title: Transcervical drainage for descending necrotizing mediastinitis may be sufficient.
abstract: OBJECTIVE
  Descending necrotizing mediastinitis (DNM) is a serious form of mediastinitis with a high mortality rate. It is caused by the downward spread of an oropharyngeal or cervicofascial infection. The optimal surgical approach for this often fatal disease is controversial. This article describes the authors' experience and characterizes the surgical strategies and treatment outcomes of patients with DNM.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  A tertiary referral medical center.
  
  
  METHODS
  This study conducted a retrospective chart review of patients with deep neck infections treated at a medical center from 1994 to 2007 and identified 29 patients with DNM. The clinical characteristics and outcomes were compared between patients treated with transcervical drainage alone (group I) and those with both cervical and thoracic drainage (group II).
  
  
  RESULTS
  There were 20 patients in group I and 9 patients in group II. The overall mortality rate was 10.3%. The mean duration of the hospital stay was 29.3 ± 15.5 days. There was no statistically significant difference in age, sex distribution, or duration from the appearance of symptoms to hospital admission between the 2 groups. The duration of hospital stay, tracheotomy rate, and mortality rate also did not differ significantly between the 2 groups. However, the numbers of surgeries were significantly higher in group II than in group I.
  
  
  CONCLUSIONS
  Transthoracic mediastinal drainage is not a compulsory therapy, but timely, aggressive, transcervical mediastinal drainage with extensive debridement is very important for a good outcome when treating DNM patients.
authors.affiliation: Department of Otolaryngology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan, ROC.
authors.forename: Ruey-Fen
authors.initials: RF
authors.lastname: Hsu
authors.forename: Pei-Yin
authors.initials: PY
authors.lastname: Wu
authors.forename: Chi-Kung
authors.initials: CK
authors.lastname: Ho
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009333:Neck; D009336:Necrosis; D012189:Retrospective Studies; D012737:Sex Factors; D013909:Thorax; D014140:Tracheotomy