Mediastinitis following deep neck infections : A therapeutic challenge

To emphasize the salient features of surgical management of Mediastinitis occurring secondary to deep neck infections.

Case series. Retrospective analysis

Institutional teaching department Patients Four consecutive cases of mediastinal abscess treated between 1990 to 1996. Selection criteria were presence of deep neck infection radiological evidence of widening of mediastinum and confirmation of mediastinal infection at surgery. Computerized tomography of neck and thorax was done in one case to document the extent of abscess. SARGICAL MANAGEMENT: All the patients underwent transcervical drainage of neck abscess and superior mediastintomy. The involved spaces in the neck and mediastinum were irrigated with betadine antimicrobial solution and negative suction drains put in the superior mediastinum ta facilitate contituous drainage of the mediastinum. One patient required intercostal chest drainage for associated empyema. Tracheotomy was done in all the patients.

All the patients survived and discharged after a hospital stay of around three weeks.

Mediastinal complication of deep neck infections can he alarmingly rapid and can be effectively managed by early recognition and aggressive surgical drainage combined with antibiotic therapy after appropriate aerobic and anaerobic cultures.