Abstract
We report a case of descending necrotizing mediastinitis (DNM) arising from odontogenic infection with emergent airway management. The patient, an 84-year-old woman, was referred to our hospital emergency center due to diffuse submandibular swelling on the right side accompanied with pain. Panoramic X-ray imaging showed a radiolucent area at the root apex of the right upper second molar. Enhanced computed tomography showed an air-dominant abscess spreading to the masticator, submental, submandibular, retrovisceral, pre-tracheal, and vascular visceral spaces and the superior mediastinum. Three hours after presentation, she developed acute respiratory distress and decreased mental status. We performed an emergency intensive care unit (ICU) transfer for early management. The ICU doctor performed endotracheal intubation. The deep cervical and mediastinal areas were drained and extensive debridement was performed by an otolaryngologist. The patient had to undergo four operations for the DNM; treatment was successful, and she was ambulatory at discharge. Appropriate timing of airway management and drainage was important for the successful treatment of DNM. A team approach, in collaboration with other departments, is required for successful treatment.
