CT12 SURGICAL MANAGEMENT OF DESCENDING NECROTIZING MEDIASTINITIS

Abstract

Descending necrotizing mediastinitis is a form of mediastinitis caused by odontogenic infection or deep cervical infections, which spreads to the mediastinum via the cervical facial planes. Criteria adopted for the diagnosis of Descending Necrotizing mediastinitis are clinical manifestations of severe infection, demonstration of characteristic roentgenographic features, documentation of the necrotizing mediastinal infection and establishment of oropharyngeal or cervical infection with the development of the necrotizing mediastinal process. Most of the published reports in literature are single case report. The largest series published is of 17 patients over 15 years. Despite the increased use of CT scan as a diagnostic aid and the improvement in antibiotics, mortality in patients with descending necrotizing mediastinitis remains high, reported between 25–40% in the literature.We have treated two patients with descending necrotizing mediastinitis at our institution. The primary oropharyngeal infection was Ludwig’s angina in one and odontogenic abscess in other. Both patients underwent mediastinal drainage, one through midsternotomy and other through right thoracotomy in addition of cervical infection drainage. The outcome was favorable in both the patients.Delay of diagnosis and inappropriate drainage of the mediastinum are the main cause of mortality in this life threatening condition. The various surgical approaches have been reported for mediastinal drainage to treat Descending necrotizing mediastinitis.We report our experience of patients with Descending necrotizing mediastinitis and discuss the surgical management of this highly fatal condition.