Abstract

Objective: Descending Necrotizing Mediastinitis (DNM) is a primary complication of cervical or odontogenical infections that can spread to the mediastinum through the anatomic cervical spaces. We reviewed the last ten years of our surgical experience in DNM and commented on early diagnosis and aggressive surgical treatment in these patients.

Methods: Five male patients (71%) and two females (29%), with a mean age of 34 years-old, with DNM, were surgically treated. Primary oropharyngeal infection occurred in three patients (43%) and odontogenic abscess in four (57%). All patients had serious cervical and mediastinal infections with severe respiratory and hemodynamic repercussions such as: bacteriemia, systemic arterial hypotension, mental obnubilation. The diagnosis was confirmed by the computerized chest tomography.

Results: All patients were submitted to surgical drainage of the cervical region by bilateral transverse cervicotomy with debridement of the necrotic and infected tissues, associating ample mediastinal drainage with or without thoracotomy. Six patients (86%) evolved well receiving hospital release after a mean of 35 days. Two patients (29%) were re-operated upon due to local surgical complications: empyema and deiscence of the sternum. One patient (14%) died on the second postoperative day due to renal and respiratory insufficiency. The microbial cultures of DNM showed the development of aerobic and anaerobic conjunctive flora in 71% of the operated patients and exclusively aerobic in 29%.

Conclusions: The early diagnosis through neck and thoracic computerized tomography serves for rapid indication of surgical approach of DNM. Performing ample cervicotomy with mediastinal drainage generally associated with thoracotomy can significantly reduce the mortality rate for this condition to 14%.