Successful Surgical Treatment for Dysphagia Secondary to Descending                    Necrotizing Mediastinitis

Objectives: In patients hospitalized due to deep neck infections (DNIs), to investigate the association between demographic parameters, etiology, and localization of abscesses and/or phlegmons, complications, comorbidities, treatment, and bacterial cultures. Methods: We analyzed data of 263 patients that were hospitalized from January 1, 2012, to December 31, 2015, due to deep neck space phlegmons and/or abscesses. We performed statistical analysis with the SPSS 22.0 software; statistical significance was set p<0.05. Results: Among the analyzed patients, dental infections were the most frequent, followed by acute phlegmonous pharyngitis. Submandibular space abscesses or phlegmons of the neck were the most frequent complications of these infections. Re-operation was performed in 19.8% of cases, and complications developed in 11% (mostly airway obstruction). DNI complications were less common in smokers than in non-smokers (OR=0.038, p=0.025). Discussion: In our study, dental infections accounted for 70.6% of DNI cases. Thus, our study explains why odontogenic DNIs are the most common DNI type studied in the literature. Poor oral health and odontogenic infections should not be underestimated because they can lead to uncommon but lethal diseases such as descending necrotizing mediastinitis, which requires aggressive surgical treatment and is associated with a mortality rate of 10%-40% despite treatment. The complication developed in 11.4% of cases. In conclusion, oral health and hygiene contribute to DNI development.

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Descending necrotizing mediastinitis

Vojnosanitetski pregled ◽

10.2298/vsp0607677c ◽

2006 ◽

Vol 63 (7) ◽

pp. 677-680 ◽

Cited By ~ 1

Author(s):

Vlado Cvijanovic ◽

Vojkan Stanic ◽

Aleksandar Ristanovic ◽

Bojan Gulic ◽

Savo Durkovic ◽

...

Keyword(s):

Surgical Treatment ◽

Massive Bleeding ◽

Peritonsillar Abscess ◽

Descending Necrotizing Mediastinitis ◽

Right Thoracotomy ◽

Oropharyngeal Infection ◽

Disease Case ◽

Mediastinal Drainage ◽

Optimal Approach ◽

Prompt Diagnosis

Background: Descending necrotizing mediastinitis (DNM) is an acute, serious, septic disease which results from a complication of oropharyngeal infection. The disease requires a prompt diagnosis and radical surgical treatment to reduce high mortality (40%). The optimal form of mediastinal drainage remains controversial. The reason for publishing this report is both the fact that DNM is very rare and our experience preferring thoracotomy as an optimal approach to treating the disease. Case report. We reported a 34-years-old woman with DNM. The disease began as a peritonsillar abscess. After a bilateral double pleural drainage the disease worsened. In order to achieve radical mediastinal debridement and drainage, we carried out posterolateral right thoracotomy. We also had to perform left thoracotomy because of massive bleeding caused by septic erosion. There were no more reoperations. Conclusion. Aggressive surgical treatment, regardless the localization and the extent of changes is the key to success in the treatment of patients with necrotizing mediastinitis.

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Descending necrotizing mediastinitis following dental extraction. Radiological features and surgical treatment considerations

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2010.10.001 ◽

2011 ◽

Vol 39 (5) ◽

pp. 335-339 ◽

Cited By ~ 11

Author(s):

Raúl González-García ◽

Roberto Risco-Rojas ◽

Leticia Román-Romero ◽

Carlos Moreno-García ◽

Cipriano López García

Keyword(s):

Surgical Treatment ◽

Dental Extraction ◽

Descending Necrotizing Mediastinitis ◽

Radiological Features ◽

Treatment Considerations

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Diffuse descending necrotizing mediastinitis: surgical treatment and outcomes in a single-centre series

Acta medica Lituanica ◽

10.6001/actamedica.v20i3.2727 ◽

2013 ◽

Vol 20 (3) ◽

pp. 117-128 ◽

Cited By ~ 1

Author(s):

Ričardas Janilionis ◽

Žymantas Jagelavičius ◽

Pavel Petrik ◽

Gintaras Kiškis ◽

Vytautas Jovaišas ◽

...

Keyword(s):

Surgical Treatment ◽

Hospital Stay ◽

Pearson Correlation ◽

Favourable Outcome ◽

Cervical Region ◽

Type I ◽

Descending Necrotizing Mediastinitis ◽

Transcervical Approach ◽

Odontogenic Abscess ◽

Oropharyngeal Infection

Objectives. Descending necrotizing mediastinitis is a severe infection spreading from the cervical region to the mediastinum. Since this pathology is uncommon, only a few reports of large series of patients with descending necrotizing mediastinitis have been published. The present aim was to evaluate our treatment strategy and survival for this disease by a retrospective chart review. Methods. Retrospective analysis of 45 cases with descending necrotizing mediastinitis was performed between 2002 and 2011. The mean age was 55.3 ± 15.4 years. The primary oropharyngeal infection was found in 16 (35.6%), an odontogenic abscess in 17 (37.7%) and other causes in 12 (26.7%) patients. Endo type I mediastinitis was assessed in 25 (56%) patients, Endo type IIA in 10 (22%) and Endo type IIB in 10 (22%) patients. Broad spectrum antibiotics were administered empirically and surgical treatment consisting of cervical drainage, thoracotomy with radical surgical debridement of the mediastinum and placement of permanent mediastinal irrigation were performed in all the cases. Results. Collar incision and drainage only were performed in 16 (35.6%) patients, whereas only transthoracic approach was used in five cases (11%). In the remaining 24 (53.4%) patients cervical drainage and thoracic operation were performed. Fifteen patients had severe complications: septic shock, multiple organ failure and haemorrhage from mediastinal vessels. The median hospital stay was 21 days. The outcome was favourable in 35 patients. Ten patients died (overall mortality 22.2%). There was a negative correlation between the time from the onset of symptoms till the first admittance to hospital and hospitalization time (Pearson correlation coefficient 0.357, p = 0.016). That allows us to suggest that time of illness spent at home without appropriate treatment plays a crucial role on the survival. It was found that younger age, Endo type I, negative bacterial culture and longer hospital stay are true precursors of favourable outcome. Conclusions. For descending necrotizing mediastinitis limited to the upper part of the mediastinum a transcervical approach and drainage may be sufficient. However, in advanced cases an immediate and more aggressive surgical approach is required to combat a much higher morbidity and mortality in this subset of patients.

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Descending Necrotizing Mediastinitis: Surgical Treatment Via Clamshell Approach

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(96)00683-2 ◽

1996 ◽

Vol 62 (6) ◽

pp. 1650-1654 ◽

Cited By ~ 55

Author(s):

Hans-Beat Ris ◽

Andrej Banic ◽

Markus Furrer ◽

Marco Caversaccio ◽

Andreas Cerny ◽

...

Keyword(s):

Surgical Treatment ◽

Descending Necrotizing Mediastinitis

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Descending Necrotizing Mediastinitis: Analysis of 9 Cases in Our Hospital

Ear Nose & Throat Journal ◽

10.1177/0145561320933964 ◽

2020 ◽

pp. 014556132093396

Author(s):

Peng Wu ◽

Fan Ye ◽

Ziheng Zhang ◽

Linghao Zhang ◽

Hailiang Lin ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Surgical Treatment ◽

Hospital Stay ◽

Intensive Care Unit Stay ◽

Multidisciplinary Approach ◽

Average Length ◽

Length Of Hospital Stay ◽

Descending Necrotizing Mediastinitis ◽

Hospital Deaths

Objectives: Descending necrotizing mediastinitis (DNM) is a serious and progressive infection involving the neck and chest and with high mortality if not treated quickly and properly. The aim of this study is to share our practices for managing this condition. Methods: We retrospectively evaluated 9 patients diagnosed with DNM in our hospital between January 2006 and October 2019. Age, gender, origin of infection, length of hospital stay, microorganisms present, type of surgical treatment, and clinical outcomes were reviewed. Results: All patients underwent surgery to drain neck and mediastinal secretions and collections. Three (33.3%) patients were treated with transcervical drainage alone, and 6 (66.7%) patients were treated with combined transcervical and transthoracic drainage. Reoperations were reported in 3 (33.3%) cases. The average length of hospital stay was 22.78 ± 10.05 days (range: 9-40 days). The average length of intensive care unit stay was 6.44 ± 10.10 days (range: 0-25 days). There were no in-hospital deaths, and all patients were discharged home with good outcomes. Conclusions: To improve the prognosis of DNM, we suggest early and adequate debridement of all affected areas along with the proper use of antibiotics. A multidisciplinary approach involving both cardiothoracic and ENT surgeons is also required.

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Human Stapes Crura: Normal Ultrastructure. Scanning Electron Microscopic Findings

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100116267 ◽

1975 ◽

Vol 33 ◽

pp. 528-529

Author(s):

M.D. Graham

Keyword(s):

Electron Microscope ◽

Surgical Treatment ◽

Scanning Electron Microscope ◽

Osmic Acid ◽

Human Cadaver ◽

Electron Microscopic ◽

Scanning Electron Microscopic ◽

Normal Human ◽

Microscopic Findings ◽

Scanning Electron

The recent development of the scanning electron microscope has added great impetus to the study of ultrastructural details of normal human ossicles. A thorough description of the ultrastructure of the human ossicles is required in order to determine changes associated with disease processes following medical or surgical treatment.Human stapes crura were obtained at the time of surgery for clinical otosclerosis and from human cadaver material. The specimens to be examined by the scanning electron microscope were fixed immediately in the operating room in a cold phosphate buffered 2% gluteraldehyde solution, washed with Ringers, post fixed in cold 1% osmic acid and dehydrated in graded alcohol. Specimens were transferred from alcohol to a series of increasing concentrations of ethyl alcohol and amyl acetate. The tissue was then critical point dried, secured to aluminum stubs and coated with gold, approximately 150A thick on a rotating stage in a vacuum evaporator. The specimens were then studied with the Kent-Cambridge S4-10 Scanning Electron Microscope at an accelerating voltage of 20KV.

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