İbrahim Halil Yasak, Duygu İclal Gerger
Journal of Emergency Medicine Case Reports - 2025;16(4):164-166
Descending necrotizing mediastinitis (DNM) is a rare but life-threatening clinical condition that arises when infections originating in the head and neck extend into the mediastinum. In this case, we evaluate a 41-year-old male patient without any known systemic illness who presented with dysphagia, facial swelling, and dyspnea approximately three weeks after a dental filling procedure. Imaging revealed air-containing collections in the parapharyngeal space and subcutaneous emphysema extending toward the mediastinum. Despite detailed counseling regarding the risks, the patient refused hospitalization and surgery recommended by a multidisciplinary team. Oral antibiotic therapy was initiated, and close outpatient monitoring was advised. The clinical course of this case highlights the rapidly progressive nature of DNM and the ethical complexities arising from treatment refusal. It underscores the potential for systemic spread of localized infections after dental procedures, emphasizing the importance of early diagnosis, thorough patient education, and close follow-up whenever possible.
