Descending Necrotizing Mediastinitis

Abstract

Today DNM most commonly arises from pharyngeal foci and mixed polymicrobial aerobic and anaerobic infections. Reduced tissue oxygenation and impaired immune function promotes its development. Most cases of DNM are limited to the upper mediastinum and can be adequately drained by a transcervical approach. Formal thoracotomy should be reserved for cases extending below the plane of the tracheal bifurcation. Although DNM remains an aggressive infection with high morbidity, a favorable outcome can now be obtained in 85% of patients, even with this selective approach. Early diagnosis and surgical intervention are crucial.

Less invasive management of deep neck infection and descending necrotizing mediastinitis

“…Downward spread of DNI is always accelerated by gravity, respiration, the negative intrathoracic pressure in the mediastinum, and pleural cavities. [5,11] …”

“…For decades, a lot of authors have approved the significance of CT as the mainstay for early diagnosing of DNM. [11–14] CT scanning is also an accurate and specific tool to direct surgical drainage and monitor postoperative progression. We considered contrast-enhanced CT as the “gold standard” in the diagnosis and evaluation of DNI and DNM.…”

“…They call for compulsory mediastinal exploration and debridement despite the involved level. [11,15] But an increasing number of doctors will chose a more rational and individualized strategy according to clinical types. [3,9,16] We were opposed to overtreatment, such as mediastinal exploration and thoracotomy.…”

Descending necrotizing mediastinitis complicating hyperimmunoglobulin E syndrome

“…The most common etiology of DNM is attributed to DNI secondary to odontogenic, pharyngeal, and cervicofacial infections. Although DNM is often associated with an immunocompromised state with a high incidence of 38% reported by Ridder et al 1, to the best of our knowledge, cases of HIES‐associated DNM have not been previously reported. HIES is an extremely rare complex immune deficiency with a low incidence of <1:1000 000 2, 3 and is characterized by elevated immunoglobulin E in serum and recurrent skin abscesses of staphylococcal etiology 2.…”

“…Descending necrotizing mediastinitis (DNM) is a rare, potentially lethal disease originating from a deep neck infection (DNI) and is often associated with an immunocompromised state 1. Hyperimmunoglobulin E syndrome (HIES) is a complex immune deficiency characterized by elevated immunoglobulin E levels in serum and recurrent abscesses of staphylococcal etiology 2.…”