PMC6735635_01
- Appearance of the patient during the initial treatment. Patient, without the prosthesis, with trismus while attempting to open her mouth.
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The initial clinical examination revealed severe trismus, limited side-to-side head movement, intense halitosis, as well as a large quantity of purulent secretion, accompanied by volumetric changes and skin redness of the lower third of the face, neck, and of the upper thorax (Figures 1 and 2). The patient said that she was using antibiotics (amoxicillin at admission, and that she had also previously used azithromycin and metronidazole, for less than 3 days in both cases.
- Static physical examination (anterior and profile). Note the swelling and redness of the neck.
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The initial clinical examination revealed severe trismus, limited side-to-side head movement, intense halitosis, as well as a large quantity of purulent secretion, accompanied by volumetric changes and skin redness of the lower third of the face, neck, and of the upper thorax (Figures 1 and 2). The patient said that she was using antibiotics (amoxicillin at admission, and that she had also previously used azithromycin and metronidazole, for less than 3 days in both cases.
- Axial CT images in the craniocaudal dimension, suggestive of the presence of gas produced at the site of infection dissecting the right pterygoid space and the pretracheal fascia.
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An emergency CT scan showed disseminated infection, originating in the left submandibular space and extending from the pretracheal fascia space to the mediastinum (Figure 3).
- Patient on post-admission day 41. Mouth opening to a near-normal extent (34 mm). Note the repair of the tracheal fistula.
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After discharge from the ICU, the patient was hospitalized for two days in the infirmary until the removal of the tracheostomy tube, after which she was discharged to outpatient follow-up.  : Fifty-four days later, the patient underwent repair of the tracheal fistula (Figure 4) and was discharged on post-procedure day 7.