Ten Years of Descending Necrotizing Mediastinitis: Management of 23 Cases

Roccia, Fabio; Pecorari, Gian Carlo; Oliaro, Alberto; Passet, Ettore; Rossi, Paolo; Nadalin, Juri; Garzino-Demo, Paolo; Berrone, Sid

doi:10.1016/j.joms.2006.10.060

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 65, Issue 9 , Pages 1716-1724, September 2007

Ten Years of Descending Necrotizing Mediastinitis: Management of 23 Cases

Fabio Roccia, MD
- Assistant Professor, Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
- Address correspondence and reprint requests to Dr Roccia: Via Febo 19-10133, Torino, Italy
Gian Carlo Pecorari, MD
- Assistant Professor, Division of ENT 1, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
Alberto Oliaro, MD
- Professor, Department of Thoracic Surgery, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
Ettore Passet, MD
- Assistant Professor, Division of ENT 2, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
Paolo Rossi, MD
- Resident, Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
Juri Nadalin, MD
- Resident, Division of ENT 1, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
Paolo Garzino-Demo, MD
- Assistant Professor, Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
Sid Berrone, MD, DDS
- Professor, Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy.

Purpose

Through a 10-year retrospective study, we report our experience in the management of descending necrotizing mediastinitis (DNM), a rare and often lethal complication of odontogenic and oropharyngeal infections.

Patients and Methods

We reassessed 23 patients between the ages of 16 and 69 years (mean, 49 years) seen between 1996 and 2005, with DNM secondary to odontogenic abscess or phlegmon in 9 cases or secondary to peritonsillar abscess in 14 cases. In this study, 48% of the patients had immune system disorders, mainly diabetes mellitus (6 patients). The diagnosis of DNM was confirmed by cervicothoracic computed tomography.

Results

Eight patients underwent a bilateral collar cervicotomy, and 15 underwent a combined cervicothoracic approach. Five, 2, 1, and 1 patients underwent surgery 2, 3, 4, and 5 times, respectively. Seven patients died as a result of septic shock and multiorgan failure, for a mortality rate of 30.4%. Four of those who died had a compromised immune system.

Conclusion

The relatively high mortality rate seen in this study shows that, in addition to early diagnosis and aggressive treatment, it is important to give greater attention to and be more medically and surgically aggressive in the management of patients whose immune system is compromised in any way.