Profile of patients with oral phlegmon with mediastinitis at Dr. Soetomo General Hospital, Surabaya
Authors: Permana Agung , Wibowo Marjono Dwi 
Published: January 2025

Link of Video Abstract: https://youtu.be/jH9aVrnC3DE
 
Introduction: Phlegmon of the floor of the mouth is an acute suppurative cellulitis of the mouth that spreads mainly in loose connective tissue, and it is one of the most serious disorders of the maxillofacial area that can be life-threatening. One of the most feared complications of oral floor phlegmon is mediastinitis, while the main causes of death in oral floor phlegmon are airway obstruction and sepsis. Postoperative and descending necrotizing mediastinitis is associated with high morbidity and mortality if it is not treated early. The mortality rate is also quite high despite adequate treatment. This study describes the profile of patients with oral phlegmon with mediastinitis complications that were treated at Dr.Soetomo General Hospital, Surabaya.
Methods: We collected samples from all patients with oral phlegmon with mediastinitis who sought treatment at Dr. Soetomo General Hospital, Surabaya, from January 10, 2021, to December 31, 2022. The data are secondary data taken from medical records. We collected the patient’s demographic data (e.g., age and sex), odontogenic risk factors, molar dental infections, anatomical space involvement (submental, submandibular, sublingual), pus culture result, therapy, and outcome.
Results: We recruited 55 patients with oral phlegmon, but only 15 patients had complications of mediastinitis at Dr. Soetomo General Hospital, Surabaya, from January 2021 to December 2022. Based on age, it shows that the age of phlegmon patients with mediastinitis complications is older than those without complications. Based on gender, this study shows that patients with oral floor phlegmon are dominated by men. Most cases of oral floor phlegmon with odontogenic etiology, mainly caused by second and third molar infections, with complications and without complications of mediastinitis, have as many as 11 cases or 20% of the total cases. Based on pus culture, the bacteria reported in this study were Enterococcus faecium, Staphylococcus constellatus, Gemella haemolysans, Pseudomonas aeruginosa, and Acinetobacter baumannii. Enterococcus faecium was the most common germ found in blood cultures. The type of surgery performed in all patients with oral phlegmon with or without mediastinitis complications is incision and drainage. In addition, other options include thoracotomy, tracheostomy, and debridement. In this study, thoracotomy was performed in 6 cases of mediastinitis. Mediastinitis is considered a life-threatening condition, but with advances in surgical management techniques and better evaluation and treatment, mortality rates have been reduced.  This study found that most patients with oral floor phlegmon had a high survival outcome with and without complications.
Conclusion: Patients with oral phlegmon complicated by mediastinitis tend to be older than patients without complications. Enterococcus faecium was the most common germ found in the blood cultures of patients with oral floor phlegmon complicated by mediastinitis. Incision and drainage, followed by debridement and thoracotomy, is the choice of surgical management for patients with basic oral phlegmon complicated by mediastinitis.