Odontogenic deep neck infection progressing to descending necrotizing mediastinitis and sepsis: A case report

Kim, Jong-Won; Seo, Yo-Seob; Kim, Jin-Soo

doi:2026.64.10.375

J Korean Dent Assoc > Volume 64(10); 2026 > Article

Case Report

Journal of Korean Dental Association 2026;64(10):375-385.
DOI: https://doi.org/10.22974/jkda.2026.64.10.004 Published online October 30, 2026.

Odontogenic deep neck infection progressing to descending necrotizing mediastinitis and sepsis: A case report

Jong-Won Kim

, Yo-Seob Seo

, Jin-Soo Kim

Department of Oral and Maxillofacial Radiology, College of Dentistry, Chosun University, Jeonnam-Gwangju, Korea

Correspondence: Jin-Soo Kim, Tel: +82-62-616-3886,
Email: idds@chosun.ac.kr

Received: 17 June 2026 • Revised: 12 October 2026 • Accepted: 15 October 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.

Key Words: Periapical Abscess; Mediastinitis; Sepsis; Tomography, X-Ray Computed; Contrast Media