Odontogenic Descending Necrotizing Mediastinitis (DNM)

Clinical features:

(1) an odontogenic infection

(1a) most often there is an infection of a mandibular tooth, especially the third molar

(1b) it can occur after a dental extraction

(2) swelling of the face and neck

(3) dental and/or neck and/or chest pain

(4) fever

(5) dysphagia

(6) dyspnea

The diagnosis of mediastinitis can be made by chest CT. Abscesses may be found in various spaces of the head and neck.

The infections are often polymicrobial but can be monomicrobial. Anaerobic bacteria may be present.

Comorbid conditions include diabetes and chronic liver disease.

Complications:

(1) sepsis

(2) pyothorax

(3) pericarditis

(4) multi-organ failure