Successful Conservative Treatment of Descending Necrotizing Mediastinitis With Fistula Formation in the Hypopharynx

Abstract

Descending necrotizing mediastinitis is a rare life-threatening complication of odontogenic or oropharyngeal infection spreading into the mediastinum through the cervical fasciae. Despite improvements in diagnostic imaging and treatment, its mortality rate remains relatively high. We describe a unique case of descending necrotizing mediastinitis leading to the formation of a fistula in the lateral wall of the hypopharynx. The fistula, providing spontaneous drainage of the purulent mediastinitis, contributed to the successful outcome of the patient requiring only transcervical surgical drainage.