Descending necrotizing mediastinitis: a retrospective surgical experience.
OBJECTIVE
Descending necrotizing mediastinitis (DNM) is a primary complication of cervical or odontogenical infections that can spread to the mediastinum through the anatomic cervical spaces. We reviewed the last 10 years of our surgical experience in DNM and commented on early diagnosis and aggressive surgical treatment in these patients.


METHODS
Five males (71%) and two females (29%), mean age 34 years, with DNM, were surgically treated. Primary oropharyngeal infection occurred in three (43%) and odontogenic abscess in four (57%) patients. All had serious cervical and mediastinal infections with severe respiratory and hemodynamic repercussions, i.e. bacteremia, systemic arterial hypotension and obnubilation. Diagnosis was confirmed by computerized chest tomography.


RESULTS
All patients underwent surgical drainage of the cervical region by bilateral transverse cervicotomy with debridement of the necrotic and infected tissues, associating ample mediastinal drainage with or without thoracotomy. Six patients (86%) evolved well and were discharged after a mean of 35 days. Two patients (29%) required reoperation due to local surgical complications: empyema and dehiscence of the sternum. One patient (14%) died on the second postoperative (p.o.) day due to renal and respiratory insufficiency. Cultures of DNM showed the development of associated aerobic and anaerobic flora in 71% of the operated patients and only aerobic in 29%.


CONCLUSIONS
Early diagnosis by CAT scan of the neck and thorax aids in rapid indication of a surgical approach of DNM. Performing ample cervicotomy with mediastinal drainage generally associated with thoracotomy can significantly reduce the mortality rate for this condition to 14%.
Sancho
L M
LM
Thoracic Surgery Division, Hospital das Clinicas, University of São Paulo Medical Center, SP, Brazil.
Minamoto
H
H
Fernandez
A
A
Sennes
L U
LU
Jatene
F B
FB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D002648:Child; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis; D010508:Periodontal Abscess / Q000150:complications / Q000382:microbiology / Q000628:therapy; D000039:Peritonsillar Abscess / Q000150:complications / Q000382:microbiology / Q000628:therapy; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013396:Suction / Q000379:methods*; D015996:Survival Rate; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents