[Necrotizing mediastinitis in deep neck infections]

Mediastinitis is a rare complication of deep neck abscesses with a high mortality. An accelerated extension to the mediastinum can happen before the identification of the primary site of infection, delaying diagnosis and treatment.

To report the results of treatment of patients with mediastinitis as a complication of deep neck infection.

Case series. Consecutive patients with mediastinitis secondary to deep neck abscesses, from March 2001 to February 2004.

We studied five patients: three males (60%) and two females (40%), mean age 42.2 +/- 18.4 years. In all patients there was at least a 3-day delay before appropriate diagnosis was made. Hospitalization ranged between 1 and 56 days. Symptoms were fever in five cases (100%), dysphagia in four (80%), dyspnea in four (80%), retrosternal pain in three (60%), orthopnea in two (40%), and tachycardia in one (20%). Primary infection sites were of dental origin in four cases (80%) and upper respiratory tract infection in one. Surgical management consisted of cervical and mediastinal drainage with tracheotomy in all patients (100%). Three also required pleurostomy and two required gastrostomy to improve nutritional status. Mean number of surgical procedures was 5.4 +/- 1.8. All patients developed respiratory insufficiency requiring mechanical ventilation. Mortality was 60%.

The delayed diagnosis was common in this case series. The length of hospitalization was long because patients required management with ventilatory support and multiple surgical procedures to limit the infectious process. High mortality is an indication for the early identification and treatment of all cases.