A rare cause of pneumomediastinum and descending necrotizing mediastinitis: Untreated odontogenic abscess
Sureyya Tuba Fettahoglu1
, Zeynep Afra Akbıyık-Az2, Tugay Saricicek1, Oguzhan Haciosman1, Adem Az1
1Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Türkiye
Keywords: Dental abscess, descending necrotizing mediastinitis, odontogenic infection, Parvimonas micra, pneumomediastinum
Abstract
Pneumomediastinum is the presence of free air within the mediastinum and may be primary or secondary. Secondary pneumomediastinum typically follows trauma, invasive procedures, mechanical ventilation, or dental interventions using pressurized air; odontogenic causes without prior intervention are exceptionally rare. We report the case of a 52 year old male with liver cirrhosis who presented with chest and neck pain 2 days after being diagnosed with a dental abscess and receiving antibiotics, with no dental procedure performed. He had fever, cervical swelling with crepitus, odynophagia, and dysphagia. Computed tomography revealed extensive subcutaneous emphysema tracking from the cervical region into the mediastinum, and inflammatory markers were elevated. He was diagnosed with secondary pneumomediastinum complicated by descending necrotizing mediastinitis and underwent mediastinal exploration and surgical drainage. Cultures grew Parvimonas micra. Postoperatively, he required intensive care and mechanical ventilation for 8 days. With culture directed antibiotics and multidisciplinary management, he recovered fully and was discharged without sequelae. Anaerobic bacterial gas production may contribute to this rare complication. Clinicians should consider secondary pneumomediastinum in patients with chest and neck pain in the setting of odontogenic infection, even without preceding dental procedures, as early recognition, prompt imaging, surgical drainage, and definitive source control are critical for favorable outcomes.
How to cite this article: Fettahoglu ST, AkbıyıkAz ZA, Saricicek T, Haciosman O, Az A. A rare cause of pneumomediastinum and descending necrotizing mediastinitis: Untreated odontogenic abscess. Turk J Emerg Med 2026;26:345-50.
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Sureyya Tuba Fettahoglu: Conceptualization; Investigation; Data curation; and Writing – original draft. Zeynep Afra Akbiyik Az: Conceptualization; Methodology; Investigation; Formal analysis; Visualization; Writing – original draft; Writing – review and editing; and Supervision. Tugay Saricicek: Investigation; Resources; Data curation; Validation; and Writing – review and editing. Oguzhan Haciosman: Investigation; Data curation; Visualization; Validation; and Writing – review and editing. Adem Az: Supervision; Project administration; Methodology; Formal analysis; and Writing – review and editing. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.
None declared.
None.