Abstract
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 clinic. We retrospectively evaluated 13 consecutive patients with the diagnosis of DNM between February 2005 and February 2018. All of them had the typical physical appearance, history and radiological findings. Ten (77%) patients were male, 3 (23%) patients were female with a median age of 48.2 (18-76 years). All patients underwent Cervico-Mediastinal Drainage (CMD) with debridement of the necrotic and infected tissues. Other supplimantary surgical procedures were tube thoracostomy (n = 8), VATS mediastinal drainage (n = 4), tracheostomy (n = 2) and thoracatomy (n = 1). The median time to diagnosis of DNM, tube drainage (inserted after CMD) removal time, tube thoracostomy removal time, lenght of hospital stay were 1.8 (range 1-4) days, 13.6 (range 10-20), 12.6 days (range 10-27) and 21.5 days (range 15-30), respectively. Appropriate and potent antibiotics were used according to the fever-CRP response with the consultation on infectious disease specialist. Two patients were lost due to fulminant sepsis (n = 1) and massive cervical haemorrhage (n = 1). Overall mortality rate was 15%. Complications were recorded in 6 patients (46%). The critical point in the management of DNM is the correct diagnosis, rapid surgical intervention with antibiotherapy and close follow-up for possible complications. We concluded that the combination of minimally invasive management as VATS-tube thoracostomy with CMD is the most appropriate surgical interventions.
Highlights
Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental-odontogenic infections
Demographic-clinical features and surgical outcomes of patients were summarised in Table 1. 10 (77%) patients were male, 3 (23%) patients were female with a median age of 48.2 (18-76 years)
In six of the patients(46%) retropharyngeal abscess, in five of them(38% peritonsillar abscess and two of them (16%) odontogenic infection was suspected for the formation of the DNM
Summary
Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental-odontogenic infections. Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and usually develops as a complication of peritonsillar abscesses or dental-odontogenic infections [1,2]. Formed deep cervical infection leads to necrotizing cellulitis and multiple small vessel thromboses. This process causes the clinical manifestations of DNM. DNM was first described in ten patients with mediastinitis complicating an oropharyngeal infection by Estrere at al.[8] the beginning of the 1980s.They described the diagnostic criteria in the following four titles: 1)Clinical
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