Management of descending necrotizing mediastinitis.
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%.
Makeieff
Marc
M
Otolaryngology Head and Neck Surgery Department, Gui de Chauliac Hospital, University of Medicine, Montpellier, France. m-makeieff@chu-montpellier.fr
Gresillon
Nicolas
N
Berthet
Jean Philippe
JP
Garrel
Renaud
R
Crampette
Louis
L
Marty-Ane
Charles
C
Guerrier
Bernard
B
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
D000890:Anti-Infective Agents