Optimal treatment of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis.
BACKGROUND
Cervical necrotizing fasciitis (CNF) associated with descending necrotizing mediastinitis (DNM) is a rapidly evolving and life-threatening condition. The aim of this retrospective study was to describe a treatment strategy for CNF with DNM and present a management algorithm for mediastinal extensions of CNF.


METHODS
Patients diagnosed and treated for CNF with DNM over 14 years in a tertiary referral centre were included.


RESULTS
Seventeen adult patients were included. The origin of infection was mainly oropharyngeal. The diagnosis of CNF/DNM was based on clinical and computed tomography findings. All patients underwent cervicotomy for CNF. In ten patients, DNM was located above the carina and could be accessed by a cervical approach. In seven patients, DNM was below the carina, and necessitated sternotomy for anteroinferior mediastinal involvement and posterolateral thoracotomy for posteroinferior mediastinal involvement. All patients received broad-spectrum antibiotics. One patient died 3 days after surgery. The median hospital stay was 30 days. There was no recurrence during long-term follow-up.


CONCLUSIONS
Prompt diagnosis and early surgical treatment are essential for reducing mortality in CNF/DNM. All patients should undergo extensive cervicotomy. The surgical approach to the mediastinum depends on the supracarinal or infracarinal location of the disease.
Karkas
A
A
Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre of Grenoble, Grenoble, France.
Chahine
K
K
Schmerber
S
S
Brichon
P-Y
PY
Righini
C A
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004322:Drainage; D019115:Fasciitis, Necrotizing / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy* / Q000601:surgery; D008875:Middle Aged; D009333:Neck; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D014140:Tracheotomy / Q000379:methods; D055815:Young Adult
D000900:Anti-Bacterial Agents