Presentations 2020: OMFS

371 - The Impact of Mental Health and Self Harm Tendencies on the Presentation of Dento-alveolar Sepsis: A Case Report

F Dylgjeri A Goodson S Bhatia
Presented by: Flavia Dylgjeri
Cardiff Dental Hospital

Odontogenic infections are common in OMFS, with a variety of factors being involved in making the difference between a simple, manageable infection, to a life-threatening infection requiring urgent surgical intervention and ICU management. As OMFS SHOs, we often hear of the serious complications of odontogenic infections, but are not always exposed to them in a clinical situation. One of these complications includes descending necrotizing mediastinitis (DNM); a life-threatening oropharyngeal infection which spreads to the mediastinum via the cervical fascia. DNM remains a very serious disease with a reported 20-50% mortality rate. This, likely being because of late presentation and diagnosis. This case involves a 45 year old female patient with left submandibular and submental swelling associated with the lower left second molar (LL7). She presented to A&E with trismus and dysphagia. Medically, she suffered from mental illness involving self-harm. Urgent CT revealed right tracheal deviation and swelling extending into the pterygomandibular space. She was medically managed with intravenous antibiotics, steroids and fluids, and taken to emergency theatre for incision and drainage. However, upon deterioration and subsequent CT revealing increased gas and pus collection up to the superior mediastinum, she was taken back to theatre for drainage and spent over 2 weeks in ICU before discharge. This case offers us many learning points. It is an interesting example of how patient neglect of the signs and symptoms, due to her mental health and self-harm tendencies, contributed to her late presentation and lead to the development of a life threatening condition of mediastinitis. It is therefore important to recognise and ‘red flag’ such patients as they may deliberately delay their presentation. We must also make patients and healthcare professionals aware of such risks, while being sensible as to when to refer an abscess as a matter of utter urgency.
Consent Statement: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian. A copy of the consent form is available for review by the the meeting organisers..

Poster