Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Features of Deep Neck Infections and Predisposing Factors for Mediastinal Extension

  • Kang, Shin-Kwang (Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Lee, Seok-Kee (Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Oh, Hyun-Kong (Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kang, Min-Woong (Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Na, Myung-Hoon (Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Yu, Jae-Hyeon (Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Koo, Bon-Seok (Department of Otorhinolaryngology, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Lim, Seung-Pyung (Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine)
  • Received : 2011.10.14
  • Accepted : 2011.10.22
  • Published : 2012.06.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Deep neck infections (DNI) can originate from infection in the potential spaces and fascial planes of the neck. DNI can be managed without surgery, but there are cases that need surgical treatment, especially in the case of mediastinal involvement. The aim of this study is to identify clinical features of DNI and analyze the predisposing factors for mediastinal extension. Materials and Methods: We reviewed medical records of 56 patients suffering from DNI who underwent cervical drainage only (CD group) and those who underwent cervical drainage combined with mediastinal drainage for descending necrotizing mediastinitis (MD group) from August 2003 to May 2009 and compared the clinical features of each group and the predisposing factors for mediastinal extension. Results: Forty-four out of the 56 patients underwent cervical drainage only (79%) and 12 patients needed both cervical and mediastinal drainage (21%). There were no differences between the two groups in gender (p=0.28), but the MD group was older than the CD group (CD group, $44.2{\pm}23.2$ years; MD group, $55.6{\pm}12.1$ years; p=0.03). The MD group had a higher rate of co-morbidity than the CD group (p=0.04). The CD group involved more than two spaces in 14 cases (32%) and retropharyngeal involvement in 12 cases (27%). The MD group involved more than two spaces in 11 cases (92%) and retropharyngeal involvement in 12 cases (100%). Organism identification took place in 28 cases (64%) of the CD group and 3 cases of (25%) the MD group (p=0.02). The mean hospital stay of the CD group was $21.5{\pm}15.9$ days and that of the MD group was $41.4{\pm}29.4$ days (p=0.04). Conclusion: The predisposing factors of mediastinal extension in DNI were older age, involvement of two or more spaces, especially including the retropharyngeal space, and more comorbidities. The MD group had a longer hospital stay, higher mortality, and more failure to identify causative organisms of causative organisms than the CD group.

Keywords

References

  1. Lee JK, Kim HD, Lim SC. Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J 2007;48:55-62. https://doi.org/10.3349/ymj.2007.48.1.55
  2. Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983;157:545-52.
  3. Endo S, Murayama F, Hasegawa T, et al. Guideline of surgical management based on diffusion of descending necrotizing mediastinitis. Jpn J Thorac Cardiovasc Surg 1999;47:14-9
  4. Ridder GJ, Maier W, Kinzer S, Teszler CB, Boedeker CC, Pfeiffer J. Descending necrotizing mediastinitis: contemporary trends in etiology, diagnosis, management, and outcome. Ann Surg 2010;251:528-34. https://doi.org/10.1097/SLA.0b013e3181c1b0d1
  5. Marty-Ane CH, Berthet JP, Alric P, Pegis JD, Rouviere P, Mary H. Management of descending necrotizing mediastinitis: an aggressive treatment for an aggressive disease. Ann Thorac Surg 1999;68:212-7. https://doi.org/10.1016/S0003-4975(99)00453-1
  6. De Freitas RP, Fahy CP, Brooker DS, et al. Descending necrotising mediastinitis: a safe treatment algorithm. Eur Arch Otorhinolaryngol 2007;264:181-7.
  7. Wheatley MJ, Stirling MC, Kirsh MM, Gago O, Orringer MB. Descending necrotizing mediastinitis: transcervical drainage is not enough. Ann Thorac Surg 1990;49:780-4. https://doi.org/10.1016/0003-4975(90)90022-X
  8. Corsten MJ, Shamji FM, Odell PF, et al. Optimal treatment of descending necrotising mediastinitis. Thorax 1997;52:702-8 https://doi.org/10.1136/thx.52.8.702
  9. Freeman RK, Vallieres E, Verrier ED, Karmy-Jones R, Wood DE. Descending necrotizing mediastinitis: an analysis of the effects of serial surgical debridement on patient mortality. J Thorac Cardiovasc Surg 2000;119:260-7. https://doi.org/10.1016/S0022-5223(00)70181-4
  10. Yu JH, Lim SP, Lee SK, et al. Clinial analysis of surgical management for descending necrotizing mediastinitis. Korean J Thorac Cardiovasc Surg 2008;41:463-8.
  11. Inoue Y, Gika M, Nozawa K, Ikeda Y, Takanami I. Optimum drainage method in descending necrotizing mediastinitis. Interact Cardiovasc Thorac Surg 2005;4:189-92. https://doi.org/10.1510/icvts.2004.105395
  12. Scaglione M, Pinto A, Romano S, Giovine S, Sparano A, Romano L. Determining optimum management of descending necrotizing mediastinitis with CT: experience with 32 cases. Emerg Radiol 2005;11:275-80. https://doi.org/10.1007/s10140-005-0422-3
  13. Iwata T, Sekine Y, Shibuya K, et al. Early open thoracotomy and mediastinopleural irrigation for severe descending necrotizing mediastinitis. Eur J Cardiothorac Surg 2005;28: 384-8. https://doi.org/10.1016/j.ejcts.2005.05.018
  14. Marty-Ane CH, Alauzen M, Alric P, Serres-Cousine O, Mary H. Descending necrotizing mediastinitis. Advantage of mediastinal drainage with thoracotomy. J Thorac Cardiovasc Surg 1994;107:55-61.
  15. Min HK, Choi YS, Shim YM, Sohn YI, Kim J. Descending necrotizing mediastinitis: a minimally invasive approach using video-assisted thoracoscopic surgery. Ann Thorac Surg 2004;77:306-10. https://doi.org/10.1016/S0003-4975(03)01333-X
  16. Pearse HE. Mediastinitis following cervical suppuration. Ann Surg 1938;108:588-611. https://doi.org/10.1097/00000658-193810000-00009

Cited by

  1. Descending necrotizing Mediastinitis caused by Kocuria rosea : a case report vol.13, pp.None, 2012, https://doi.org/10.1186/1471-2334-13-475
  2. Deep neck infections: risk factors for mediastinal extension vol.271, pp.6, 2012, https://doi.org/10.1007/s00405-013-2651-5
  3. Incidentally Discovered Deep Neck Infection in a Septic Patient vol.29, pp.2, 2012, https://doi.org/10.4266/kjccm.2014.29.2.105
  4. Descending necrotizing mediastinitis: 5 years of published data in Japan : DNM: 5 years' review in Japan vol.2, pp.1, 2012, https://doi.org/10.1002/ams2.56
  5. Deep neck infection after third molar extraction vol.49, pp.2, 2012, https://doi.org/10.17096/jiufd.82633
  6. A Novel Mediastinal Drainage Tube for Mediastinitis vol.48, pp.5, 2015, https://doi.org/10.5090/kjtcs.2015.48.5.378
  7. Deszendierende nekrotisierende Mediastinitis : Therapiekonzept aus thoraxchirurgischer Sicht vol.87, pp.7, 2016, https://doi.org/10.1007/s00104-015-0127-4
  8. Therapie der akuten Mediastinitis vol.87, pp.6, 2012, https://doi.org/10.1007/s00104-016-0171-8
  9. Die akute und chronische Mediastinitis vol.87, pp.6, 2016, https://doi.org/10.1007/s00104-016-0172-7
  10. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description vol.38, pp.suppl1, 2012, https://doi.org/10.1002/hed.24183
  11. Serially Transplanted Nonpericytic CD146− Adipose Stromal/Stem Cells in Silk Bioscaffolds Regenerate Adipose Tissue In Vivo vol.34, pp.4, 2016, https://doi.org/10.1002/stem.2325
  12. Should we consider IgG hypogammaglobulinemia a risk factor for severe complications of Ludwig angina? : A case report and review of the literature vol.96, pp.47, 2012, https://doi.org/10.1097/md.0000000000008708
  13. Clinical Evaluation and Management of Deep Neck Space Infections vol.8, pp.3, 2017, https://doi.org/10.5005/jp-journals-10001-1315
  14. A Novel Technique for Surgical Reduction of Long-standing Temporomandibular Joint Dislocation vol.8, pp.3, 2012, https://doi.org/10.5005/jp-journals-10001-1316
  15. Less invasive management of deep neck infection and descending necrotizing mediastinitis : A single-center retrospective study vol.96, pp.15, 2012, https://doi.org/10.1097/md.0000000000006590
  16. Deep Neck Space Infections-A Study in Diabetic Population in a Tertiary Care Centre vol.70, pp.1, 2012, https://doi.org/10.1007/s12070-017-1196-0
  17. Acinetobacter Prevertebral Abscess: Presenting as Dysphagia in a Diabetic Patient vol.2018, pp.None, 2012, https://doi.org/10.1155/2018/6051641
  18. Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report vol.12, pp.1, 2012, https://doi.org/10.1186/s13256-018-1611-5
  19. 18 F-fluorodeoxyglucose positron emission tomography/computed tomography findings in descending necrotizing mediastinitis and cervical vertebral osteomyelitis in a cancer patient : A case vol.99, pp.30, 2012, https://doi.org/10.1097/md.0000000000021353
  20. Clinical predictors of descending necrotizing mediastinitis after deep neck infections vol.130, pp.11, 2012, https://doi.org/10.1002/lary.28406
  21. Deep neck cellulitis: a challenging diagnosis vol.13, pp.12, 2012, https://doi.org/10.1136/bcr-2020-236415
  22. Smoking and Alcohol Consumption Are Associated With the Increased Risk of Peritonsillar Abscess vol.130, pp.12, 2012, https://doi.org/10.1002/lary.28510
  23. Factors associated with treatment outcomes of patients hospitalized with severe maxillofacial infections at a tertiary center vol.47, pp.3, 2012, https://doi.org/10.5125/jkaoms.2021.47.3.197