[Diffuse cervical cellulites and descending necrotizing mediastinitis].
OBJECTIVE
To give a report on the progress in physical examination, investigations and treatment of diffuse cervical cellulites (DCC) associated with descending necrotizing mediastinitis.


METHODS
A Retrospective study (1995-2005) of patients presenting DCC with mediastinitis was made. All had a cervical and thoracic Computed tomography (CT) scan. The references were collected by a Medline search.


RESULTS
Six men and 2 women, average ages 53 years were treated. Four had an immunodeficient status. Two had had an anti-inflammatory drug treatment without antibiotic treatment. The average for diagnosis and treatment was 4 days. In 2 cases we found a dental origin and in 6 cases a pharyngeal origin. The most frequently identified germs were streptococcus beta haemolytic group A and Prevotella. In 4 cases, no physical sign of mediastinitis was noted. The diagnosis of mediastinitis was made thanks to the thoracic CT scan. All the patients were treated by broad-spectrum antibiotic therapy. All had cervical and thoracic surgical drainage. Mediastinal drainage was made by cervical way in 3 cases and by thoracotomy in 5 cases. One patient died.


CONCLUSIONS
The DCC with mediastinum extension are serious infectious emergencies with a high mortality rate. Clinical diagnosis of mediastinitis is difficult. A thoracic CT scan should be performed systematically. Performing thoracotomy best controls mediastinal drainage.
Righini
C-A
CA
Service d'ORL et de chirurgie cervicofaciale, CHU A.-Michallon, 38043 Grenoble cedex 09, France. crighini@chu-grenoble.fr
Motto
E
E
Ferretti
G
G
Boubagra
K
K
Soriano
E
E
Reyt
E
E
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002481:Cellulitis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000382:microbiology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D009333:Neck; D009336:Necrosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D010894:Piroxicam / Q000627:therapeutic use; D013290:Streptococcal Infections / Q000150:complications*; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010894:Piroxicam