Necrotizing Soft-Tissue and Retropharyngeal Space Infections and Mediastinitis

A 50-year-old man from a rural area presented with a 3-day history of left-sided tooth and jaw pain, fever, and shortness of breath. Examination revealed poor dentition, trismus, stridor, and erythema with crepitus extending from the cheek to the upper chest. CT imaging identified severe periodontitis, periapical abscesses, and gas-forming soft-tissue inflammation involving the retropharyngeal space, chest wall, and mediastinum. The diagnosis was odontogenic infection leading to necrotizing soft-tissue infection, retropharyngeal space infection, and mediastinitis. The infection likely spread via the “danger space” of the deep cervical fascia. Treatment included surgical washouts, broad-spectrum antibiotics, and reconstructive surgery. Type 2 diabetes was newly diagnosed. The patient was discharged in good condition after 45 days.

A 50-year-old man from a rural area presented with a 3-day history of left-sided tooth and jaw pain, fever, and shortness of breath. Examination revealed poor dentition, trismus, stridor, and erythema with crepitus extending from the cheek to the upper chest. CT imaging identified severe periodontitis, periapical abscesses, and gas-forming soft-tissue inflammation involving the retropharyngeal space, chest wall, and mediastinum. The diagnosis was odontogenic infection leading to necrotizing soft-tissue infection, retropharyngeal space infection, and mediastinitis. The infection likely spread via the “danger space” of the deep cervical fascia. Treatment included surgical washouts, broad-spectrum antibiotics, and reconstructive surgery. Type 2 diabetes was newly diagnosed. The patient was discharged in good condition after 45 days.