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Management of Deep Neck Infection Associated with Descending Necrotizing Mediastinitis: A Scoping Review
Bogdan Mihail Cobzeanu1,2, Liliana Moisii1,3, Octavian Dragos Palade1,3
1ENT Clinic Department, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania.
Medicina (Kaunas, Lithuania)
|February 26, 2025
Summary
Deep neck infections can spread to the chest, causing descending necrotizing mediastinitis. Early diagnosis and a multidisciplinary approach are crucial for managing this severe condition.
Area of Science:
- Otorhinolaryngology and Maxillofacial Surgery
- Infectious Diseases
- Surgical Pathology
Background:
- Deep neck infection (DNI) is a critical condition at the intersection of otorhinolaryngology and maxillofacial surgery.
- DNIs can progress to descending necrotizing mediastinitis (DNM), a life-threatening thoracic complication with a poor prognosis.
Purpose of the Study:
- To conduct a scoping review of recent (last 5 years) research on deep neck infections associated with descending necrotizing mediastinitis.
- To summarize the etiology, bacteriology, clinical presentation, diagnostic methods, and treatment strategies for DNI and DNM.
Main Methods:
- Scoping review of literature published within the last five years.
- Analysis of etiological factors, common bacterial species (aerobic and anaerobic), and potential complications.
- Evaluation of diagnostic tools, focusing on the role of CT scans, and review of current treatment paradigms.
Main Results:
- Common origins of DNI include odontogenic and tonsillar infections; other sources include salivary glands, foreign bodies, malignancies, and iatrogenic causes.
- Polymicrobial infections involving aerobic and anaerobic bacteria are frequent. Complications include jugular vein thrombosis, airway obstruction, ARDS, sepsis, and DIC.
- CT scans are the gold standard for diagnosis, guiding empirical antibiotic therapy and surgical interventions like drainage and debridement.
Conclusions:
- Prompt diagnosis and management are vital for favorable outcomes in DNI and DNM.
- A multidisciplinary team approach is essential for effectively managing patients with deep neck infections progressing to descending necrotizing mediastinitis.
- Treatment involves a combination of broad-spectrum antibiotics, surgical drainage, and debridement of necrotic tissues.
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