gms | German Medical Science

76th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

04.05. - 08.05.2005, Erfurt

Descending necrotizing mediastinitis - incidence and management

Meeting Abstract

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  • corresponding author Annett Sandner - Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie der Universität Halle, Halle
  • Hasan Bushnaq - Klinik für Herz-Thorax-Chirurgie der Universität Halle, Halle
  • author Marc-Boris Bloching - Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie der Universität Halle, Halle

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. 76. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V.. Erfurt, 04.-08.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05hno253

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/hno2005/05hno117.shtml

Published: September 22, 2005

© 2005 Sandner et al.
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Outline

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Background: Descending necrotizing mediastinitis is a rare but potential life threatening complication of deep neck infections. It is caused by the rapid downward spread of oropharyngeal infection along the facial planes into the mediastinum. Despite improved diagnostical and therapeutical methods the mortality rate is still high. Causes may be delayed diagnosis and therapy.

Methods and Material: Between June 1997 and December 2004 6 patients with DNM were treated at the MLU Halle. The primary etiology was in 2 cases peritonsillar abscess, 3 cases parapharyngeal abscess and one odontogenic abscess. Most patients presented with risk factors like diabetes mellitus or alcoholism in history. Mean age was 44,3 years. The mean duration of signs before diagnosis was 6,3 days. Thoracotomy was associated with the cervical approach in 4 cases. Tracheotomy was performed in 4 cases.

Results: 4 Patients were successful treated. The mean duration of hospitalisation was 48,2 days. 2 patients die despite intensive treatment on sepsis and multiorgan failure.

Conclusions: DNM must be dectected as soon as possible. The mean symptoms are persistent complaints after treatment for oropharyngeal infections but medical treatment can cover up symptoms. Only immediately computertomographic scanning and aggressive surgical drainage and debridment of the neck and the mediastinum can realistically reduce the high mortality rate.