Clinial Analysis of Surgical Management for Descending Necrotizing Mediastinitis / 대한흉부외과학회지

ABSTRACT

BACKGROUND: Descending necrotizing mediastinitis (DNM) is a life-threatening cervico-mediastinal infection extending from the oropharynx or periodontal space. We reviewed clinical outcomes of DNM patients that underwent surgical management. MATERIAL AND METHOD: We analyzed the demographic and surgical data from 8 patients (6 males and 2 females) that underwent surgical management for DNM between August 2003 and August 2007. RESULT: The mean age was 56.6+/-12.3 (34~72) years. Types of DNM were I (n=2), IIA (n=1), and IIB (n=5), based on the classification system of Endo et al. Four patients were septic at the time of operation. The infectious organism was identified in three cases and turned out to be Streptococcus. ICU stay was 24.3+/-17.9 (3~58) days, and hospital stay was 49.1+/-33.8 (20~125) days. There were two deaths (25%), both of which were due to multi-organ failure. CONCLUSION: Despite aggressive surgical drainage and appropriate medical management, DNM still had a high mortality rate. Early diagnosis and prompt surgical intervention are key to DNM management. In addition, transcervical drainage should be used in limited disease only.