Descending Necrotizing Mediastinitis: Ten Years’ Experience

Abstract

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.

Citrobacter freundiicausing pharyngitis and secondary retropharyngeal abscess with intrathoracic extension to the diaphragm: minimally invasive management of a rare case

“…Its mortality rate has been quoted as 25-40 per cent, despite advances in antibiotics, surgical and resuscitation procedures, and critical care techniques. 13 Our patient's presentation was uncharacteristic: despite extensive purulent collections, she was afebrile at presentation and remained so throughout the course of her illness. Also, she presented primarily with a four-day history of left facial swelling, only disclosing her sore throat as an afterthought.…”

Descending necrotizing mediastinitis secondary to retropharyngeal abscess in a child

“…In its severe clinical form, the mortality rate of DNM remains high, despite the availability of broadspectrum antibiotics and the development of surgical and intensive care techniques. 4 Early diagnosis is important in order to initiate appropriate treatment without delay. Although many adult cases of DNM have been reported in the literature, to our knowledge, only three childhood cases of DNM Aggressive surgical drainage of a mediastinal abscess is recommended for successful treatment, in addition to the administration of antibiotics, including broadspectrum β-lactams.…”

“…6,7 Others believe that transcervical drainage alone is suffi cient for patients with mediastinal involvement that is limited to a single superior mediastinal space, as in our patient. 4,13 In all the reported cases of mediastinal abscess, including the childhood cases, the patients underwent surgical drainage of the abscess. In our patient, the fever dropped and the DNM did not become worse after the initial therapy with PAPM/BP and CLDM.…”

“…[1][2][3][4][5] Early diagnosis is very important, and aggressive surgical drainage of the mediastinal abscess is recommended for successful treatment. [5][6][7] Although adult cases of DNM have been reported, there have been few reports of childhood cases thus far.…”

A fatal case of empyema thoracis: the price for underestimating odontogenic infections

“…Surgical treatment of associated mediastinitis can be achieved using either a cervical incision or thoracotomy, although cervical incision is associated with a lower anesthetic complication and pleural contamination. It has been advocated that thoracotomy should be performed only when infection spread below the carina anteriorly or the fourth cervical vertebrae posteriorly, and when >1 mediastinal compartment is involved [30,31].…”