[Suppurative cervico-mediastinitis of odontogenic origin]

Five cases are presented, of suppurated cervico-mediastinitis developed after acute suppurated apical parodontitis of a lower molar tooth. In two cases the severity and the extension of the lesions resulted in a fatal outcome. In one of the cases the patient also had pericarditis, pleurisy and purulent meningitis, and in the second case the necrotizing mediastinitis extended to the pleural and pericardic cavities, and was associated to bilateral bronchopneumonia. In three cases the patients were cured following cervical mediastinotomy, efficient mediastinal aspiration of the anterior and of the posterior mediastinum, in association with antiinfectious and resuscitation therapy. Since the prognosis of these major complications is still severe the risk of diffusion of odontogenic suppurations should not be ignored or minimized since in all the cases iatrogenic factors have occurred over the evolution of the patients. Knowledge of stomatologists should be improved and they should be aware of the risks of odontogenic suppuration involving parapharyngeal and cranio-encephalic extension, or the risk of cervico-mediastinal diffusion.