title: Descending necrotising mediastinitis: a safe treatment algorithm.
abstract: Descending necrotising mediastinitis can complicate oropharyngeal infection and has a high associated mortality. We present three cases treated in our department and propose a treatment algorithm based on our experience and literature review. The primary oropharyngeal infection was peritonsillar abscess in two cases and odontogenic abscess in one. Two patients underwent cervicotomy and later thoracotomy. The third underwent cervicotomy with transcervical mediastinal drainage and later required pericardial drainage via a subxiphoid incision. All recovered fully and were discharged within 6 weeks. To enable successful treatment, diagnosis needs to be prompt and surgical drainage adequate. Thoracic management of the chest is essential.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland. rpdefreitas-email@yahoo.com
authors.forename: R P
authors.initials: RP
authors.lastname: De Freitas
authors.forename: C P
authors.initials: CP
authors.lastname: Fahy
authors.forename: D S
authors.initials: DS
authors.lastname: Brooker
authors.forename: W J
authors.initials: WJ
authors.lastname: Primrose
authors.forename: K G
authors.initials: KG
authors.lastname: McManus
authors.forename: J A
authors.initials: JA
authors.lastname: McGuigan
authors.forename: S J
authors.initials: SJ
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D037981:Neck Dissection; D009336:Necrosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D000039:Peritonsillar Abscess / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D013396:Suction; D013906:Thoracoscopy; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed