Descending necrotizing mediastinitis – a surgical view

Abstract

Introduction: Descending necrotizing mediastinitis (DNM) is a relatively uncommon but serious type of inflammation. Even today, the mortality is around 20%. An overview of DNM issues, recent literature and clinical practice of our department is presented.

Anatomy and etiology: The cause is the descent of an originally oropharyngeal infection from the deep neck space into the mediastinum.

Therapy: Treatment takes place in an intensive care department, with a combination of antibiotics. Elimination of the neck source of inflammation is a prerequisite. The type of surgical drainage depends on the stage and extent of mediastinal involvement. Cervicomediastinal, mediastinothoracic, or cervicomediastinothoracic “Rendezvous” drainage are options.

Conclusion: The basis of DNM treatment is adequate surgical drainage, but interdisciplinary care (surgeon, anesthesiologist, ENT and dental surgeon) is a necessary condition.

doi: 10.48095/ccrvch2024502