Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study

Abstract

Cervical necrotizing fasciitis, commonly of pharyngeal, tonsillar, or odontogenic origins, is a rare polymicrobial infection. Reports show that in 40-45% of cases, cervical necrotizing fasciitis spreads rapidly to the mediastinum, often becoming fatal.1) Prompt diagnosis and treatment of descending necrotizing mediastinitis (DNM), e.g., securing the airway, administering antibiotics, performing drainage, and providing intensive care for sepsis, can contribute to improved survival. Complications include a compromised airway, jugular vein thrombosis, suppurative jugular thrombophlebitis (Lemierre's syndrome), carotid artery erosion and rupture, septic shock, empyema, and a bronchocavitary fistula.2) Dysphagia can persist after DNM treatment. Such dysphagia is thought to be caused by movement disorder of the hypopharyngeal muscle and hyoid/thyroid cartilage that develops as a result of fibrosis and scarring caused by the inflammatory changes in the fascial space.3,4) However, the mechanism remains a matter of speculation. There are very few reports on rehabilitation for this condition,5) probably