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[Necrotizing cervico-mediastinal cellulitis. Apropos of 3 cases]
P B Verdalle1, E Roguet, M Raynal
1Service d'ORL et de Chirurgie Cervico-Faciale, HIA Val-de-Grâce, Paris.
Summary
Early diagnosis and aggressive surgical intervention, including cervicomediastinal drainage, are crucial for treating descending necrotizing mediastinitis. This approach, even for severe cases, can lead to successful patient survival.
Area of Science:
- Medicine
- Surgery
- Infectious Diseases
Background:
- Descending necrotizing mediastinitis (DNM) is a severe infection with high mortality.
- Prompt diagnosis and timely intervention are critical for patient outcomes.
Observation:
- This study reviewed three adult patients with DNM originating from odontogenic or oropharyngeal infections.
- All patients underwent extensive surgical debridement and cervicomediastinal drainage via a cervical incision.
- The study highlights the importance of CT scans for early diagnosis.
Findings:
- Surgical debridement and cervical drainage are effective for upper mediastinal DNM.
- Thoracotomy is necessary for infections extending below the carina.
- Multidisciplinary support, including intensivists and surgeons, is vital.
Implications:
- Aggressive, early surgical management of neck and mediastinal infections can significantly reduce mortality.
- This case series demonstrates a 100% survival rate, contrasting with the typical >40% mortality.
- The findings support a protocol of early, aggressive surgical intervention for DNM.