Diagnosis and treatment for oral and maxillofacial multiple space infections with purulent pericarditis.

PURPOSE: To analyze the clinical characteristics, diagnosis and treatment of oral and maxillofacial multiple space infection with purulent pericarditis. METHODS: A total of four patients from 2005 to 2010 were included in the study. Clinical data including etiology, episode of the disease, radiology, bacteriology, treatments and outcomes were retrospectively analyzed. RESULTS: These four cases were all males, aged between 27-52 years old. They all resumed from odontogenic ildection. The interval between the diagnosis of oral and maxillofacial multiple space infection and descending necrotizing mediastinitis (DNM) was 0 to 12 days (mean 6 days), 0 to 7 days from diagnosis of DNM to purulent pericarditis (mean 2.5 days). The hospitalization time ranged from 9 to 63 days (mean 42.5 days). Four different pathogens were identified by pus and blood culture from three patients. Surgical drainage, tracheotomy and intravenous antibiotics were conducted. Three were cured while one died. CONCLUSION: With the characteristics of occult process and high mortality rate, diagnosis of DNM and purulent pericarditis should be taken into consideration when there is a complaint of chest pain or dyspnea in patients with oral and maxillofacial multiple space infection. Early detection and adequate drainage is the key to success. Bacterial culture plays a guiding role for antibiotic therapy. [ABSTRACT FROM AUTHOR]