Ten Years of Descending Necrotizing Mediastinitis: Management of 23 Cases

Roccia, Fabio; Pecorari, Giancarlo; Oliaro, A; Passet, Ettore; Rossi, P; Nadalin, Juri; Garzino-Demo, Paolo; Berrone, Sid

doi:10.1016/j.joms.2006.10.060

Cited by 92 publications

(68 citation statements)

References 25 publications

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“…The diagnosis of cervical infection is obvious clinically, but the early diagnosis of mediastinitis is often difficult because of the vagueness of early symptoms suggesting mediastinal involvement [10]. Additionally, the use of nonsteroidal anti-inflammatory drugs or steroids can reduce functional symptoms [10,31]. Persisting symptoms after treatment of an oropharyngeal infection tend to support the diagnosis of DNM.…”

Section: Causes Clinical Presentation and Pathologymentioning

confidence: 99%

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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Section: Causes Clinical Presentation and Pathologymentioning

confidence: 99%

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

Sandner

Börgermann

2011

Curr Infect Dis Rep

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“…In reported cases of DNM, successful surgical management involves a combination of cervical and mediastinal drainage with or without open thoracotomy [3,4,8,15,21,29,30,[36][37][38][39][40][41][42][43][44]. ENDO et al [29] proposed a classification scheme to facilitate management of DNM based on CT assessment of the extent of infection.…”

Section: Review: Descending Necrotising Mediastinitis E Weaver Et Almentioning

confidence: 99%

Descending necrotising mediastinitis: two case reports and review of the literature

Weaver¹,

Nguyen²,

Brooks³

2010

Eur Respir Rev

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Descending necrotising mediastinitis is a rare and serious infection with a high mortality rate, which complicates pharyngeal or odontogenic infection. Early recognition and treatment are essential in order to minimise morbidity. Evaluation with computed tomography is necessary to confirm the diagnosis and facilitate surgical planning. In addition to prompt empirical antiobiotic therapy, surgical intervention is necessary in nearly all cases. Surgical drainage and debridement may be performed through cervicotomy alone, or through combined cervicotomy and thoracotomy, depending upon the extent of disease. Hyperbaric oxygen therapy may play an auxiliary role. We present two recent cases with characteristic imaging findings, and review the relevant literature. KEYWORDS: Computed tomography, mediastinitis CASE ONEA 60-yr-old male presenting with neck swelling, dysphagia and hoarseness had been extubated 2 days previously following a pneumonia. He had a past medical history of laryngeal cancer treated 10 yrs ago with external beam radiation and chemotherapy. On examination he had bilateral diffuse neck erythema, oedema and right-sided induration. Fibre-optic laryngoscopy showed scabbing of the right hypopharynx and erythematous swelling of the false vocal folds, aryepiglottic folds, and epiglottis. Over the course of 12 h, he developed septic shock with a blood pressure of 70/ 30 mmHg, heart rate of 135 beats?min, and a temperature of 103uF. He was started empirically on vancomycin and piperacillin/tazobactam. After stabilisation in the intensive care unit (ICU), computed tomography (CT) imaging of the neck and chest was performed. There was a large amount of subcutaneous air tracking into the deep fascial planes of the anterior neck, oedematous laryngeal mucosa, and bilateral loculated fluid collections tracking throughout the anterior neck extending to the superior mediastinum ( fig. 1). CT imaging of the chest showed a complex air and fluid collection in the anterior mediastinum extending to the base of the neck ( fig. 2). After review of the images, the patient was taken to the operating room for a combined procedure performed by both head and neck surgeons and thoracic surgeons. Bilateral anterior neck dissections were performed, and blunt dissection, irrigation and debridement were carried out to several centimeters below the sternal manubrium. Penrose drains were left in place. Then, left anterior thoracotomy with debridement of the anterior mediastinum, left pleural decortication and a pericardial window were performed by the thoracic surgeons. Microbiology of the anterior mediastinal fluid grew multiple organisms including Fusobacterium, Prevotella, Bacteroides fragilis, Peptostreptococcus, and a heavy growth of Streptococcus intermedius. Pathology of the pharyngeal lesions showed necrosis and granulation tissue. No neoplasm was identified. The patient later received a tracheostomy and pectoralis myocutaneous flap repair of the neck without sequelae. His total ICU length of stay was 32 days, and hi...

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“…One of the most lethal forms of mediastinitis is descending necrotizing mediastinitis (DNM), which usually occurs as a complication of odontogenic infections or peritonsillar abscesses. 1,2 Most oropharyngeal infections are self-limiting and contained. However, they can spread through the fascial and deep neck spaces while progressing inferiorly into the mediastinum, especially in the diabetic, immunocompromised, or debilitated patient.…”

Section: Introductionmentioning

confidence: 99%

“…6 With advancements in antibiotics, diagnostic imaging, and surgical management, the mortality rate has declined marginally to 20-40%. 2,4,[7][8][9][10] …”

Section: Introductionmentioning

confidence: 99%

Descending necrotizing mediastinitis as a complication of odontogenic infection

Diamantis

Giannakopoulos

Chou

et al. 2011

International Journal of Surgery Case Reports

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Descending necrotizing mediastinitis (DNM) is a serious, life threatening complication that can occur from a common odontogenic infection. Even with advancements in antibiotics, diagnostic imaging, and surgical management, the mortality rate remains between 20 and 40%. It is imperative that the practitioner taking care of patients with odontogenic infections be sensitized to this potentially fatal complication. We report the successful management of a case of mediastinitis complicating an odontogenic infection in a 39-year-old male.

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Ten Years of Descending Necrotizing Mediastinitis: Management of 23 Cases

Cited by 92 publications

References 25 publications

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

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

Descending necrotising mediastinitis: two case reports and review of the literature

Descending necrotizing mediastinitis as a complication of odontogenic infection

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