Surgical Management of Descending Necrotizing Mediastinitis

• Published in: Cirugia española (English ed.) Vol. 91; no. 9; pp. 579 - 583
• Main Authors: Bayarri Lara, Clara Isabel, Sevilla López, Sebastián, Sánchez-Palencia Ramos, Abel, Alkourdi Martínez, Amira, Hernández Escobar, Francisco, Quero Valenzuela, Florencio, Ruiz Zafra, Francisco Javier, Cueto Ladrón de Guevara, Antonio
• Format: Journal Article
• Language: English
• Published: Elsevier España, S.L.U 01-11-2013
• Subjects: Descending necrotizing mediastinitis; Mediastinitis necrosante descendente; Mediastino; Mediastinum; Surgery; Surgical treatment; Tratamiento quirúrgico; Mediastinitis necrosante descendente; Tratamiento quirúrgico; Descending necrotizing mediastinitis; Mediastinum; Surgical treatment; Mediastino
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2014.01.005

Abstract Introduction Descending necrotizing mediastinitis (DNM) is a serious infection which occurs as a complication of oropharyngeal infection. Its surgical management and the routine transthoracic approach remain controversial. In this article we report our experience in the management of this disease, and review the different surgical approaches that have been reported in the medical literature. Materials and methods A retrospective review of the clinical records of 29 patients treated between 1988 and 2009 was made. Several demographic variables were analyzed, origin of the initial infection, stage of the disease according to Endo's classification, surgical technique and outcome. Results Surgical treatment consisted of both cervical and mediastinal drainage and radical debridement. The mediastinal drainage was made through a transcervical approach in 10 cases and transthoracic in 19, depending on the extent of the mediastinitis. The outcome was satisfactory in 24 patients and 5 died (mortality 17.2%). Conclusions According to our results and the conclusions of the main authors, we recommend a prompt and aggressive surgery with a transthoracic approach in cases of widespread DNM.