One possible complicaton after wisdom teeth extraction is known as Lemierre’s Syndrome. Lemierre’s Syndrome is a rare complication with limited cases being reported that can happen after having wisdom teeth extracted. Since antibiotics have been introduced it is also referred to as “the forgotten disease.” It has been covered on this site before, and is listed as a complication of wisdom teeth removal at http://www.teethremoval.com/complications.html. Lemierre’s Syndrome starts with an infection in the head and neck region and presents with swelling, a high fever, neck pain, and a sore throat. It has a high mortality rate of 18% and thus imaging and antibiotic treatment are of the upmost importance if it presents. Diagnosis involves laboratory results including blood cultures and radiological scans such as CT imaging. Particularly, a CT scan with contrast can identify a thrombosed vein, such as the internal jugular vein.
In one article covered before on this site (Near Death Wisdom Teeth Removal Experience) a 17 year old woman had her wisdom teeth removed and later began to feel a purple lump on her left temple that was accompanied by with pain and swelling. A follow-up with a dentist resulted in nothing happening as the dentist that she was okay. However, this was not the case and she had to be airlifted to a hospital because she was suffering from septic shock due to an infection that had spread to her main arteries and organs. A ten hour surgery was needed to remove a piece of skull and clean the infection. The woman remained hospitalized for nearly 3 months until being released to a rehabilitation center. At the rehabilitation center she had to learn how to talk again and had to undergo extensive physical therapy and occupational therapy as she was partially paralyzed in her right arm and leg.
In another article covered before on this site (Lemierre’s Syndrome after Wisdom Teeth Removal) a case of an 18 year old man who had his wisdom teeth extracted and then presented with a three day history of nausea, vomiting, swelling, and jaw pain, twenty days after having all four of his wisdom teeth removed was discussed. A physical exam of the man showed a low blood pressure of 98/57 mmHg, a swollen jaw, and pain in the lower left abdominal region. A CT scan without contrast of his abdomen showed an enlarged spleen and several small nodes in the mesentery. After this diagnosis, he was given intravenous antibiotics (vancomycin and piperacillin plus tazobactam), fluids, and admitted to a hospital. Three days after the teenager was hospitalized, he developed severe acute hypoxic respiratory failure and was intubated. He began to deteriorate rapidly and developed septic shock with multiorgan failure. An ultrasound of the neck showed a thrombosed superficial internal jugular vein consistent with thrombophlebitis. A second chest-xray was taken (the first was unremarkable) and showed right lung opacities consistent with pneumonitis. A CT angiography (CTA) scan showed scattered nodular-appearing infiltrates throughout both of his lungs and moderate bilateral effusion. His blood was tested and was positive for Fusobacterium necrophorum. A later CT scan showed evolving cavitation of the many nodular densities seen on the initial chest x-ray consistent with septic pulmonary emboli.
The teenager improved without any surgery required and was discharged after spending 12 days in the hospital. However, his later CT scan showed a periosteal reaction and he was given ertapenem for six weeks.
While Lemierre’s Syndrome is rare after wisdom teeth removal, recognizing the symptoms and knowing steps for treatment is important to prevent potential loss of life and an extended hospital stay with lasting complications.