Cervical Drainage of Descending Necrotizing Mediastinitis Caused by Deep Neck Infection

Abstract

Descending necrotizing mediastinitis (DNM) is a lethal process which originates from an oral or pharyngeal infection and descends along fascial planes into the mediastinum. Even with early antibiotic treatment and surgical drainage, the mortality rate remains high. We report a 75-year-old woman with diabetes and chronic liver cirrhosis who presented with symptoms of sore throat, muffled voice, and dyspnea. Parapharyngeal infection was initially identified; computed tomography revealed diffused deep neck infection with upper mediastinum involvement. Emergency tracheostomy and cervical incision and drainage were performed. The patient survived and was discharged after 51 days of systemic antibiotic treatment. DNM caused by deep neck infection is an uncommon but extremely aggressive form of mediastinitis. The importance of timely drainage and proper antibiotic treatment should be emphasized.