• Journal of Chest Surgery
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• v.41 no.4
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• pp.463-468
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• 2008

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 $56.6{\pm}12.3$ ($34{\sim}72$) 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 $24.3{\pm}17.9$ ($3{\sim}58$) days, and hospital stay was $49.1{\pm}33.8$ ($20{\sim}125$) 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.

• Journal of Chest Surgery
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• v.34 no.10
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• pp.769-774
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• 2001

Background: Descending necrotizing mediastinitis(DNM) is a serious complication originating in odontogenic or oropharyngeal infection with previously reported mortality rates of 25% to 40%. We retrospectively reviewed the 4 years of our surgical drainage and debridement in DNM. Material and Method: We studied 7 cases diagnosed as DNM from 1997 through 2000. Primary oropharyngeal infection lead to DNM in four cases(57%) and odontogenic abscess in three cases(43%). All patients were received emergent cervicotomy and thoracotomy or sternotomy for debridement of necrotic tissue and mediastinal or pleural drainage. Result: Five cases were evolved well and were discharged after a mean of 42 days. Two patients(28.6%) died. Three patients required reoperation due to local surgical complication; empyema(two) and impending cardiac tamponade. One of these patients died on 12 post-reoperative day due to great vessel erosion, renal and respiratory insufficiency. The other patient died of broncho- esophageal fistula and asphyxia on 10 postoperative day without reoperation. Conclusion: On the basis of experience accrued in treating these patients, early diagnosis by cervicothoracic computed tomographic scan of neck and thorax aids in rapid indication of a surgical approach of DNM. We emphasize that performing early surgical drainage and debridement of necrotic tissues with intensive postoperative care can significantly reduce the mortality rate.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.82-88
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• 2008

Background: Descending necrotizing mediastinitis (DNM) is a serious disease originating in odontogenic or oropharyngeal infection with high mortality despite adequate antibiotics and aggressive surgery. We analyzed results of treatment for DNM. Material and Method: We studied 8 cases diagnosed as DNM from 1998 to 2007. All patients received emergent surgical drainage and debridement with broad spectrum antibiotics just after diagnosis. Antibiotics were changed after bacterial susceptibility testing. The surgical approach included 2 cases of cervicotomy, 6 cases of cervicotomy, and a thoracotomy. Result: The interval between symptom onset and hospitalization was $4.6{\pm}1.8$ days ($1{\sim}9$ day). DNM originated in 4 cases of odontogenic infection (50%), 2 cases of oropharyngeal infection (25%), and 2 cases of unknown origin (25%). Causative organisms were found in 6 cases; Streptococcus in 4 cases, Staphylococcus in 1 case, and Klebsiella in 1 case. The Endo DNM classification was type I (2 cases), IIA (3 cases), and IIB (3 cases). The incidence of thoracotomy was 75%. The surgical mortality rate was 25% (2/8). The cause of death was multiple organ failure caused by septic shock. All mortality cases received only cervicotomy and aggravated infections after initial drainage. Conclusion: Early diagnosis, immediate surgical drainage, and adequate antibiotics, including covered anaerobes, are required. Thoracotomy should be performed with cervicotomy even for localized DNM.

• Journal of Chest Surgery
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• v.45 no.3
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• pp.171-176
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• 2012

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.