Migliario M, Bello L, Greco Lucchina A, Mortellaro C
Department of Clinical and Experimental Medicine "Amedeo Avogadro" Piemonte Orientale University, Novara, Italy.
Minerva Stomatol. 2010 Oct;59(10):551-60.
Mediastinitis is a frequently-fatal infection of the connective tissue that surrounds the mediastinal organs. The principal causes are perforation of the oesophagus or infections following thoracic surgery with sternotomy, but it may also occur as a rare but dangerous complication of oropharyngeal or cephalic infections that, spreading through the fascias of the cervical spaces, reach and infect the connective tissue present in the mediastinum and between the pleura. The chief cause of the high rate of mortality still carried by this disease is the poor understanding of this possible complication of oro-facial infections (sometimes initially trivial) and the consequent delay in diagnosis and failure to provide adequate therapy. Mediastinal infections of odontogenic aetiology is a rare occurrence but its management requires an early diagnosis and an aggressive surgical treatment. So all the dentists and the oral surgeons should consider the possibility of onset of this dangerous complication also of banal infections of mandibular molars. The aim of this article is to review the literature, and to report two cases of patients whom, following on to odontogenic infections originating from molars in the mandibular arch, developed an odontogenic cervical abscess complicated by pleural effusion, mediastinal empyema and septic shock, with severe risk of a fatal outcome.
纵隔炎是纵隔器官周围结缔组织的一种常致命的感染。主要病因是食管穿孔或开胸手术后的感染，但它也可能作为口咽或头部感染的一种罕见但危险的并发症出现，这些感染通过颈部间隙的筋膜扩散，到达并感染纵隔和胸膜之间的结缔组织。这种疾病仍然具有高死亡率的主要原因是对这种口面部感染可能的并发症（有时最初很轻微）认识不足，以及随之而来的诊断延迟和未能提供充分治疗。牙源性病因的纵隔感染很少见，但其治疗需要早期诊断和积极的手术治疗。因此，所有牙医和口腔外科医生都应考虑到这种危险并发症也可能发生在下颌磨牙的普通感染中。本文的目的是回顾文献，并报告两例患者，他们在下颌牙弓磨牙引起牙源性感染后，发展为牙源性颈深部脓肿，并发胸腔积液、纵隔积脓和感染性休克，有严重的致命风险。
