Cervicotomy vs. thoracotomy: management of descending necrotizing mediastinistis due to odontogenic infections

ABSTRACT

Descending necrotizing mediastinitis is a condition characterized by inflammation of connective tissues in mediastinum. It is a very serious illness with a very high mortality rate and early diagnosis of DNM is very important to prevent morbidity and mortality. About 70% of the cases of DNM occur through the retropharyngeal pathway and 8% occur via the pretracheal route. Despite various surgical approaches for the treatment of DNM, the optimal approach still remains controversial. We present our experience of 6 patients of DNM with involvement of anterior and posterior mediastinum managed by cervicotomy and transverse cervical drainage with placement of corrugated drains and a pleural chest drain, we advocate a conservative approach with limited debridement and emphasis on drainage of infection in line with published case series