Article
Descending necrotizing mediastinitis - incidence and management
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Published: | September 22, 2005 |
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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.