Deep cervical infections may be of dental origin and cause life threatning conditions, including airway obstruction, mediastinitis and sepses. We report a 29 year old man with uncomfortable toothache in his right jaw, who presented deep cervical infection of dental origin.
The patient was attended in the emergency department and complained of having a sore throat, dysfagia and dyspnea.
The patient previously presented healthy and no underlying disease with the exception of presenting chronic alcohol abuse and smoking. Physical examination showed limited mouth opening, pre-auricular pain and infection of the first lower right molar. There was a difficulty towards visualizing the oropharynx.
The case was diagnosed as Ludwig’s Angina. There was the need for surgical intervention. The reduced airway passage required nasal fibroscopy intubation. The surgical strategy involved the exploration of the laterpharyngeal, retropharyngeal, submandibular and pterygomandibular spaces. A retromandibular incision was extended to submandibular and cervical region allowing the exploration of the submandibular, retromandibular and pterygoid region. Walter drains were placed. The patient remained intubated for 24 h post surgery. Seven days latter the patient presented pleural pulmonar effusion.
This case illustrates the need for early surgical intervention and adequate post operative control. In the case of deep cervical infection spreading to the thoracic region. The occurrence of pleural effusion might be related to mediastinitis in a very early stage, successively be treated by wide cervical drainage. Therefore the oral surgeon should be alert towards the possibility of descending mediastinitis in deep cervical infection of dental origin.
Conflict of interest: None declared.