Surgical Excision of Unusual Sacked Neck and Mediastinum Abscess of Odontogenic Origin

Abstract

The most common cause of neck infections is odontogenic abscesses that can often be life-threatening and require a surgical drain associated with antibiotic therapy. We present a case of the surgical management of an odontogenic sack-shaped and walled abscess arising from elements 3.6, 3.7 and 3.8 that reached the laterocervical spaces and anterior mediastinum in a 28-year-old healthy woman. Typical signs and symptoms of cervical complications of dental origin are fever, a neck mass, lymphadenopathy, trismus and odynophagia. The gold standard treatment in these situations is a multidisciplinary approach involving an oral surgeon, ENT specialist and thoracic surgeon to drain the infected material. To the best of our knowledge, this is the first described case report of a dental abscess enclosed in a sack in the deep space of the neck and in the anterior space of the mediastinum.

Keywords: abscess; odontogenic infection; surgical drain; tracheostomy.

Figure 1

Computed tomography scan of the abscess affecting the deep space of the neck and the anterior mediastinum in coronal view (A). The red arrow in sagittal view shows the abscess behind the sternal manubrium (B). In the axial view the red circle shows the broken third inferior left molar (C).

Figure 2

The wall of the abscess in the neck during the surgical drain (A) and after the removal (B).

Figure 3

CT scan performed 15 days after surgical drain shows the healing in coronal view (A) and in sagittal view (B).

Figure 4

Descending mediastinitis (DM) classifications. The grey area indicates the extension of infections. Type I: DM is localized in the upper mediastinum above the tracheal bifurcation. Type II: DM extends to the lower anterior mediastinum. Type III: DM extends to the anterior and lower posterior mediastinum.