Infections of the head and neck leading to descending necrotizing mediastinitis: management of 9 cases / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To report nine cases of descending necrotizing mediastinitis (DNM) and to summarize the management experience.</p><p><b>METHODS</b>Between December 2005 and December 2008, nine patients (mean age, 55.7 years; age range, 38 to 78 years) with DNM were treated. Eight patients underwent surgical drainage of the involved cervical region and mediastinum (4 with cervical drainage alone; 4 with cervical drainage and right thoracotomy).</p><p><b>RESULTS</b>Two patients died, one of them refused surgical therapy and the other one died of multiorgan failure related to postoperative septic shock. Seven patients recovered. The mortality rate was 22%.</p><p><b>CONCLUSIONS</b>Delayed diagnosis and inadequate drainage are the main causes of high mortality rate of DNM. Aggressive surgical drainage and debridement of the neck and mediastinum by a multidisciplinary team of surgeons are very important in the treatment of DNM.</p>

Experimental study on the reconstruction of mandibular symphyseal defects by internal tri-focal distractor / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To introduce the internal tri-focal distractor developed by the authors and evaluate its primary application and feasibility in animal experiment.</p><p><b>METHODS</b>Four hybrid dogs were selected and segmental resection at the mandibular symphysis was performed. Two transfer disks, 10 mm in width, were respectively fixed at the two ends of bone defect and the internal tri-focal distractor was installed. The force was applied one week after the operation, with a tractive speed of 0.5 mm/12 h. After 13 - 16 days, the traction was completed when the two transfer disks were combined. The occlusal films were taken at the 1st day, 4th, 8th and 12th week after traction. The animals were killed at the 12th week, samples of the traction area taken and histological examination performed. Finally, the new bone formation was observed.</p><p><b>RESULTS</b>All the animals survived in the experiment, abruption and rust-eaten was not found in distractor. In the 12th week after installation, new bones in traction gap were mature and bony union between the two transfer dishes was accomplished.</p><p><b>CONCLUSIONS</b>The internal tri-focal distractor used in this study may become a potential device in reconstruction of mandibular symphyseal defects.</p>