Clinical analysis of 70 cases of odontogenic descending necrotizing mediastinitis

doi:10.19438/j.cjoms.2018.02.015

China Journal of Oral and Maxillofacial Surgery ›› 2018, Vol. 16 ›› Issue (2): 171-175.doi: 10.19438/j.cjoms.2018.02.015

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Clinical analysis of 70 cases of odontogenic descending necrotizing mediastinitis

XIA Yun-hui¹, QU Lu-yao², LIANG Xiang³, JIANG Bin⁴, QIAN Wen-tao², CAI Xie-yi², ZHANG Wei-jie², GUAN Xin³

1.Department of Oral and Craniomaxillofacial Surgery, 2.Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology. Shanghai 200011;
3. Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
4.Department of Stomatology, Shanghai Renji Hospital,Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China;

Received:2017-09-26 Revised:2017-11-22 Online:2018-03-20 Published:2018-04-08

Abstract

Abstract: PURPOSE: To analyze the clinical features of patients with odontogenic descending necrotizing mediastinitis (DNM) in order to provide prompt diagnosis and treatment. METHODS: A retrospective study was conducted on 70 patients receiving treatment for odontogenic DNM from January 2014 to December 2016. Demographics, etiology of infection, clinical symptom, laboratory tests, bacterial cultures, treatment and outcomes were collected and analyzed. Statistical analysis of the results was performed using SPSS 22.0 software package. RESULTS: There were 57 males and 13 females, with a mean age of 57.8±11.42 years. The most frequent teeth involved were the lower posterior molars (38.6%). Periapical periodontitis was the most frequent triggering cause in 50 cases. Treatments consisted of antibiotic therapy and aggressive transcervical drainage (63 cases) and thoracotomy (7 cases). The mortality was 5.7%. The risk factors for mortality were associated complications (P<0.005) and severe sepsis or septic shock(P<0.002). CONCLUSIONS: Success in management of odontogenic DNM is based on prompt identification of suspected symptoms, quick CT scanning and aggressive mediastinal drainage.

Key words: Odontogenic infection, Descending necrotizing mediastinitis, Mediastinal drainage

CLC Number:

R782.3

XIA Yun-hui, QU Lu-yao, LIANG Xiang, JIANG Bin, QIAN Wen-tao, CAI Xie-yi, ZHANG Wei-jie, GUAN Xin. Clinical analysis of 70 cases of odontogenic descending necrotizing mediastinitis[J]. China Journal of Oral and Maxillofacial Surgery, 2018, 16(2): 171-175.

References

[1] Huang L, Jiang B, Cai X, et al. Multi-space infections in the head and neck: do underlying systemic diseases have a predictive role in life-threatening complications? [J]. J Oral Maxillofac Surg, 2015, 73(7): 1320.e1-10.
[2] Estrera AS, Landay MJ, Grisham JM, et al.Descending necrotizing mediastinitis[J]. Surg Gynecol Obstet,1983, 157(6): 545-552.
[3] Freeman RK, Vallieres E, Verrier ED, et al.Descending necrotizing mediastinitis: An analysis of the effects of serial surgical debridement on patient mortality[J]. J Thorac Cardiovasc Surg, 2000, 119(2): 260-267.
[4] Li KK, Varvares MA, Meara JG.Descending necrotizing mediastinitis: a complication of dental implant surgery[J]. Head Neck, 1996, 18(2): 192-196.
[5] Van Straalen HC, Jansveld KA, Michels LF, et al.Mediastinitis with fistula formation to the left main bronchus. A complication of wisdom tooth extraction[J]. Chest, 1994, 106(2): 623-624.
[6] Roccia F, Pecorari GC, Oliaro A, et al.Ten years of descending necrotizing mediastinitis: management of 23 cases[J]. J Oral Maxillofac Surg, 2007, 65(9): 1716-1724.
[7] Ridder GJ, Maier W, Kinzer S, et al.Descending necrotizing mediastinitis: contemporary trends in etiology, diagnosis, management, and outcome[J]. Ann Surg, 2010, 251(3): 528-534.
[8] Endo S, Murayama F, Hasegawa T, et al.Guideline of surgical management based on diffusion of descending necrotizing mediastinitis[J]. Jpn J Thorac Cardiovasc Surg, 1999, 47(1): 14-19.
[9] Kocher GJ, Hoksch B, Caversaccio M, et al.Diffuse descending necrotizing mediastinitis: surgical therapy and outcome in a single-centre series[J]. Eur J Cardiothorac Surg, 2012, 42(4): e66-72.
[10] Wright CT, Stocks RM, Armstrong DL, et al.Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess[J]. Arch Otolaryngol Head Neck Surg, 2008, 134(4): 408-413.
[11] Zhang C, Tang Y, Zheng M, et al.Maxillofacial space infection experience in West China: a retrospective study of 212 cases[J]. Int J Infect Dis, 2010, 14(5): e414-e417.
[12] Sato FR, Hajala FA, Freire Filho FW, et al.Eight-year retrospective study of odontogenic origin infections in a postgraduation program on oral and maxillofacial surgery[J]. J Oral Maxillofac Surg, 2009, 67(5): 1092-1097.
[13] Scaglione M, Pinto A, Giovine S, et al.CT features of descending necrotizing mediastinitis--a pictorial essay[J]. Emerg Radiol, 2007, 14(2): 77-81.
[14] Novakov IP, Safev GP, Peicheva SE.Descending necrotizing mediastinitis of odontogenic origin--personal experience and literature review[J]. Folia Med (Plovdiv), 2010,52(3): 13-20.
[15] Wakahara T, Tanaka Y, Maniwa Y, et al.Successful management of descending necrotizing mediastinitis[J]. Asian Cardiovasc Thorac Ann, 2011, 19(3-4): 228-231.
[16] Dajer-Fadel WL, Ibarra-Pérez C, Sánchez-Velázquez LD, et al.Descending necrotizing mediastinitis below the tracheal carina[J]. Asian Cardiovasc Thorac Ann, 2014, 22(2): 176-182.
[17] Prado-Calleros HM, Jiménez-Fuentes E, Jiménez-Escobar I.Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description[J]. Head Neck, 2016, 38( Suppl 1): E2275-2283.
[18] Deu-Martin M, Saez-Barba M, Lopez Sanz I, et al.Mortality risk factors in descending necrotizing mediastinitis[J]. Arch Bronconeumol , 2010,46(4): 182-187.

Clinical analysis of 70 cases of odontogenic descending necrotizing mediastinitis

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