Descending Necrotizing Mediastinitis due to Odontogenic Infection: An unusual Case Report

A 21-year-old normossemic patient sought care in an emergency hospital with a major complaint of neck swelling and pain to breathe, talk, eat and drink water, presenting anodontogenic infection of the lower right first molar tooth that evolved for 9 days with no previous medical assistance. The clinical aspect showed (Figure 1) redness and extensive swelling of hardened consistency of neck, submandibular, submental and sublingual spaces bilaterally, trismus, dysphasia, dyspnea, dehydration, speech alteration and limited cervical mobilization. The diagnostic hypothesis was deep cervical infection and descending mediastinitis arising from Ludwig’s Angina at the expense of a dental infection source. Due to the clinical characteristics presented, complementary exams were requested for diagnostic assistance: chest, neck and face CTs, complete blood count, hemoculture, antibiogram, renal function markers and rapid HIV test (as the request of the patient).