title: Thoracoscopic management of descending necrotizing mediastinitis.
abstract: Descending necrotizing mediastinitis (DNM) is a lethal process originating from odontogenic, pharyngeal, or cervical infectious sources that descends along fascial planes into the mediastinum. Despite earlier use of antibiotics and surgical drainage, the mortality (>50%) has changed little since the first large series reported in the preantibiotic era. The surgical management remains controversial, with support ranging from cervical drainage alone to cervical drainage and routine thoracotomy. We report a case of thoracoscopic drainage and debridement of a mediastinal abscess resulting from descending necrotizing mediastinitis. The decreased morbidity of this approach compared with posterolateral thoracotomy and the improved drainage of the mediastinum compared with cervical drainage support this method as an attractive management of patients with DNM.
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Roberts
authors.forename: W R
authors.initials: WR
authors.lastname: Smythe
authors.forename: R W
authors.initials: RW
authors.lastname: Weber
authors.forename: M
authors.initials: M
authors.lastname: Lanutti
authors.forename: B R
authors.initials: BR
authors.lastname: Rosengard
authors.forename: L R
authors.initials: LR
authors.lastname: Kaiser
mesh_terms: D000038:Abscess / Q000601:surgery; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D004322:Drainage / Q000379:methods; D004724:Endoscopy; D004945:Esophagoscopy / Q000009:adverse effects; D004947:Esophagus / Q000293:injuries; D005205:Fascia / Q000473:pathology; D005260:Female; D006801:Humans; D008480:Mediastinitis / Q000473:pathology / Q000601:surgery*; D008482:Mediastinum / Q000473:pathology; D009336:Necrosis; D010614:Pharynx / Q000293:injuries; D015996:Survival Rate; D013906:Thoracoscopy; D013908:Thoracotomy
chemical_list: D000900:Anti-Bacterial Agents