ABSTRACT
BACKGROUND: "Descending necrotizing mediastinitis" (DNM) is a rare but potentially life-threatening complication of deep neck infections caused by the rapid downward spread of a oropharyngeal infection along the facial planes into the mediastinum. MATERIAL AND METHODS: Between June 1997 and December 2004, 6 patients with DNM were treated in our department. The primary etiology was a peritonsillar abscess in 2 cases, a parapharyngeal abscess in 3 cases and in 1 case an odontogenic abscess. Most patients presented with risk factors such as diabetes mellitus or alcoholism, the mean age was 44.3 years and the mean duration of signs before diagnosis was 6.3 days. Thoracotomy was associated with the cervical approach in 4 cases and tracheostomy was also performed in 4 cases. RESULTS: Four patients were successfully treated, the mean duration of hospitalisation was 48.2 days and 2 patients died from sepsis and multiorgan failure despite intensive treatment. CONCLUSIONS: Descending necrotizing mediastinitis must be detected as soon as possible. The mean symptoms are persistent complaints after treatment of oropharyngeal infections, which may be masked by analgetic treatment. Only an immediate computer tomographic scanning, aggressive surgical drainage and debridement of the neck and the mediastinum can reduce the high mortality rate.
Subject(s)
Fasciitis, Necrotizing/surgery , Mediastinitis/surgery , Periapical Abscess/surgery , Peritonsillar Abscess/surgery , Retropharyngeal Abscess/surgery , Streptococcal Infections/surgery , Adult , Debridement , Drainage , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/mortality , Fatal Outcome , Female , Humans , Incidence , Length of Stay , Male , Mediastinitis/diagnosis , Mediastinitis/mortality , Middle Aged , Neck/surgery , Periapical Abscess/diagnosis , Periapical Abscess/mortality , Peritonsillar Abscess/diagnosis , Peritonsillar Abscess/mortality , Retropharyngeal Abscess/diagnosis , Retropharyngeal Abscess/mortality , Streptococcal Infections/diagnosis , Streptococcal Infections/mortality , Thoracotomy , Tomography, X-Ray Computed , TracheostomyABSTRACT
Deaths from dental abscesses today are so rare, that it is difficult to fathom that only 200 years ago, this was a leading cause of death. When the London (England) Bills of Mortality began listing the causes of death in the early 1600's, "teeth" were continually listed as the fifth or sixth leading cause of death. (This does not include the category of "Teething" which was probably erroneously blamed for many children's deaths. As we examine several historic factors of this period, it is apparent that the number of deaths attributed to "teeth" in the seventeenth and eighteenth centuries was probably fairly accurate, and it was not antibiotics, nor the discovery of asepsis, that brought about the dramatic reduction in these dental mortalities, but two much earlier dental innovations.
