We describe a descending necrotizing mediastinal abscess caused by post-extraction infection that was successfully treated by endoscopic-transthoracic drainage.
The patient was 55-year-old man with an odontogenic infection of the oral floor and submandibular region after extraction of the lower second molar.
We performed incisional drainage and administered broad-spectrum antibiotics. Despite treatment the inflammation persisted and formed a deep neck abscess that spread to the mediastinum, resulting in an abscess and subsequent sepsis.
Surgical neck drainage for the deep-space neck abscess was performed by an otolaryngologist, and endoscopictransthoracic drainage for the descending necrotizing mediastinal abscess was performed by thoracic surgeons. On bacterial culture, abundant growth of Streptococcus constellatus was disclosed. We gave antibiotics against which the pathogen was sensitive to control the spread of inflammation.
Systemic management was performed in an intensive care unit.
