Odontogenic descending necrotizing mediastinitis (DNM) is a rare but sometimes fatal
complication of tooth infections. The mortality rate remains high, up to 40%, and
there is no consensus on optimal workup and management currently. This review aims
to summarize cases of odontogenic DNM in the literature to optimize management strategies
and aid physicians in its early recognition. A systematic review of the Ovid Medline,
EMBASE Classic and Pubmed databases was conducted using PRISMA guidelines. Original
research studies reporting an odontogenic etiology of DNM were included. Our search
identified 226 articles. Final inclusion consisted of 60 studies describing 204 cases.
Most patients were male (80.4%) with a mean age of 47.64 ± 15.96 years old. Patients
primarily presented with edema (57.7%), fever (42.3%), trismus (37.2%), dyspnea, (26.9%),
dysphagia (26.9%). Common radiologic findings were abscesses or fluid collection in
the mediastinum (53.1%), air in the soft tissues (50.0%), pleural effusion or empyema
(37.5%), mediastinal widening (32.8%), and pericardial effusion (7.8%). Patients were
treated with intravenous antibiotics and a variety of surgical techniques such as
cervicotomy only (51.2%), thoracotomy only (15.9%), cervicotomy and chest tube (3.5%).
The mortality rate was 14.2% with a mean length of hospital stay of 30.1 ± 20.2 days.
This systematic review reports and analyzes epidemiological, clinical and treatment-related
data regarding patients with odontogenic DNM. Effective disease recognition and patient-specific
targeted treatment are needed to ensure treatment success. Further research is needed
to promote implementation of such data into clinical practice, with potential to reduce
the associated mortality rate.
KEYWORDS
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Operative Techniques in Otolaryngology-Head and Neck SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Descending necrotizing mediastinitis: Surgical management.Eur J Cardiothorac Surg. 2001; 20: 739-742https://doi.org/10.1016/s1010-7940(01)00790-4
- Descending necrotizing mediastinitis caused by group A streptococcus (serotype M1T1).Scand J Infect Dis. 2001; 33: 771-772https://doi.org/10.1080/003655401317074608
- Descending necrotizing mediastinitis secondary to a retropharyngeal abscess.Eur Respir J. 1994; 7: 1716-1718https://doi.org/10.1183/09031936.94.07091716
- Cervical necrotizing fasciitis with descending mediastinitis: Literature review and case report.J Oral Maxillofac Surg. 2012; 70: 1342-1350https://doi.org/10.1016/j.joms.2011.05.007
- Preferred reporting items for systematic reviews and meta analyses: The PRISMA statement.PLoS Med (6):. 2009; : e1000097https://doi.org/10.1371/journal.pmed1
- PLoS Med. 6 (7)(4):264. doi:10.7326/0003-4819-151-4-200908180-00135.
- Necrotizing fasciitis caused by dental infection: A retrospective analysis of 9 cases and a review of the literature.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95: 283-290https://doi.org/10.1067/moe.2003.85
- Guideline of surgical management based on diffusion of descending necrotizing mediastinitis.Jpn J Thorac Cardiovasc Surg. 1999; 47: 14-19https://doi.org/10.1007/BF03217934
- Synergistic necrotizing cellulitis.Ann Surg. 1972; 175: 702-711https://doi.org/10.1097/00000658-197205000-00010
- Severe deep neck space infections and mediastinitis of odontogenic origin: Clinical relevance and implications for diagnosis and treatment.Acta Otolaryngol. 2009; 129: 62-70https://doi.org/10.1080/00016480802008181
- Mediastinal irrigation in the treatment of descending necrotizing mediastinitis.J Clin Anal Med. 2015; 6: 389-392https://doi.org/10.4328/JCAM.1042
- Cervical fascia and deep neck infections.Laryngoscope. 1970; 80: 409-435https://doi.org/10.1288/00005537-197003000-00004
- Deep neck space infection - A retrospective study of 270 cases at tertiary care center.World J Otorhinolaryngol - Head Neck Surg. 2016; 2: 208-213https://doi.org/10.1016/j.wjorl.2016.11.003
- Deep neck abscess: A retrospective review of 210 cases.Ann Otol Rhinol Laryngol. 2001; 110: 1051-1054https://doi.org/10.1177/000348940111001111
- Deep neck abscesses–changing trends.J Laryngol Otol. 1994; 108: 138-143https://doi.org/10.1017/s0022215100126106
- Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description.Head Neck. 2016; 38: E2275-E2283https://doi.org/10.1002/hed.24183
- Update on necrotizing mediastinitis: causes, approaches to management, and outcomes.Curr Infect Dis Rep. 2011; 13: 278-286https://doi.org/10.1007/s11908-011-0174-z
- Antibiotic selection in head and neck infections.Oral Maxillofac Surg Clin North Am. 2012; 15: 17-38https://doi.org/10.1016/s1042-3699(02)00082-1
- Descending necrotizing mediastinitis.Surg Gynecol Obstet. 1983; 157: 545-552
- Mediastinitis as complication of odontogenic infection: A case report.Niger J Clin Pract. 2019; 22: 869-871https://doi.org/10.4103/njcp.njcp_539_18
- Difficult cases of odontogenic deep neck infections: A report of three patients.Balkan Med J. 2017; 34: 172-179https://doi.org/10.4274/balkanmedj.2015.1379
- The value of early intervention and a multidisciplinary approach in the management of necrotizing fasciitis of the neck and anterior mediastinum of odontogenic origin.J Oral Maxillofac Surg. 2015; 73: 918-927https://doi.org/10.1016/j.joms.2014.12.021
- Cervical facial necrotizing fasciitis with medistinic spread from odontogenic origin. Two case reports.Ann Ital Chir. 2014; 85 (Available at:) (Accessed November 10, 2019): 79-84
- Descending necrotizing mediastinitis of odontogenic origin–personal experience and literature review.Folia Med (Plovdiv). 2010; 52: 13-20https://doi.org/10.2478/v10153-010-0002-5
- Use of interventional radiology in the management of mediastinitis of odontogenic origin.Br J Oral Maxillofac Surg. 2006; 44: 538-542https://doi.org/10.1016/j.bjoms.2005.09.003
- Descending necrotizing mediastinitis due to odontogenic infections.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89: 412-419https://doi.org/10.1016/s1079-2104(00)70121-1
- Descending necrotizing mediastinitis: A retrospective surgical experience.Eur J Cardiothorac Surg. 1999; 16: 200-205https://doi.org/10.1016/s1010-7940(99)00168-2
- Mediastinitis with fistula formation to the left main bronchus: A complication of wisdom tooth extraction.Chest. 1994; 106: 623-624https://doi.org/10.1378/chest.106.2.623
- Cervical necrotizing fasciitis.Otolaryngol Head Neck Surg. 1981; 89: 935-937https://doi.org/10.1177/019459988108900610
- Transcervical drainage for descending necrotizing mediastinitis may be sufficient.Otolaryngol - Head Neck Surg. 2011; 145: 742-747https://doi.org/10.1177/0194599811406064
- Odontogenic infections and descending necrotizing mediastinitis: Case report and review of the literature.Int Dent J. 2004; 54: 97-102https://doi.org/10.1111/j.1875-595x.2004.tb00262.x
- Descending necrotizing mediastinitis: A minimally invasive approach using video-assisted thoracoscopic surgery.Ann Thorac Surg. 2004; 77: 306-310https://doi.org/10.1016/s0003-4975(03)01333-x
- Is video-assisted thoracoscopic surgery an optimal approach for descending necrotizing mediastinitis? [3].Ann Thorac Surg. 2005; 79: 751https://doi.org/10.1016/j.athoracsur.2004.02.135
- Acute descending mediastinitis secondary to an odontogenic infection in a patient initially suspected of having acute thyroiditis: A case report.J Acute Med. 2011; 1: 52-54https://doi.org/10.1016/j.jacme.2011.10.004
- Non-Candida albicans Candida mediastinitis of odontogenic origin in a diabetic patient.Med Mycol. 2008; 46: 345-348https://doi.org/10.1080/13693780701837140
- Treatment of mediastinitis using video-assisted thoracoscopic surgery.Eur J Cardio-thoracic Surg. 2008; 34: 520-524https://doi.org/10.1016/j.ejcts.2008.05.034
- Successful management of descending necrotizing mediastinitis with minimally invasive mediastinal interventions.Infect Dis Clin Pract. 2018; 26: 288-290https://doi.org/10.1097/IPC.0000000000000570
- Descending necrotizing mediastinitis: Transcervical drainage is not enough.Ann Thorac Surg. 1990; 49: 780-784https://doi.org/10.1016/0003-4975(90)90022-x
- Descending necrotizing mediastinitis: Surgical treatment via clamshell approach.Ann Thorac Surg. 1996; 62: 1650-1654https://doi.org/10.1016/s0003-4975(96)00683-2
- Management of descending necrotizing mediastinitis: An aggressive treatment for an aggressive disease.Ann Thorac Surg. 1999; 68: 212-217https://doi.org/10.1016/s0003-4975(99)00453-1
- Optimal treatment of descending necrotizing mediastinitis.Thorax. 1997; 52: 702-708https://doi.org/10.1136/thx.52.8.702
- Odontogenic necrotizing fasciitis: A systematic review of the literature.BMC Ear, Nose Throat Disord. 2018; 18https://doi.org/10.1186/s12901-018-0059-y
- Hyperbaric oxygen therapy as an anti-infective agent.Expert Rev Anti Infect Ther. 2009; 7: 1015-1026https://doi.org/10.1586/eri.09.76
- Mediastinitis following cervical suppuration.Ann Surg. 1938; 108: 588-611https://doi.org/10.1097/00000658-193810000-00009
- Case reports and case series from Lancet had significant impact on medical literature.J Clin Epidemiol. 2005; 58: 1227-1232https://doi.org/10.1016/j.jclinepi.2005.04.003
Article info
Publication history
Published online: March 27, 2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
