Descending Necrotizing Mediastinitis: A 7-Year Single-Centre Experience

Descending necrotizing mediastinitis (DNM) is a life- threatening condition that originates from head and neck infections, subsequently extending into the mediastinum. Prompt diagnosis and emergent surgical intervention are critical for patient survival. This study aims to present our experience in managing DNM.

The present study retrospectively analyzed patients with DNM who underwent surgical treatment in our center, between 2017 and 2023.

We identified 14 adult patients treated in our center in the 7- year period, with male predominance and a mean age of 45 years. The primary infection sites were pharyngeal in 7, cervical in 5 and odontogenic in 2 patients. At diagnosis, 4 patients had type I DNM, 3 had type IIA and 7 had type IIB. Disease progression to stage II occurred in the majority of patients (n = 12). A total of 34 cervical procedures and 20 thoracic surgeries were performed, with a median of 2 cervical [1- 7] and 1 thoracic [0- 3] interventions per patient. Combined cervicotomy and thoracotomy was the preferred surgical approach. There was a low rate of long- term morbidity and no mortality.

Successful management of DNM relies on early diagnosis trough computed tomography scan, appropriate antibiotic therapy, and urgent surgical drainage of the affected cervical and mediastinal planes. Our experience highlights favorable outcomes, underscoring the value of a well- coordinated multidisciplinary approach.