Descending Necrotizing Mediastinitis in Covid- 19 Time

Abstract

Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental- odontogenic infections. The aim of this study is to evaluate clinical and surgical feature of the patients with DNM who were managed in our Department during the period of general lockdown in Greece, between March 2020 and June 2020, because of the Covid19. Patients and Methods: During the period of general lockdown in Greece, 4 patients, mean age 46, 25 years (range 39-59), with DNM treated to our Department of General Thoracic Surgery. Primary odontogenic abscess occurred to 2 patients and peritonsillar abscess to other 2 of them. Diagnosis was confirmed by computed tomography (CT) of the neck and chest. All patients underwent surgical drainage of abscesses of the involved cervical region and mediastinum by lateral cervicotomy and left thoracotomy in three of them and cervicotomy, and bilateral thoracotomy in one patient. Results: The delay between the occurrence of thoracic symptoms and mediastinal drainage varied from 1 to 3 days. The side of the thoracotomy depended on the involved mediastinal compartments and side of pleural effusion. The duration of mediastinal drainage varied from 12 to 20 days (mean: 17 days). One patient died of multiorgan failure related to post-op septic shock. Conclusion: Between January 2000 and January 2020, 21 patients with DNM were treated at our Department, whilst during the four - month of lockdown, four patients were treated. We concluded that the patients delay for dentistry recourse because of covid-19, result in the increased number of patients with DNM in the above period. Delayed diagnosis and inadequate drainage are the main causes of the high mortality rate of DNM. If one realistically hopes to avoid the high mortality rate, aggressive surgical drainage and debridement of the neck and drainage of the mediastinum via a posterolateral thoracotomy by a multidisciplinary team of surgeons is a must.