Descending necrotizing mediastinitis (DNM) is a lethal process originating from odontogenic, pharyngeal, or cervical infections that descends along the fascial planes into the mediastinum. The surgical management ranges from cervical drainage to routine thoracotomy but remains controversial. We here describe two patients treated successfully who underwent cervical drainage alone or cervical drainage combined with thoracotomy. Wide cervical exploration with postural drainage was effective in one patient with limited DNM above the carina. Mediastinal exploration through thoracotomy was required to salvage the other with DNM extending below the carina and associated with pericardial invasion.