A Clinical Study of Fourteen Cases of Deep Neck Infection with Mediastinal Involvement

Lee, Joon Kyoo

Abstract

BACKGROUND AND OBJECTIVES
Acute mediastinitis occasionally occurs as a complication of deep neck infections, which spreads to the mediastinum via cervical fascial planes. The purpose of this article is to investigate the differences in the clinical manifestation of deep neck infections between mediastinitis patients and non-mediastinitis patients so as to aid in the treatment of acute mediastinitis. SUBJECTS AND METHOD: The present study reviewed the medical records of 158 patients with deep neck infections from 1995 to 2004 and the author analyzed clinical findings of 14 patients with mediastinitis. To find out the characteristics of mediastintis patients, the author compared these patients with non-mediastinitis patients using student t-test and chisquare test. RESULTS: Compared with the non-mediastinitis patients, the unique features of deep neck infections in mediastinitis patients were as follows: 1) older age, 2) dyspnea on hospitalization, 3) tendency to involve multiple spaces, and 4) prolonged hospitalization (p<0.05). Transcervical drainage was performed in 11 cases and thoracotomy drainage in 3 cases. Three patients died of septic shocks after transcervical mediastinal drainage. CONCLUSION: In this study, patients with mediastinitis were found to have older age, dyspnea, multiple involved spaces, and longer hospitalization. Mediastinitis remain potentially fatal, but morbidity and mortality can be reduced when a combination of following factors is applied: early radiologic diagnosis, maintenance of airway, aggressive drainage of pus, and appropriate intravenous antibiotics.