Odontogenic acute descending necrotizing mediastinitis in 1 case reported.doc

 PAGE \* MERGEFORMAT 6 Odontogenic acute descending necrotizing mediastinitis in 1 case reported A medical record Patients, male, aged 66, at 2 months ago left no obvious incentive to sudden toothache, the body temperature normal, did not attract attention, intermittent pain attacks, not given special treatment, 3 days ago left facial and neck swelling, pain aggravated , accompanied by cough, spit a small amount of yellow phlegm, no hemoptysis, no other abnormalities. disease at a local hospital after the anti-inflammatory treatment, results are poor, then come to our hospital for treatment. examination: BP: 130/80mmHg the left submandibular area and diffuse swelling of the left side of the neck, skin redness, palpable sense of twisted hair, tenderness was no obvious sense of volatility, lower left 3rd molar caries, trismus, mild throat congestion, swelling of the left tonsil grade Ⅱ large. thorax no deformity, both sides generally normal respiratory mobility, bilateral breast tenderness, and the right touch fremitus enhanced call-voiceless lungs lung, right lung decreased breath sounds can be heard and moist rales, breath sounds clear left lung , is not known and obvious wet and dry rales. admission, chest CT Hint: pneumomediastinum. After treatment: patients admitted to hospital to give combined cephalosporins and quinolones, maintain oral health, and symptomatic treatment. Ineffective treatment for 2 days, local swelling has increased, the left side of the neck skin hair twisted sense of obvious, and there fever. The first 3 days left side of the mouth mucous membrane ulceration, with bloody purulent fluid introduced into the mouth, then reduce the swelling of the left lower jaw and neck. this time to give the left side of the neck incision drainage, in the sternocleidomastoid muscle before the incision edge of the middle, about 4cm, drain the day much the next day appeared a wide range of necrosis of the subcutaneous connective tissue, accompa