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Descending necrotizing mediast initis is a rare diseas e that is usually caused by a spreading, diffuse irfiammatory reaction (phl eginon) to an odontoge nic inf ection or pe rito nsillar abscess. Rep ortedmortality rates rangefrom 25 to 40%. The use of antib iotics and advances in resuscitation pro cedures and critical care techniques have not essentially imp roved survival, and an effective treatm ent has not been clearly established. We rep ort the fi ndings ofour 10-y ear study of21 patients affected by phle gmon and/orfasciitis ofthe neck. The aim ofour contribution is to help define the clinical criteria and diagnos tic procedures that will impro ve the early diagno sis of mediastinal sepsis sec ondary 10 neckfasciitis and 10 suggest optima l treatment approaches. Our experience indicates tha t (1) cervical dra inage alane is sufficient for cases ofcervical phle gm on or mediastin al invo lvement that are limited to a single sup erior mediastinal sp ace and (2) thora cotomy and drainage oft nediastinal collec tions is necessary when mediastinal sepsis is mare extensive.

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