title: Management of descending necrotizing mediastinitis.
abstract: OBJECTIVE
  Descending necrotizing mediastinitis is caused by downward spread of neck infections and constitutes a highly lethal complication of oropharyngeal lesions. This infection previously had a much worse prognosis. In recent years, more aggressive management has been recommended. The aim of this study is to evaluate the results with the association of thoracotomy and cervicotomy, medical care in an intensive care unit, and daily washing of drained cervical and thoracic tissues.
  
  
  METHODS
  Retrospective study of 17 patients treated from 1984 to 1998.
  
  
  METHODS
  Descending necrotizing mediastinitis was consecutive to pharyngitis (6 cases), peritonsillar abscess (3 cases), dental abscess (6 cases), foreign body infection (1 case), and laryngitis (1 case). Corticotherapy was reported in seven cases. Twelve patients had no particular medical history. Mean age was 42 years. Mean duration of signs before diagnosis was 6 days. Thoracotomy was associated with the cervical approach in 14 cases, whereas 3 patients were treated by cervicotomy only.
  
  
  RESULTS
  Fourteen patients of 17 (82.3%) were successfully treated. Three deaths occurred. The mean duration of hospitalization in the intensive care unit was 30 days, and the mean total duration of hospitalization was 45 days.
  
  
  CONCLUSIONS
  Descending necrotizing mediastinitis must be detected as soon as possible by computed tomography (CT) scanning in patients with persistent symptomatologia after treatment for oropharyngeal infections. Prompt surgical drainage with thoracotomy and cervicotomy in all cases of mediastinal involvement below the tracheal carena, use of CT scanning to monitor the disease evolution, and medical management in an intensive care unit significantly reduces the mortality rate to less than 20%.
authors.affiliation: Otolaryngology Head and Neck Surgery Department, Gui de Chauliac Hospital, University of Medicine, Montpellier, France. m-makeieff@chu-montpellier.fr
authors.forename: Marc
authors.initials: M
authors.lastname: Makeieff
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gresillon
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Berthet
authors.forename: Renaud
authors.initials: R
authors.lastname: Garrel
authors.forename: Louis
authors.initials: L
authors.lastname: Crampette
authors.forename: Charles
authors.initials: C
authors.lastname: Marty-Ane
authors.forename: Bernard
authors.initials: B
authors.lastname: Guerrier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D004322:Drainage; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007827:Laryngitis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008480:Mediastinitis / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis; D000039:Peritonsillar Abscess / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D010612:Pharyngitis / Q000150:complications* / Q000382:microbiology; D012189:Retrospective Studies; D013908:Thoracotomy
chemical_list: D000890:Anti-Infective Agents