Department of Oral and Maxillofacial Surgery, University Hospital Infanta Cristina, Badajoz, Spain.
J Craniomaxillofac Surg. 2011 Jul;39(5):335-9. doi: 10.1016/j.jcms.2010.10.001. Epub 2010 Nov 11.
Descending necrotizing mediastinitis (DNM) following dental extraction is an extremely serious infection with a high mortality rate. Oral infection may rapidly descend into the mediastinum across the retropharyngeal and retrovisceral spaces. Once established, mediastinitis is rapidly followed by sepsis and death. If DNM is suspected cervical and thoracic CT must be carried out urgently. After this, prompt control of the upper airway with tracheostomy, aggressive surgical debridement of the deep cervical spaces and mediastinum, and intravenous broad spectrum antibiotic therapy are mandatory. The present paper reports two new cases of DNM following dental extraction, and focuses on radiological features of abscess progression through the cervical spaces down into the mediastinum.
下行性坏死性纵隔炎（DNM）继发于拔牙后，是一种极其严重的感染，死亡率很高。口腔感染可通过咽后和内脏后间隙迅速下行至纵隔。一旦发生纵隔炎，很快就会继发败血症和死亡。如果怀疑发生 DNM，必须紧急进行颈胸部 CT 检查。在此之后，必须立即通过气管切开术控制上呼吸道，积极对深层颈部间隙和纵隔进行清创，以及静脉注射广谱抗生素治疗。本文报告了两例新的拔牙后 DNM 病例，并重点介绍了脓肿通过颈部间隙向纵隔进展的放射学特征。
