HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Marty-Ane, C.-H. Articles by Mary, H. Search for Related Content PubMed PubMed Citation Articles by Marty-Ane, C.-H. Articles by Mary, H.

J Thorac Cardiovasc Surg 1994;107:55-61
© 1994 Mosby, Inc.

GENERAL THORACIC SURGERY

Descending necrotizing mediastinitisAdvantage of mediastinal drainage with thoracotomy

Montpellier, France

Received for publication Feb. 22, 1993. Accepted for publication April 12, 1993. Address for reprints: Charles-Henri Marty-Ane, MD, Service de Chirurgie Thoracique et Vasculaire, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire, 34059 Montpellier Cedex, France.

Abstract

Descending necrotizing mediastinitis can occur as a complication of oropharyngeal and cervical infections that spread to the mediastinum via the cervical spaces. Delayed diagnosis and inadequate mediastinal drainage through a cervical or minor thoracic approach are the primary causes of a high published mortality rate (near 40%). Between 1985 and 1992, six men (mean age, 49 years) with descending necrotizing mediastinitis were surgically treated at our institution. The primary oropharyngeal infection was peritonsillar abscess (three cases) and odontogenic abscess (three cases). In all cases, occurrence of respiratory insufficiency associated with serious cervical infection suggested the mediastinitis diagnosis. Computed tomographic scans confirmed the mediastinitis, showing mediastinal abscess and mediastinal emphysema. All patients underwent surgical drainage of the deep neck infection combined with mediastinal drainage through a thoracic approach. The outcome was favorable in five patients who had mediastinal drainage through a thoracotomy; the patient who had mediastinal drainage through a minor thoracic approach (anterior mediastinotomy) died of tracheal fistula on postoperative day 18. In our experience, aggressive mediastinal drainage by a thoracotomy approach regardless of the level of mediastinal involvement led to improvement in survival of these patients, with a 17% mortality rate. (J THORAC CARDIOVASC SURG 1994;107:55-61)

This article has been cited by other articles:

				Y. Sumi, H. Ogura, Y. Nakamori, I. Ukai, O. Tasaki, Y. Kuwagata, T. Shimazu, H. Tanaka, and H. Sugimoto Nonoperative Catheter Management for Cervical Necrotizing Fasciitis With and Without Descending Necrotizing Mediastinitis Arch Otolaryngol Head Neck Surg, July 1, 2008; 134(7): 750 - 756. [Abstract] [Full Text] [PDF]

				M. Gorlitzer, M. Grabenwoeger, J. Meinhart, H. Swoboda, W. Oczenski, N. Fiegl, and F. Waldenberger Descending Necrotizing Mediastinitis Treated With Rapid Sternotomy Followed by Vacuum-Assisted Therapy Ann. Thorac. Surg., February 1, 2007; 83(2): 393 - 396. [Abstract] [Full Text] [PDF]

				M. R. Aerni, J. G. Parambil, M. S. Allen, and J. P. Utz Nontraumatic disruption of the fibrocartilaginous trachea: causes and clinical outcomes. Chest, October 1, 2006; 130(4): 1143 - 1149. [Abstract] [Full Text] [PDF]

				K. Shimizu, Y. Otani, T. Nakano, Y. Takayasu, Y. Yasuoka, and Y. Morishita Successful Video-Assisted Mediastinoscopic Drainage of Descending Necrotizing Mediastinitis Ann. Thorac. Surg., June 1, 2006; 81(6): 2279 - 2281. [Abstract] [Full Text] [PDF]

				T. Iwata, Y. Sekine, K. Shibuya, K. Yasufuku, A. Iyoda, T. Iizasa, Y. Saito, and T. Fujisawa Early open thoracotomy and mediastinopleural irrigation for severe descending necrotizing mediastinitis Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 384 - 388. [Abstract] [Full Text] [PDF]

				Y. Inoue, M. Gika, K. Nozawa, Y. Ikeda, and I. Takanami Optimum drainage method in descending necrotizing mediastinitis Interactive CardioVascular and Thoracic Surgery, June 1, 2005; 4(3): 189 - 192. [Abstract] [Full Text] [PDF]

				S-L Chou, C-H Chern, J-D Chen, C-K How, L-M Wang, and C-H Lee Descending necrotising mediastinitis: a report of misdiagnosis as thoracic aortic dissection Emerg. Med. J., March 1, 2005; 22(3): 227 - 228. [Abstract] [Full Text] [PDF]

				S. Endo, T. Hasegawa, Y. Sato, and Y. Sohara Is Video-Assisted Thoracoscopic Surgery an Optimal Approach for Descending Necrotizing Mediastinitis? Ann. Thorac. Surg., February 1, 2005; 79(2): 751 - 751. [Full Text] [PDF]

				F. Stella and F. Petrella Transsternal transpericardial approach for acute descending necrotizing mediastinitis J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 212 - 214. [Full Text] [PDF]

				M Bulut, V Balci, S Akkose, and E Armagan Fatal descending necrotising mediastinitis Emerg. Med. J., January 1, 2004; 21(1): 122 - 123. [Abstract] [Full Text] [PDF]

				T. Nagayasu, S. Akamine, T. Oka, and M. Muraoka Thoracoscopic drainage with wound edge protector for descending necrotizing mediastinitis Interactive CardioVascular and Thoracic Surgery, March 1, 2003; 2(1): 58 - 60. [Abstract] [Full Text] [PDF]

				H. Kato, N. Ohkubo, K. Akazawa, H. Iseki, and M. Haruna Spontaneous closure of a large tracheal fistula due to descending necrotizing mediastinitis Ann. Thorac. Surg., April 1, 2000; 69(4): 1249 - 1251. [Abstract] [Full Text] [PDF]

				R. K. Freeman, E. Vallieres, E. D. Verrier, R. Karmy-Jones, and D. E. Wood DESCENDING NECROTIZING MEDIASTINITIS: AN ANALYSIS OF THE EFFECTS OF SERIAL SURGICAL DEBRIDEMENT ON PATIENT MORTALITY J. Thorac. Cardiovasc. Surg., February 1, 2000; 119(2): 260 - 267. [Abstract] [Full Text] [PDF]

				C.-H. Marty-Ane, J.-P. Berthet, P. Alric, J.-D. Pegis, P. Rouviere, and H. Mary Management of descending necrotizing mediastinitis: an aggressive treatment for an aggressive disease Ann. Thorac. Surg., July 1, 1999; 68(1): 212 - 217. [Abstract] [Full Text] [PDF]

				P. D. Kiernan, A. Hernandez, W. D. Byrne, R. Bloom, B. Dicicco, V. Hetrick, P. Graling, and B. Vaughan Descending Cervical Mediastinitis Ann. Thorac. Surg., May 1, 1998; 65(5): 1483 - 1488. [Abstract] [Full Text] [PDF]

				H.-B. Ris, A. Banic, M. Furrer, M. Caversaccio, A. Cerny, and P. Zbaren Descending Necrotizing Mediastinitis: Surgical Treatment Via Clamshell Approach Ann. Thorac. Surg., December 1, 1996; 62(6): 1650 - 1654. [Abstract] [Full Text]