Oropharyngeal sepsis with endothoracic spread.

Two patients who had oropharyngeal infection with extension into the thoracic cavity through the fascial planes were recently seen at the Health Sciences Centre in Winnipeg. In both instances the infection was odontogenic. A 5-year review of the literature yielded 14 other cases with a similar presentation. In most cases the infection was odontogenic. The overall mortality was 25% (four deaths in 16 patients). Transient deficiency of the swallowing mechanism led to aspiration pneumonia in 44% of the patients. An aggressive surgical approach and appropriate antibiotic therapy are essential in managing these patients. Oral intake should be restricted and nasogastric tube feedings should be considered to diminish the risk of aspiration pneumonia.