2014 Volume 60 Issue 12 Pages 682-686
We report a case of descending necrotizing mediastinitis due to severe odontogenic infection successfully treated by thoracoscopic drainage. A 24-year-old man was referred to our hospital emergency center because of bilateral submandibular swelling and was hospitalized on the same day. He had diffuse swelling and redness from the submandible to neck bilaterally and had difficulty in swallowing. He had spontaneous pain at the third right mandibular molar, but no tenderness, swelling, or pus discharge around the buccal gingiva. Panoramic X-ray images showed a radiolucent area at the root apex of the right mandibular third molar. Enhanced computed tomography revealed a diffuse abscess spreading to the sublingual, submental, and submandibular spaces. The patient underwent a laryngotracheotomy and cervical drainage because he had laryngeal edema. However, an abscess had formed in the anterior mediastinum through the left intercarotic space, and hydrothorax was found. Then, surgical drainage for the deep cervical abscess and endoscopic transthoracic drainage for the descending necrotizing mediastinitis were performed. The treatment succeeded, and he was discharged.
