This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Surgical Drainage and Tracheostomy

Alessandro Brunelli, MD; Armando Sabbatini, MD; Gianbattista Catalini, MD; Aroldo Fianchini, MD

Arch Otolaryngol Head Neck Surg. 1996;122(12):1326-1329.

Abstract
Objective
To outline the most appropriate treatment of descending necrotizing mediastinitis.

Design
Case series.

Setting
General community, institutional practice, hospitalized care.

Patients
Five consecutive cases of descending necrotizing mediastinitis that were treated at our institution from 1983 to 1995. Selection criteria included clinical manifestations of severe cervical infection, characteristic radiographic features, documentation of the mediastinal infection at operation, and establishment of the relationship of the oropharingeal infection with the mediastinal process. Cases of mediastinitis due to perforation of the cervical esophagus were excluded. A cervicothoracic computed tomographic scan was obtained in the last 4 patients on admission. In the first case, computed tomographic scanning was not yet available at our institution.

Interventions
All patients underwent drainage of the cervical infection through a cervical incision. Mediastinitis was drained by thoracotomy in 2 patients, since the lower mediastinum was involved, whereas 3 patients underwent cervicomediastinal drainage alone. Tracheostomy was performed in 2 patients.

Results
All patients survived, with a short hospital stay (mean, 35 days).

Conclusions
Cervicomediastinal drainage is adequate when the descending mediastinitis is limited to the upper mediastinum. Thoracotomy has to be performed only when the process has diffusely spread below the carina. Early diagnosis is crucial, and we strongly recommend a cervicothoracic computed tomographic scan in every patient with deep cervical infection. We consider tracheostomy not always necessary. Adequate early drainage, with the cervical wounds left open, and antibiotic and anti-inflammatory therapy should prevent upper airway obstruction.

Arch Otolaryngol Head Neck Surg. 1996;122:1326-1329

Author Affiliations
From the Department of Thoracic Surgery, University of Ancona School of Medicine, Ancona, Italy.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Treatment of mediastinitis using video-assisted thoracoscopic surgery
Cho et al.
Eur. J. Cardiothorac. Surg. 2008;34:520-524.
ABSTRACT | FULL TEXT  

Descending necrotizing mediastinitis: A 10-year surgical experience in a single institution
Chen et al.
J. Thorac. Cardiovasc. Surg. 2008;136:191-198.
ABSTRACT | FULL TEXT  

Descending Necrotizing Mediastinitis Treated With Rapid Sternotomy Followed by Vacuum-Assisted Therapy
Gorlitzer et al.
Ann. Thorac. Surg. 2007;83:393-396.
ABSTRACT | FULL TEXT  

Descending necrotizing mediastinitis in a child with chickenpox
Macarron et al.
J. Thorac. Cardiovasc. Surg. 2007;133:271-272.
FULL TEXT  

Fatal descending necrotising mediastinitis
Bulut et al.
Emerg. Med. J. 2004;21:122-123.
ABSTRACT | FULL TEXT  

Descending Cervical Mediastinitis
Kiernan et al.
Ann. Thorac. Surg. 1998;65:1483-1488.
ABSTRACT | FULL TEXT