HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Angelo Fernandez Fabio Biscegli Jatene Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sancho, L. M. M. Articles by Jatene, F. B. Search for Related Content PubMed PubMed Citation Articles by Sancho, L. M. M. Articles by Jatene, F. B.

Eur J Cardiothorac Surg 1999;16:200-205
© 1999 Elsevier Science NL

Descending necrotizing mediastinitis: a retrospective surgical experience

Thoracic Surgery and Otorhinolaryngology Divisions, Hospital das Clinicas, University of São Paulo Medical Center, São Paulo, Brazil

Corresponding author. Rua Dr. Diogo de Faria, 964 Vila Clementino, São Paulo, SP, Brasil, CEP 04037-003. Tel./fax: +55-11-2826365

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 10 years of our surgical experience in DNM and commented on early diagnosis and aggressive surgical treatment in these patients. Methods: Five males (71%) and two females (29%), mean age 34 years, with DNM, were surgically treated. Primary oropharyngeal infection occurred in three (43%) and odontogenic abscess in four (57%) patients. All had serious cervical and mediastinal infections with severe respiratory and hemodynamic repercussions, i.e. bacteremia, systemic arterial hypotension and obnubilation. Diagnosis was confirmed by computerized chest tomography. Results: All patients underwent 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 and were discharged after a mean of 35 days. Two patients (29%) required reoperation due to local surgical complications: empyema and dehiscence of the sternum. One patient (14%) died on the second postoperative (p.o.) day due to renal and respiratory insufficiency. Cultures of DNM showed the development of associated aerobic and anaerobic flora in 71% of the operated patients and only aerobic in 29%. Conclusion: Early diagnosis by CAT scan of the neck and thorax aids in rapid indication of a 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%.

Key Words: Descending necrotizing mediastinitis • Mediastinitis • Necrotizing fasciitis

This article has been cited by other articles:

				D. Robertson and A. J. Smith The microbiology of the acute dental abscess J. Med. Microbiol., February 1, 2009; 58(2): 155 - 162. [Abstract] [Full Text] [PDF]

				T. Sasaki, S. Toriumi, T. Asakage, K. Kaga, D. Yamaguchi, and N. Yahagi The Toothbrush: A Rare but Potentially Life-Threatening Cause of Penetrating Oropharyngeal Trauma in Children Pediatrics, October 1, 2006; 118(4): e1284 - e1286. [Abstract] [Full Text] [PDF]

				F. Stella and F. Petrella Transsternal transpericardial approach for acute descending necrotizing mediastinitis J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 212 - 214. [Full Text] [PDF]

				T. Nagayasu, S. Akamine, T. Oka, and M. Muraoka Thoracoscopic drainage with wound edge protector for descending necrotizing mediastinitis Interactive CardioVascular and Thoracic Surgery, March 1, 2003; 2(1): 58 - 60. [Abstract] [Full Text] [PDF]