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Published on: June 28, 2018
Descending necrotizing mediastinitis of oropharyngeal infections
Mohsen Sokouti1, Saeed Nezafati
1Associate Professor, Department of Thoracic Surgery, Faculty of Medicine and Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Background And Aims:
Descending necrotizing mediastinitis (DNM) is a rare and life-threatening infection. Management of this condition is very difficult and before 1990s, DNM had a mortality rate of 40% despite the use of antibiotics. One of the etiologies of this condition is rapid downward spread of oropharyngeal infection along the cervical fascia planes into the medi-astinum.
Materials And Methods:
Patients with DNM from odontogenic, peritonsillar and retropharyngeal origins, who underwent surgical treatment from 1990 to 2007, were reviewed. Data extracted from medical records of the patients included age, gender, origin of the infection, surgical approaches, and the cause of mortality. Descriptive data were expressed as a Mean ± SE.
Results:
Thirteen patients aged 15 to 56 (mean, 34.5 years old; 8 males and 5 females) were studied. The origins of infection included odontogenic abscess in 10 cases and peritonsillar and retropharyngeal abscess in 3 patients. The mean duration from onset of symptoms to the surgery was 12.18 ± 0.98 days (range 3 to 24 days) and the mean duration from initial surgery to dis-charges was 28.51 ± 3.25 days (range 5 to 92 days). Post-operative mortality was seen in three patients.
Conclusion:
Descending necrotizing mediastinitis can arise from odontogenic abscesses and must be detected as early as possible, as it is a life-threatening infection.
Insights
Descending necrotizing mediastinitis (DNM) is a severe infection often originating from the oropharynx. Early detection and surgical intervention are crucial for managing this life-threatening condition, especially when arising from odontogenic abscesses.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Thoracic Surgery
Background:
- Descending necrotizing mediastinitis (DNM) is a rare but life-threatening infection.
- Historically, DNM has a high mortality rate (40%) despite antibiotic use.
- It often results from the rapid spread of oropharyngeal infections into the mediastinum via fascial planes.
Purpose of the Study:
- To review surgical management of DNM.
- To identify origins and outcomes of DNM patients.
- To emphasize early detection and treatment of DNM.
Main Methods:
- Retrospective review of 13 patients with DNM treated surgically between 1990 and 2007.
- Data collected included patient demographics, infection origin, surgical approaches, and mortality causes.
- Descriptive statistics were used to analyze the data.
Main Results:
- The study included 13 patients (8 males, 5 females; age 15-56).
- Odontogenic abscesses were the origin in 10 cases; peritonsillar/retropharyngeal abscesses in 3.
- Mean time to surgery was 12.18 days; mean post-op stay was 28.51 days, with 3 post-operative deaths.
Conclusions:
- Descending necrotizing mediastinitis can originate from odontogenic abscesses.
- Prompt diagnosis and surgical intervention are critical for managing this potentially fatal infection.
- Early detection significantly impacts patient outcomes in DNM.
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