著者

川越 弘就 吉位 尚 大塚 芳基 竹野々 巌 寺延 治 古森 孝英

出版者

JAPANESE SOCIETY OF ORAL THERAPEUTICS AND PHARMACOLOGY

雑誌

歯科薬物療法 (ISSN:02881012)

巻号頁・発行日

vol.18, no.3, pp.139-143, 1999-12-01 (Released:2010-06-08)

参考文献数

22

---

Death due to gas gangrene following tooth extraction of mandibular third molar was reported. The patient was a 53-year-old female. Her mandibular left third molar was extracted 8 days before she was referred to our clinic. She did not receive any prophylactic antibiotics. After tooth extraction she developed swelling and pain of the left oral floor and the neck with severe sore throat and trismus. She had been treated with intravenous antibiotics and surgical drainage at a local hospital, however, the symptoms did not improve. The CT findings of the neck were abundant gas in the soft tissue of the neck. The diagnosis was cervical gas gangrene. The hematological tests revealed increase of white blood cells (13600/mm3), CRP (25.9mg/dl), blood sugar (332mg/dl), hypoalbuminemia (Alb ; 2.5g/dl), and liver dysfunction (GOT ; 42IU/l, GPT ; 63IU/l) .She seemed to be getting better due to drainage on Day 4 after admission, however, the neck skin became necrotic widely. On Day 8, rapid swelling and severe pain from the neck to chest were observed. The general conditions began to worsen, and she died of multi-organ failure on Day 12 (19 days after tooth extraction) . Enterococcus faecalis, Streptococcus milleri, Gemella haemolysan and Peptostreptococcus micros were isolated from the pus.It was considered that the necrotic tissues of the neck, which might cause residual infection, should have been removed completely, and the management for hyperglycemia and hypoalbuminemia was also very important to treat severe infectious gas gangrene.