A Retrospective Cohort Study of Risk Factors for Descending Necrotizing Mediastinitis Caused by Multispace Infection in the Maxillofacial Region

Abstract

Descending necrotizing mediastinitis (DNM) has been the most common life-threatening complication of multispace infection (MSI) in the maxillofacial region owing to the lack of a timely diagnosis and treatment. We assessed the clinical characteristics and diagnosis of odontogenic MSI and evaluated the risk factors for DNM caused by MSI. We performed a retrospective cohort study of inpatients with MSI in the maxillofacial region from January 2012 to October 2016. The patients were classified into a non-DNM group and a secondary DNM group. The information collected included gender, age, systemic comorbidities, source of maxillofacial infection, computed tomography imaging data, and laboratory test results. Univariate analysis (t test and χ2 test, or the Fisher exact test) and logistic regression analysis were applied. A total of 296 patients were included. The mortality was 6.3%. On univariate analysis, the following factors were statistically significant: gender (P=.001); age (P=.003); source of infection (P=.004); number of affected spaces (P<.001); involvement of the parotid space (P<.001), submandibular space (P<.001), subgingival space (P<.001), pterygomandibular space (P<.001), parapharyngeal space (P<.001), and retropharyngeal space (P<.001); and percentage of neutrophils (P<.001). On multivariate analysis, the parapharyngeal space (P=.008), source of infection (P=.037), and number of affected spaces (P<.001) were statistically significant. Glandular infection, parapharyngeal space involvement, and the presence of multiple affected spaces were risk factors for DNM. Clinicians should vigilantly watch for these factors during clinical treatment and effective measures taken to prevent the occurrence of DNM as soon as possible.