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Published on: September 11, 2021
Less invasive management of deep neck infection and descending necrotizing mediastinitis: A single-center
Dong Wei1, Ling Bi, Huiyong Zhu
1Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Abstract:
By a 7-year retrospective review, we reported our experience in management of descending necrotizing mediastinitis (DNM) and deep neck infection (DNI). A retrospective design was used to reveal the clinical characteristics of DNI and DNM. The clinical outcome was analyzed to validate less invasive management. We reviewed 82 patients between 2009 and 2016, 12 of which were diagnosed as DNM by clinical and computed tomography findings. A total of 35 patients had relevant systemic conditions, mainly diabetes mellitus (19 patients). Most cases were secondary to oropharyngeal or dental infections. All patients underwent transcervical drainage, and 10 DNM patients were treated with additional closed thoracic drainage simultaneously. Twenty patients accepted more than 1 operation. Seven patients died as a result of sepsis and/or multiple organ failure. The mortality rate in our study was similar to that in other studies. In our opinion, less invasive therapies are useful to most patients. Transcervical drainage alone is optimal management for all DNI cases and some DNM cases. Additional closed thoracic drainage is enough for type I and IIA DNM with pleural effusion or empyema.
Insights
This study reviewed 82 patients with deep neck infections (DNI) and descending necrotizing mediastinitis (DNM). Less invasive therapies, including transcervical drainage, are effective for most patients.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Thoracic Surgery
Background:
- Deep neck infections (DNI) can progress to life-threatening descending necrotizing mediastinitis (DNM).
- Effective management strategies for DNM are crucial to reduce morbidity and mortality.
- Understanding the clinical characteristics and outcomes of DNM is essential for optimizing treatment.
Purpose of the Study:
- To report the clinical experience and outcomes of managing DNI and DNM.
- To evaluate the efficacy of less invasive management strategies for DNM.
- To identify optimal treatment approaches based on disease type and patient factors.
Main Methods:
- A 7-year retrospective review of 82 patients diagnosed with DNI or DNM (2009-2016).
- Analysis of clinical characteristics, systemic conditions (e.g., diabetes mellitus), and infection sources (oropharyngeal, dental).
- Evaluation of surgical interventions, including transcervical drainage, closed thoracic drainage, and repeat operations.
Main Results:
- Out of 82 patients, 12 were diagnosed with DNM.
- Most DNM cases were secondary to oropharyngeal or dental infections.
- Transcervical drainage was performed in all patients; 10 DNM patients received additional closed thoracic drainage.
- The overall mortality rate was similar to previous studies, with 7 deaths attributed to sepsis and/or multiple organ failure.
Conclusions:
- Less invasive therapies, particularly transcervical drainage, are effective for the majority of DNI and DNM cases.
- Transcervical drainage alone may be sufficient for DNI and certain types of DNM.
- Additional closed thoracic drainage is indicated for Type I and IIA DNM with pleural effusion or empyema.
