title: Nonoperative catheter management for cervical necrotizing fasciitis with and without descending necrotizing mediastinitis.
abstract: OBJECTIVE
  To evaluate the clinical utility of catheter drainage for cervical necrotizing fasciitis (CNF) with and without descending necrotizing mediastinitis (DNM).
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine.
  
  
  METHODS
  Thirty-two patients with clinically and radiographically diagnosed CNF with and without DNM were included.
  
  
  METHODS
  Catheters were introduced into the infected space through the patients' necks under sonographic and x-ray fluoroscopic guidance.
  
  
  METHODS
  Treatments, clinical course, complications, and mortality were evaluated.
  
  
  RESULTS
  Catheter drainage was successfully performed in all patients. The CNF was due to pharyngeal infection in 14 patients (44%) and dental infection in 14 other patients (44%). Mediastinal extension occurred in 14 patients (44%). Overall mortality was 3.1%; only 1 patient with DNM died due to Clostridium sepsis. Both pharyngeal origin and diabetes mellitus were significantly associated with the development of DNM. More intensive treatment is necessary for patients with CNF with DNM than for patients with CNF without DNM.
  
  
  CONCLUSIONS
  Percutaneous catheter drainage may be used as an effective treatment for CNF with and without DNM.
authors.affiliation: Department of Traumatologyand Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. yukasumi020503@yahoo.co.jp
authors.forename: Yuka
authors.initials: Y
authors.lastname: Sumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakamori
authors.forename: Isao
authors.initials: I
authors.lastname: Ukai
authors.forename: Osamu
authors.initials: O
authors.lastname: Tasaki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kuwagata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimazu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sugimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002408:Catheters, Indwelling; D003422:Critical Care; D004322:Drainage / Q000295:instrumentation*; D019115:Fasciitis, Necrotizing / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D010038:Otorhinolaryngologic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015996:Survival Rate; D036542:Tomography, Spiral Computed; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents