Form Of Mediastinitis Research Articles

Sternotomy with electrocautery and sternal wound infection in congenital heart surgery in patients under 1 year of age.

The present study aimed to compare the rate of wound site infection in patients <1 year of age who underwent sternotomy using electrocautery, a routinely performed procedure in our clinic, with those reported in the literature. This double-center study included patients <1 year of age who underwent cardiac surgery via sternotomy performed with electrocautery for congenital heart disease between January 2017 and June 2019. Patient's data were retrospectively obtained from the hospital records. In our study, seven patients developed SSI, which was superficial in six (1.3%) patients and in the form of mediastinitis in one (0.2%) patient. Sternotomy with electrocautery, which we consider an easy and safe method, was also not found to be statistically different from the other methods in terms of SWI.

Acute descending necrotizing mediastinitis as a complication of the retropharyngeal abscess caused by anaerobes

Descending necrotizing mediastinitis (DNM) is a rare, life-threatening form of mediastinitis caused by odontogenic, pharyngeal, or cervical infections. The retropharyngeal space is the most common primary site of infection. Given the fulminant course and high mortality rate, early diagnosis and prompt treatment are important predictors of survival in patients with DNM. Appropriate empirical antibiotic treatment, prompt surgical intervention, and proper management of patients in the intensive care unit can be of vital importance. We present the case of a previously healthy 20-year-old male patient who was successfully cured and discharged from the Clinical Center University of Sarajevo after suffering from a severe form of mediastinitis as a complication of the retropharyngeal abscess caused by anaerobes.

Descending Necrotizing Mediastinitis in Covid- 19 Time

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.

Descending Necrotizing Mediastinitis: Current Strategies for Diagnosis and Treatment

Descending necrotizing mediastinitis is an acute, polymicrobial infection. Originating in the pharynx or neck, this necrotizing process descends into the chest producing widespread tissue necrosis. Despite the introduction of modern antimicrobial therapy and computed tomographic imaging, this form of mediastinitis has continued to produce reported mortality rates of 25% to 40%. This review discusses the pathophysiology, diagnosis and treatment of descending necrotizing mediastinitis with recommendations for treating physicians based on the modern literature. Keywords: Descending, mediastinitis, necrotizing, polymicrobial infection, tissue necrosis, PATHOPHYSIOLOGY, cervicofascial infection, computed tomographic imaging, chest roentgenograms, modern.

Transcervical Drainage for Descending Necrotizing Mediastinitis May Be Sufficient

Descending necrotizing mediastinitis (DNM) is a serious form of mediastinitis with a high mortality rate. It is caused by the downward spread of an oropharyngeal or cervicofascial infection. The optimal surgical approach for this often fatal disease is controversial. This article describes the authors' experience and characterizes the surgical strategies and treatment outcomes of patients with DNM. Case series with chart review. A tertiary referral medical center. This study conducted a retrospective chart review of patients with deep neck infections treated at a medical center from 1994 to 2007 and identified 29 patients with DNM. The clinical characteristics and outcomes were compared between patients treated with transcervical drainage alone (group I) and those with both cervical and thoracic drainage (group II). There were 20 patients in group I and 9 patients in group II. The overall mortality rate was 10.3%. The mean duration of the hospital stay was 29.3 ± 15.5 days. There was no statistically significant difference in age, sex distribution, or duration from the appearance of symptoms to hospital admission between the 2 groups. The duration of hospital stay, tracheotomy rate, and mortality rate also did not differ significantly between the 2 groups. However, the numbers of surgeries were significantly higher in group II than in group I. Transthoracic mediastinal drainage is not a compulsory therapy, but timely, aggressive, transcervical mediastinal drainage with extensive debridement is very important for a good outcome when treating DNM patients.

Optimal Surgical Management of Descending Necrotising Mediastinitis: Our Experience and Review of Literature

Descending necrotising mediastinitis is a form of mediastinitis caused by odontogenic infection or deep cervical infections, which spreads to the mediastinum via the cervical fascial planes. Despite the increased use of CT scan as a diagnostic aid and the improvement in antibiotics, mortality in patients with descending necrotising mediastinitis remains high, reported between 25 and 40% in the literature. Surgical management and optimal form of mediastinal drainage remain controversial. We have treated three patients with descending necrotising mediastinitis at our institution. Two patients were male and one was female with mean age 54.3+/-12.5 years. One of the patients was a known diabetic. The primary oropharyngeal infection was Ludwig's angina, odontogenic abscess and parapharyngeal abscess. All patients underwent mediastinal drainage, one through midsternotomy and two through right thoracotomy in addition to cervical drainage. All the three patients had mixed aerobic and anaerobic infection. There was no perioperative mortality. Mean ICU stay was 32 days (12-53 days). All three patients had septicaemic shock requiring prolonged inotropic support. Two patients required tracheostomy because of prolonged ventilation. All the patients had recurrent abscesses and collections either in neck or in chest requiring drainage either surgically or percutaneously under CT scan or ultrasound guidance, thus decreasing the need of repeated surgical procedures. Descending necrotising mediastinitis is a potentially fatal condition. Early diagnosis, prompt surgical drainage, monitoring of disease process, appropriate medical management in an intensive care unit and a multi-disciplinary approach can significantly reduces the mortality in this otherwise fatal condition. Percutaneous drainage of recurrent abscesses and collections can decrease the need of repeated surgical procedures in these critically ill patients.

Descending necrotizing mediastinitis

From January 1975 through July 1981, ten patients with mediastinitis complicating an oropharyngeal infection, that is, a form of mediastinitis best termed as DNM, were encountered at our institution. Based upon rather relatively stringent diagnostic criteria, 21 other instances were found in the literature from 1960 to 1980, a time period well into the antibiotic era. The predominant underlying oropharyngeal infection was of odontogenic origin, specifically, infection involving the mandibular molars. Bacteriologically, DNM is most frequently a polymicrobial process, with anaerobes playing a major role. Although there has been a decline in the over-all incidence of DNM since the introduction of antibiotics, its morbid and lethal nature persists, as evidenced by the present prohibitive mortality of approximately 42 per cent. Delayed diagnosis and inadequate drainage procedures are the primary underlying factors contributing to this high mortality. At present, CT scan is the single most important tool for the early diagnosis of DNM. This noninvasive procedure also helps determine the adequacy of the surgical drainage procedure performed. However, with all the presently available diagnostic tools, it is still the high index of suspicion by physicians toward patients with unrelenting oropharyngeal or deep neck infection that is of utmost importance for making an early diagnosis of DNM. In view of our experience and that of others, we believe that only through aggressive combined medical and surgical management can the highly morbid, if not lethal, course of DNM be reversed. It should be emphasized that, to accomplish successful operative intervention, a thorough knowledge of the complex anatomy of the region is crucial.

Tracheobronchiale Nekrose

Mediastinitis is a bacterial or non-bacterial infection of the mediastinum. Descending necrotizing mediastinitis (DNM) is a rare but life-threatening complication. The mostly feared form of mediastinitis very often has a fatal outcome. We report on a patient with tracheobronchial necrosis following DNM and emphasize the paramount importance of early and complex surgical therapy combined with immediate intensive care treatment. This case describes the intensive medicine and anaesthetic management, which was complicated by the tracheobronchial-pleural fistula and in particular by the respiratory therapy.

CT12 SURGICAL MANAGEMENT OF DESCENDING NECROTIZING MEDIASTINITIS

Descending necrotizing mediastinitis is a form of mediastinitis caused by odontogenic infection or deep cervical infections, which spreads to the mediastinum via the cervical facial planes. Criteria adopted for the diagnosis of Descending Necrotizing mediastinitis are clinical manifestations of severe infection, demonstration of characteristic roentgenographic features, documentation of the necrotizing mediastinal infection and establishment of oropharyngeal or cervical infection with the development of the necrotizing mediastinal process. Most of the published reports in literature are single case report. The largest series published is of 17 patients over 15 years. Despite the increased use of CT scan as a diagnostic aid and the improvement in antibiotics, mortality in patients with descending necrotizing mediastinitis remains high, reported between 25–40% in the literature.We have treated two patients with descending necrotizing mediastinitis at our institution. The primary oropharyngeal infection was Ludwig’s angina in one and odontogenic abscess in other. Both patients underwent mediastinal drainage, one through midsternotomy and other through right thoracotomy in addition of cervical infection drainage. The outcome was favorable in both the patients.Delay of diagnosis and inappropriate drainage of the mediastinum are the main cause of mortality in this life threatening condition. The various surgical approaches have been reported for mediastinal drainage to treat Descending necrotizing mediastinitis.We report our experience of patients with Descending necrotizing mediastinitis and discuss the surgical management of this highly fatal condition.

Cervical Drainage of Descending Necrotizing Mediastinitis Caused by Deep Neck Infection

Descending necrotizing mediastinitis (DNM) is a lethal process which originates from an oral or pharyngeal infection and descends along fascial planes into the mediastinum. Even with early antibiotic treatment and surgical drainage, the mortality rate remains high. We report a 75-year-old woman with diabetes and chronic liver cirrhosis who presented with symptoms of sore throat, muffled voice, and dyspnea. Parapharyngeal infection was initially identified; computed tomography revealed diffused deep neck infection with upper mediastinum involvement. Emergency tracheostomy and cervical incision and drainage were performed. The patient survived and was discharged after 51 days of systemic antibiotic treatment. DNM caused by deep neck infection is an uncommon but extremely aggressive form of mediastinitis. The importance of timely drainage and proper antibiotic treatment should be emphasized.