Korean J Thorac Cardiovasc Surg.  2008 Feb;41(1):82-88.

Surgical Treatment for Descending Necrotizing Mediastinitis

• Ryu KM
• Seo PW
• Park S
• Kim SK
• Lee JW
• Ryu JW

Abstract

BACKGROUND: Descending necrotizing mediastinitis (DNM) is a serious disease originating in odontogenic or oropharyngeal infection with high mortality despite adequate antibiotics and aggressive surgery. We analyzed results of treatment for DNM. MATERIAL AND METHOD: We studied 8 cases diagnosed as DNM from 1998 to 2007. All patients received emergent surgical drainage and debridement with broad spectrum antibiotics just after diagnosis. Antibiotics were changed after bacterial susceptibility testing. The surgical approach included 2 cases of cervicotomy, 6 cases of cervicotomy, and a thoracotomy. RESULT: The interval between symptom onset and hospitalization was 4.6+/-1.8 days (1~9 day). DNM originated in 4 cases of odontogenic infection (50%), 2 cases of oropharyngeal infection (25%), and 2 cases of unknown origin (25%). Causative organisms were found in 6 cases; Streptococcus in 4 cases, Staphylococcus in 1 case, and Klebsiella in 1 case. The Endo DNM classification was type I (2 cases), IIA (3 cases), and IIB (3 cases). The incidence of thoracotomy was 75%. The surgical mortality rate was 25% (2/8). The cause of death was multiple organ failure caused by septic shock. All mortality cases received only cervicotomy and aggravated infections after initial drainage.
CONCLUSION
Early diagnosis, immediate surgical drainage, and adequate antibiotics, including covered anaerobes, are required. Thoracotomy should be performed with cervicotomy even for localized DNM.

Keyword

Mediastinitis; Necrosis; Thoracotomy

MeSH Terms

Anti-Bacterial Agents
Cause of Death
Debridement
Drainage
Early Diagnosis
Hospitalization
Humans
Incidence
Klebsiella
Mediastinitis
Multiple Organ Failure
Necrosis
Shock, Septic
Staphylococcus
Streptococcus
Thoracotomy
Anti-Bacterial Agents