Nonoperative catheter management for cervical necrotizing fasciitis with and without descending necrotizing mediastinitis.
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.
Sumi
Yuka
Y
Department of Traumatologyand Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. yukasumi020503@yahoo.co.jp
Ogura
Hiroshi
H
Nakamori
Yasushi
Y
Ukai
Isao
I
Tasaki
Osamu
O
Kuwagata
Yasuyuki
Y
Shimazu
Takeshi
T
Tanaka
Hiroshi
H
Sugimoto
Hisashi
H
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
D000900:Anti-Bacterial Agents