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Journal of Case Reports and Images in Dentistry - Journal of Case Reports and Images in Dentistry - Case Reports, Case Series, Case in Images, Clinical Images

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Case Report
 
A case of descending necrotizing mediastinitis and Lemierre's syndrome associated with an odontogenic infection
Jared Drew Weston
MBBS, BDSc, Principal House Officer, Department of Otolaryngology Head and Neck Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia

Article ID: 100005Z07JW2016
doi:10.5348/Z07-2016-5-CR-3

Address correspondence to:
Dr. Jared Drew Weston
113 Springfield Drive, Norman Gardens
Queensland Australia 4701, Rockhampton
Queensland
Australia, 4700

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How to cite this article:
Weston JD. A case of descending necrotizing mediastinitis and Lemierre's syndrome associated with an odontogenic infection. J Case Rep Images Dent 2016;2:10–14.


Abstract
Introduction: Descending necrotizing mediastinitis is a rare complication of odontogenic infections, with a high mortality rate despite the advent of antibiotics.
Case Report: An otherwise well 37-year-old male presented with descending necrotizing mediastinitis secondary to a mandibular second molar infection. He required prolonged targeted antibiotic treatment, extensive oral, neck and thoracic surgery. After a 68-day intensive care unit admission he was stepped-down to the ward for further monitoring. This admission was complicated septic shock, Lemierre's syndrome and a right phrenic nerve injury.
Conclusion: Odontogenic infections are common presentations to the local dentist yet many patients delay definitive management, placing them at increased risk of severe complications. This clinical case highlights the multiple potentially fatal complications (including Lemierre's Syndrome) associated with descending necrotizing mediastinitis originating from an infected mandibular second molar.

Keywords: Dentists, Lemierre's syndrome, Mediastinitis, Sepsis, Toothache


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Author Contributions
Jared Drew Weston – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Jared Drew Weston. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.