Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report

Abstract

Background: Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions. Clinically, if early odontogenic infections such as acute periapical periodontitis, alveolar abscess, and pericoronitis of wisdom teeth are not treated timely, effectively and correctly, the infected tissue may spread up to the skull and brain, down to the thoracic cavity, abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck. Severe multi-space infections are formed and can eventually lead to life-threatening complications (LTCs), such as intracranial infection, pleural effusion, empyema, sepsis and even death.

Case summary: We report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions. One week before admission, due to pain in the right lower posterior teeth, the patient placed a cigarette butt dipped in the pesticide "Miehailin" into the "dental cavity" to relieve the pain. Within a week, the infection gradually spread bilaterally to the floor of the mouth, submandibular space, neck, chest, waist, back, temporal and other areas. The patient had difficulty breathing, swallowing and eating, and was transferred to our hospital as an emergency admission. Following admission, oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology, thoracic surgery, general surgery, hematology, anesthesia and the intensive care unit to assist with treatment. The patient was treated with the highest level of antibiotics (vancomycin) and extensive abscess incision and drainage in the oral, maxillofacial, head and neck, chest and back regions. Unfortunately, the patient died of septic shock and multiple organ failure on the third day after admission.

Conclusion: Odontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions, which can result in multiple LTCs. The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.

Keywords: Case report; Complication; Head and neck; Maxillofacial; Multi-space infections; Odontogenic infection; Oral.

Figure 1

Sagittal and coronal computed tomography scans of the maxillofacial, neck and chest regions. Sagittal (A) and coronal (B) computed tomography scans of the maxillofacial, neck and chest regions showing extensive swelling and pneumatosis in soft tissues of bilateral oral, maxillofacial, temporal, cervical, parapharyngeal space, mediastinum, chest and back regions.

Figure 2

Transverse computed tomography scan of the hyoid plane and mediastinal plane. A: Transverse computed tomography (CT) scan of the hyoid plane showing extensive swelling and pneumatosis in soft tissues of the bilateral cervical region, parapharyngeal space, paracervical spine and posterior cervical region, especially in the right neck; B: Transverse CT scan of the mediastinal plane showing extensive pneumatosis in the mediastinal region.

Figure 3

Transverse computed tomography scan of the cardiothoracic region. A: Bilateral pleural effusion (black arrow), pericardial effusion (white arrow); B: Bilateral pneumothorax and pulmonary infection.