Descending Necrotizing Mediastinitis: Surgical Management

Abstract

Objective: Descending necrotizing medistinitis (DNM) is commonly caused by odontogenic infection, peritonsillar abscess, or retropharyngeal abscess. The diagnosis must be established rapidly. Because mortality rates are too high, aggressive surgical treatment is indicated. This investigation reviews the effects of surgical drainage on the survival of patients with DNM. Method: A retrospective review of patients from 2003 through 2010 with a diagnosis of DNM was performed. Their records were abstracted for personal demographics, hospital course, surgical treatment, morbidity, and mortality. The records of all patients were statistically analyzed for the impact of several clinical factors on survival. Results: We treated 13 patients (12 men, 1 woman) in whom DNM was identified. DNM was consecutive to dental abscess (6 cases), pharyngitis (5 cases), foreign body infection (1 case), and after tracheotomy (1 case). The mean age of the patients was 56 years (range, 26-85 years). Surgical treatment consisted of: in 6 patients combined transthoracic mediastinal and cervical drainage and in 7 patients with a less aggressive surgical approach, such as cervical drainage and transcervical mediastinal drainage. Four patients required reoperation. Tracheotomy was performed in 4 patients. Two deaths occurred. The mean duration of hospitalization was 29 days. Conclusion: DNM must be detected as soon as possible by computer tomography scanning in patients with persistent symptomatologia after treatment for pharyngeal infections. Early diagnosis and aggressive treatment are important. Ample cervicotomy associated with mediastinal drainage is essential in managing these critical patients and can significantly reduce the mortality rate.