Optimal treatment of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis

Karkas, Alexandre; Chahine, Karim; Schmerber, S.; Brichon, Pierre-Yves; Righini, Christian

doi:10.1002/bjs.6935

Cited by 63 publications

(71 citation statements)

References 27 publications

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“…This symbiotic relationship of aerobic and anaerobic organisms causes impaired tissue oxygenation synergistically, aggravating associated pathologies such as diabetes and respiratory insufficiency. [8,9] …”

Section: Discussionmentioning

confidence: 99%

Less invasive management of deep neck infection and descending necrotizing mediastinitis

Wei

Bi²,

Zhu³

et al. 2017

Medicine

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By a 7-year retrospective review, we reported our experience in management of descending necrotizing mediastinitis (DNM) and deep neck infection (DNI). A retrospective design was used to reveal the clinical characteristics of DNI and DNM. The clinical outcome was analyzed to validate less invasive management. We reviewed 82 patients between 2009 and 2016, 12 of which were diagnosed as DNM by clinical and computed tomography findings. A total of 35 patients had relevant systemic conditions, mainly diabetes mellitus (19 patients). Most cases were secondary to oropharyngeal or dental infections. All patients underwent transcervical drainage, and 10 DNM patients were treated with additional closed thoracic drainage simultaneously. Twenty patients accepted more than 1 operation. Seven patients died as a result of sepsis and/or multiple organ failure. The mortality rate in our study was similar to that in other studies. In our opinion, less invasive therapies are useful to most patients. Transcervical drainage alone is optimal management for all DNI cases and some DNM cases. Additional closed thoracic drainage is enough for type I and IIA DNM with pleural effusion or empyema.

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Section: Discussionmentioning

confidence: 99%

Less invasive management of deep neck infection and descending necrotizing mediastinitis

Wei

Bi²,

Zhu³

et al. 2017

Medicine

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“…However, complete reliance on radiological imaging to define the anatomical extent of disease should be regarded with caution. Presence of gas and fluid certainly confirms extension of disease, but cannot exclude extension of infection, because the earliest changes in mediastinitis are pure cellulitis and fasciitis, which may not be seen on CT [4].…”

Section: Causes Clinical Presentation and Pathologymentioning

confidence: 96%

Update on Necrotizing Mediastinitis: Causes, Approaches to Management, and Outcomes

Sandner

Börgermann

2011

Curr Infect Dis Rep

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Descending necrotizing mediastinitis (DNM) is one of the most feared and fatal forms of mediastinitis, occurring as a complication after odontogenic or cervicofascial infections or after cervical trauma. Delayed recognition, underestimation of the extent of disease, and insufficient therapy promote spread of infection. Primary treatment of DNM includes surgical eradication of the pharyngeal or odontogenic infection focus, and a concomitant major drainage applied to the neck and the mediastinum. However, the mortality rate of DNM remains high, even with the routine use of CT scanning, antibiotics, advancements in anesthesia and intensive care, and immediate surgical drainage. The present state of the optimal management of DNM is discussed controversially, in particular the question of whether thoracotomy should be performed routinely or if minimally invasive procedures (eg, video-assisted thoracoscopy) may be introduced. This review reports on the incidence and course of this disease and discusses management approaches to DNM.

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“…[2] Çeşitli faktörler DNM gelişme riskini artır-maktadır; ileri yaş (>60 yıl), obezite, alkolizm, immün yetmezlik, travma, böbrek ve karaciğer yetmezliği bunlardan bazılarıdır. [13][14][15][16][17] Karkas ve ark.nın [18] yayınladıkları 17 hastalık bir seride hastaların 15'inde bu faktörlerin varlığı belirtilmiştir. Guan ve ark.nın [19] 15 hastalık serisinde DNM'ye ait semptomların boyun enfeksiyonunu takiben 1-7 günde geliştiği belirtilmiştir.…”

Section: Discussionunclassified

Descending necrotizing mediastinitis secondary to cervical necrotizing fasciitis: Two case reports and contemporary literature

Yılmaz¹

2017

Kulak Burun Bogaz Ihtis Derg

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ÖZServikal nekrotizan fasiit, daha çok yaşlılarda ve immün yetmezliği bulunan hastalarda görülen, polimikrobiyal kökenli, hızlı ve yıkıcı seyreden ve bazen ölümcül olabilen bir derin boyun enfeksiyonudur. Nadiren enfeksiyon derin fasiyal planlar aracılığı ile mediastene yayılır ve desendan nekrotizan mediastenite neden olur. Desendan nekrotizan mediastinit yüksek mortaliteye sahip, acilen tanı konulup tedavi edilmesi gereken ciddi bir tablodur. Bu derlemede biri tip 1, diğeri de tip 2B desendan nekrotizan mediastinit tanısı ile servikal ve mediastinal drenaj ile tedavi edilmiş iki olgu sunuldu ve konu ile ilgili güncel literatür tartışıldı.Anahtar Sözcükler: Servikal nekrotizan fasiit; desendan nekrotizan mediastinit; mediastinoskopi; torakotomi. ABSTRACTCervical necrotizing fasciitis is a polymicrobial, rapidly progressive, destructive, and sometimes fatal deep neck infection, that is most commonly seen in the elderly and immunocompromised patients. The infection rarely spreads to mediastina via deep fascial planes and causes descending necrotizing mediastinitis. Descending necrotizing mediastinitis is a serious clinical entity with a high mortality rate that should be promptly diagnosed and treated. In this review, we present two cases with type 1 and type 2B descending necrotizing mediastinitis treated with servical and mediastinal drainage, and also discuss relevant contemporary literature.

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Optimal treatment of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis

Abstract: Prompt diagnosis and early surgical treatment are essential for reducing mortality in CNF/DNM. All patients should undergo extensive cervicotomy. The surgical approach to the mediastinum depends on the supracarinal or infracarinal location of the disease.

Cited by 63 publications

References 27 publications

Less invasive management of deep neck infection and descending necrotizing mediastinitis

Less invasive management of deep neck infection and descending necrotizing mediastinitis

Update on Necrotizing Mediastinitis: Causes, Approaches to Management, and Outcomes

Descending necrotizing mediastinitis secondary to cervical necrotizing fasciitis: Two case reports and contemporary literature

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