Abstract
Descending necrotizing mediastinitis is caused by the downward spread of neck infections and is a highly lethal complication of oropharyngeal lesions. This infection previously had a much worse prognosis. We report a case of descending necrotizing mediastinitis caused by odontogenic infection that was successfully treated in an immunocompromised elderly patient. An 87-year-old man had experienced pain in the right mandibular region for 6 days before visiting a dentist. Because the symptoms worsened, with fatigue and swallowing pain, he was referred to our hospital 2 days later. He had a history of autoimmune cerebellar ataxia, and he was being treated with steroids. A clinical examination revealed diffuse swelling and redness from the submandibular area to the superior aspect of the neck, as well as sublingual edema. Contrast-enhanced computed tomography revealed a diffuse, deep cervical abscess spreading to the right sublingual, submandibular, parapharyngeal, and carotid spaces. Thus, necrotizing fasciitis was diagnosed; appropriate antibiotics were administered, and the patient underwent surgical drainage of the abscess under general anesthesia. However, another abscess had formed in the superior mediastinum and extended into the right carotid space. Additional surgical drainage of the second abscess and transcervical drainage for the descending necrotizing mediastinitis were performed. The treatment was successful, and the patient was discharged.
