Descending necrotizing mediastinitis: ten years' experience
Renzo Mora1, Barbara Jankowska, Ugo Catrambone
1ENT Department, University of Genoa, Italy. renzomora@libero.it
Abstract:
Descending necrotizing mediastinitis is a rare disease that is usually caused by a spreading, diffuse inflammatory reaction (phlegmon) to an odontogenic infection or peritonsillar abscess. Reported mortality rates range from 25 to 40%. The use of antibiotics and advances in resuscitation procedures and critical care techniques have not essentially improved survival, and an effective treatment has not been clearly established. We report the findings of our 10-year study of 21 patients affected by phlegmon and/or fasciitis of the neck. The aim of our contribution is to help define the clinical criteria and diagnostic procedures that will improve the early diagnosis of mediastinal sepsis secondary to neck fasciitis and to suggest optimal treatment approaches. Our experience indicates that (1) cervical drainage alone is sufficient for cases of cervical phlegmon or mediastinal involvement that are limited to a single superior mediastinal space and (2) thoracotomy and drainage of mediastinal collections is necessary when mediastinal sepsis is more extensive.
Insights
Descending necrotizing mediastinitis, a serious infection, requires prompt diagnosis and treatment. Early cervical drainage suffices for limited cases, while extensive mediastinal sepsis necessitates thoracotomy and drainage.
Area of Science:
- Infectious Diseases
- Surgical Critical Care
- Otolaryngology
Background:
- Descending necrotizing mediastinitis (DNM) is a rare, severe complication of head and neck infections.
- Mortality rates for DNM remain high (25-40%), with limited improvement despite advances in critical care.
- Effective treatment strategies for DNM are not well-established.
Purpose of the Study:
- To define clinical criteria and diagnostic procedures for early diagnosis of mediastinal sepsis secondary to neck fasciitis.
- To suggest optimal treatment approaches for descending necrotizing mediastinitis based on disease extent.
Main Methods:
- A 10-year retrospective study of 21 patients with cervical phlegmon and/or fasciitis.
- Analysis of clinical presentation, diagnostic findings, and treatment outcomes.
- Correlation of treatment strategies (cervical drainage vs. thoracotomy) with disease severity and patient outcomes.
Main Results:
- Cervical drainage alone was sufficient for patients with limited cervical phlegmon or superior mediastinal involvement.
- Thoracotomy and mediastinal drainage were required for more extensive mediastinal sepsis.
- Early diagnosis and appropriate surgical intervention correlated with improved outcomes.
Conclusions:
- Early diagnosis of mediastinal sepsis secondary to neck infections is crucial.
- Treatment should be tailored to the extent of mediastinal involvement.
- Cervical drainage is adequate for limited DNM, whereas thoracotomy is necessary for extensive cases.
