1,², Yu-Jin Jee^1,², Jung-Woo Lee², Deok-Won Lee^1,²

¹Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea

²Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea

Deok-Won Lee Department of Oral and Maxillofacial Surgery, Dental Hospital, Gangdong Kyung Hee University 892 Dongnamro, Gangdong-gu, Seoul, 134-090 Korea TEL: +82-2-440-7517 FAX: +82-2-440-7589 E-mail: verycutebear@hanmail.net

Received 26 September 201017 December 2010 Accepted 21 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acute mediastinitis is a fatal infection which occurs related to connective tissue of mediastium, in the thoratic organs. Occurrence of mediastinitis due to craniocervical infection is very rare, and is defined as descending necrotizing mediastinitis.

November 8th, 2008, man in his early fifties visited ER due to severe swelling on left neck area and dyspnea. Antibiotic were administered immediately, and vast amount of abscess formation on pneumomediastinum and adjacent tissues were observed via chest computed tomography. With cooperation of thoracic and cardiovascular surgery department, emergency incision and drainage with drain insertion was done to remove abscess, and control the infection. After surgery, everyday saline irrigation through drain was done during hospitalization, with continues antibiotic therapy.

Descending necrotising mediastinitis is a most rare and dangerous infection which occurs on oropharyngeal area. In case of descending necrotising mediastinitis, accurate diagnosis, airway maintenance, remove of abscess by incision and drainage, aggressive antibiotic therapy and continuous saline irrigation is necessary to increase patient survivability. Also, computed tomography with contrast media is essential to figure out the size and location of the infection and abscess formation.

Keywords: Descending necrotising mediastinitis, Craniocervical infection, Incision, Drainage

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Fig. 1.

Panorama X-Ray image taken before surgery. Radiolucent lesion on root of right second molar can be found.

Fig. 2.

Preoperative CT image of neck. Decreased airway due to abscess formation can be noticed. (CT: computed tomography)

Fig. 3.

Preoperative CT image of chest. Radiolucent abscess space in pneumomediastinum can be noticed. (CT: computed tomography)

Fig. 4.

Postoperative neck CT image. Increased airway, decreased abscess space in pneumomediastinum can be noticed. (CT: computed tomography)

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