[Necrotizing cervico-mediastinal cellulitis. Apropos of 3 cases].
OBJECTIVE
To outline the most appropriate treatment of descending necrotizing mediastinitis.


METHODS
Three adult patients had mediastinitis occurring from a descending odontogenic infection in one case and oropharynx infection in two cases. All patients underwent extensive surgical debridement and a cervicomediastinal drainage through a cervical incision. All patients survived.


CONCLUSIONS
Soft-tissue infections of the neck with mediastinitis demand early diagnosis aided by CT scan in order to decrease their threat to life. Extensive surgical debridement and a cervico mediastinal drainage through a cervical incision is adequate when mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed when the process spread below the carina. Patients must be treated initially aggressively with the aid of multidisciplinary support team (intensive care physicians, thoracic and head and neck surgeons). Early surgery must treat both neck and mediastin. While usually associated with greater than 40% mortality, all the patients in this series survived.
Service d'ORL et de Chirurgie Cervico-Faciale, HIA Val-de-Grâce, Paris.
P B
PB
Verdalle
E
E
Roguet
M
M
Raynal
T
T
Briche
I
I
Rouquette
L
L
Brinquin
R
R
Jancovici
J L
JL
Poncet
D000328:Adult; D000368:Aged; D002481:Cellulitis / Q000209:etiology* / Q000601:surgery; D003646:Debridement; D004322:Drainage; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D009333:Neck; D009336:Necrosis; D000039:Peritonsillar Abscess / Q000150:complications*; D014081:Tooth Extraction / Q000009:adverse effects