Descending Necrotizing Mediastinitis : The Retrospective Review of Surgical Management.
- Author:
Jae Jin LEE
1
;
Ho Seung SHIN
;
Yoon Cheol SHIN
;
Hyun Kun CHEE
;
Weon Jin LEE
;
Ki Woo HONG
Author Information
1. Department of Thoracic & Cardiovascular Surgery, College of Medicine, Hallym University, Korea. thoraxshin@yahoo.co.kr
- Publication Type:Original Article
- Keywords:
Mediastinitis;
Necrosis
- MeSH:
Abscess;
Asphyxia;
Cardiac Tamponade;
Debridement;
Drainage;
Early Diagnosis;
Esophageal Fistula;
Humans;
Mediastinitis*;
Mortality;
Neck;
Necrosis;
Postoperative Care;
Reoperation;
Respiratory Insufficiency;
Retrospective Studies*;
Sternotomy;
Thoracotomy;
Thorax
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2001;34(10):769-774
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
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.
