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
PURPOSE: The incidence of deep cervical space infections has decreased after the introduction of antibiotics and improvement of oral hygiene, but they still may be lethal especially when life-threatening complications occur. In this article, we try to find out whether there are predisposing factors related to complicated deep cervical space infections and prolonged hospitalization. MATERIALS AND METHODS: We conducted a retrospective analysis of medical records of 196 patients with deep neck infections during the period from March 1996 to February 2002. Among the 196 patients, 15 patients developed lethal complications. As for data analysis, multiple regression and logistic regression with dummy variable were used. RESULTS: In multiple regressions, patients with older age or with neck swelling, trismus, underlying diseases, complications, and C-reactive protein more than 100 microg/mL stayed longer in the hospital, and the P value reached statistical significance (P <.05). In logistic regression, male patients and patients with neck pain had negative correlation, and the P value reached statistical significance (P <.05). Patients with neck swelling and patients with respiratory difficulty had positive correlation, and the P value reached statistical significance (P <.05). That means female patients, patients with neck swelling, and patients with respiratory difficulty were more likely to have complicated deep neck infections. CONCLUSION: Complicated deep neck infections remain potentially fatal, but the morbidity and mortality can be reduced. Doctors should pay more attention to those high-risk patients; they are female patients, patients with neck swelling, and patients with respiratory difficulty.
