ence of a severe infection, and an intraoral examinationshowed pus leaking out of the distal periodontal space ofthe left second molar. A mandibular cyst associated withthe impacted wisdom tooth was apparent on panoramicradiograph (Fig 1). Suppurative mediastinitis of the rightlung was detected on computed tomography scan. The di-agnosis was descending mediastinitis and cellulitis of thebuccal, submandibular, and cervical regions caused by theinfected mandibular cyst. Antibiotic therapy was given tocover both gram-positive and gram-negative organisms,and a thoracotomy was planned. After mediastinal drainage,enucleation of the mandibular cyst was performed. Thecyst was determined histologically to be a dentigerous cyst.Drains placed during the operation in the cervical and tho-racic regions were removed 25 days after surgery and thewound was permitted to close by secondary intention. Thepatient was discharged 30 days after the operation.

Discussion.—Descending necrotizing mediastinitis de-veloped as a complication of a dentigerous cyst in this pa-tient. The prompt diagnosis, aggressive drainage, and ag-gressive use of antibiotic therapy contributed to resolvethis life-threatening situation.

Basa S, Arslan A, Metin M, et al: Mediastinitis caused by an infectedmandibular cyst. Int J Oral Maxillofac Surg 33:618-620, 2004

Reprints available from S Basa, Valikonagi Cad. No. 10115, Nisantasi80200, Istanbul, Turkey; fax: +90 2122410632; e-mail: ahmetarslan@doctor.com

Clinical Significance.—Mediastinitis is, inaddition to Ludwig’s angina, another oral in-fection that is potentially life threatening.Rather than focusing only on airway inter-ference, clinicians, when confronted withrecalcitrant oral infection, must beware ofsigns and symptoms of infection spreadingto the cervical and thoracic region.

Background.—Only rarely are the common oral infec-tions accompanied by serious complications, 2 of which areLudwig’s angina and mediastinitis. Descending necrotizingmediastinitis, also called acute purulent mediastinitis, candevelop as a complication of odontogenic infection, as il-lustrated in the case report.

Case Report.—Man, 48, had pain and swelling in theleft cheek, left submandibular area, cervical region, leftsupraclavicular area, and chest area. He had had a dentalabscess for the preceding 2 months caused by a left man-dibular second molar, and the lesion had spread to the cer-vical region. The abscess had been drained through an in-cision 10 days earlier, but the patient’s general conditionhad declined rather than improved. He was febrile; hadmarked trismus, dyspnea, and dysphagia; and displayedmarked erythema of his left cheek that extended to thesupraclavicular area. Laboratory tests revealed the pres-

140 Dental Abstracts

Oral and Maxillofacial PathologyMandibular cyst produces mediastinitis

Fig 1.—OPTG showing the dentigerous cyst in the left man-dibular corpus and ramus. (Reprinted from Basa S, Arslan A,Metin M, et al: Mediastinitis caused by an infected mandibularcyst. Int J Oral Maxillofac Surg 33:618-620, 2004. Copyright 2004,with permission from the International Association of Oral andMaxillofacial Surgeons.)