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Case Report
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J Korean Dent Assoc. 2026;64(10):375-385. Published online October 31, 2026.
DOI: https://doi.org/10.22974/jkda.2026.64.10.004
- Odontogenic deep neck infection progressing to descending necrotizing mediastinitis and sepsis: A case report
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Jong-Won Kim
, Yo-Seob Seo
, Jin-Soo Kim
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Department of Oral and Maxillofacial Radiology, College of Dentistry, Chosun University, Jeonnam-Gwangju, Korea
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- Corresponding author: Jin-Soo Kim Tel: +82-62-616-3886, Email: hidds@chosun.ac.kr
- Received: June 17, 2026; Revised: October 12, 2026 Accepted: October 15, 2026.
- Abstract
- Descending necrotizing mediastinitis (DNM) is a rare but potentially fatal complication of odontogenic infection. A 62-year-old woman with diabetes mellitus presented with left facial swelling and sepsis manifested by severe hypotension and hypoxemia; the source was a periapical abscess of the left mandibular second premolar. Contrast-enhanced CT showed a deep neck abscess with gas-containing collections extending along the left carotid space into the mediastinum, accompanied by marked airway narrowing. Emergency cervical incision and drainage confirmed necrotizing fasciitis. On post-admission day 8, follow-up CT demonstrated progression of the mediastinal gas locules to a frank abscess requiring thoracic surgical drainage. This case illustrates how a localized odontogenic infection can progress to DNM and highlights serial contrast-enhanced CT as an adjunct for assessing disease progression and the need for additional surgical source control. Successful management requires airway control, broad-spectrum antimicrobial therapy, adequate cervical and mediastinal drainage, intensive sepsis care, and multidisciplinary collaboration.
Keywords :Periapical Abscess; Mediastinitis; Sepsis; Tomography, X-Ray Computed; Contrast Media
