Mediastinite descendente secundária à Angina de Ludwig: uma revisão de literatura sobre a progressão e o manejo de uma infecção letal

Descending mediastinitis secondary to Ludwig's angina is a serious infectious condition resulting from the spread of odontogenic infections to the mediastinum through the deep facial spaces of the neck. This pathology has a high mortality rate due to rapidprogression to sepsis and multiorgan failure. Early diagnosis is essential, and computed tomography is the examination of choice to assess the extent of the infection. Treatment requires an aggressive approach, including broad-spectrum antibiotic therapy and surgical drainage of the cervical and mediastinal spaces. This study reviews the pathogenesis of descending mediastinitis, its risk factors, clinical signs, diagnosis and therapeutic management. The spread of infection occurs mainly through the retropharyngeal and perivascular spaces, reaching the lower mediastinum and can lead to fatal complications. The main clinical signs include intense neck pain, high fever, respiratory distress and signs of septic shock. The prognosis depends on the speed of diagnosis and the effectiveness of treatment, with mortality ranging from 20% to 40%. Antibiotic therapy should be initiated early, and surgical drainage is essential to prevent progression of the infection. Studies indicate that early intervention significantly improves patient survival. Despite advances in imaging and therapeutic strategies, descending mediastinitis remains a significant clinical challenge. A detailed understanding of the facial anatomy and mechanisms of infection spread is crucial for effective management of the disease and reduction of associated complications.