Descending necrotizing mediastinitis secondary to an oral phlegmon: a case report

Background: Rare complications of odontogenic infection can lead to a life-threatening and fatal consequence of descending necrotizing mediastinitis The mortality rate is still between 20 and 40 percent despite improvements in surgical care, diagnostic imaging, and antibiotics. This case report presents a case of descending necrotizing mediastinitis as a secondary complication of oral phlegmon. Case Presentation: A 51-year-old male patient presented with chief complaints of swelling and pain in the lower right jaw. The patient underwent incision drainage and submandibular dissection which obtained 100 cc of pus and necrotic tissue that originated from submandibular and sublingual region. Laboratory examination showed leukocytosis, in addition the X-ray photo and CT-scan supported diagnosis of mediastinitis. The patient was assessed with oral phlegmon post re-incision drainage and descending necrotizing mediastinitis with jugular vein rupture in the area of infection. The patient received intravenous steroids, fluids, analgesia and broad-spectrum empirical antibiotics. The patient's condition has improved afterwards. Conclusion: Descending necrotizing mediastinitis is rare but has a serious complication of oral phlegmon therefore the principal management surgical drainage, antibiotics, and airway management needs to be performed accordingly.