抜歯後に生じた下行性壊死性縦隔炎の1例

• Published in: 日本口腔外科学会雑誌 Vol. 58; no. 5; pp. 332 - 336
• Main Authors: 赤崎, 幸太, 吉武, 義泰, 中山, 秀樹, 高宗, 康隆, 平木, 昭光, 篠原, 正徳
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.05.2012
• Subjects: 下行性壊死性縦隔炎; 抜歯後感染; 深頸部膿瘍
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.58.332

We describe a descending necrotizing mediastinal abscess caused by post-extraction infection that was successfully treated by endoscopic-transthoracic drainage. The patient was 55-year-old man with an odontogenic infection of the oral floor and submandibular region after extraction of the lower second molar. We performed incisional drainage and administered broad-spectrum antibiotics. Despite treatment the inflammation persisted and formed a deep neck abscess that spread to the mediastinum, resulting in an abscess and subsequent sepsis. Surgical neck drainage for the deep-space neck abscess was performed by an otolaryngologist, and endoscopictransthoracic drainage for the descending necrotizing mediastinal abscess was performed by thoracic surgeons. On bacterial culture, abundant growth of Streptococcus constellatus was disclosed. We gave antibiotics against which the pathogen was sensitive to control the spread of inflammation. Systemic management was performed in an intensive care unit.