Odontogenic infection leading to cervical emphysema and fatal mediastinitis

A case of fatal mediastinitis following an odontogenic infection has been presented. The anatomic pathways through fascial planes from the mouth to the mediastinum have been reviewed. The causes of cervical emphysema when the oral cavity is an entry site have been discussed. Usually this process is benign, but the possibility that gas-forming anaerobes could be present in the emphysema and that insidious mediastinitis could concurrently occur is stressed. The presence of Bacteroides asaccharolyticus in the anaerobic cultures from the submandibular and chest abscesses, and the recovery of aerobic organisms, leads to speculation about a synergistic action between these organisms.