DESCENDING NECROTIZING MEDIASTINITIS IN COVID-19 ERA

Abstract

TYPE: Late Breaking Abstract TOPIC: Chest Infections PURPOSE: 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 during the period of general lockdown , between March 2020 and Sept. 2021, due the Covid 19. METHODS: During the period of general lockdown, 18 patients, mean age 46, 25 years ( 39-59), with DNM treated to our Department . Primary odontogenic abscess occurred to 10 patients and peritonsillar abscess to other 8 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 , 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. CONCLUSIONS: 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. 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. CLINICAL IMPLICATIONS: Chest infections DISCLOSURE: Nothing to declare. KEYWORD: Descending Necrotizing Mediastinitis