Revista argentina de cirugía
Print version ISSN 2250-639X
RUIZ, Claudio A; OTERO, Walter G; GIACOIA, Alejandro D and DUZA, Guillermo E. Mediastinitis necrotizante descendente: Dieciséis años de experiencia. Rev. argent. cir. [online]. 2012, vol.102, n.1, pp. 7-11. ISSN 2250-639X.
Background: The descending necrotizing mediastinitis is a slightly frequent entity of high mortality that originates itself in septic oropharyngeal processes or poorly drained cervicals. The passage of infected material is realized across the parapharyngeal area and hence for the retrovisceral area towards the back mediastinum. Objective: To define the diagnostic parameters to recognize prematurely this affection and to select rapidly the effective surgical treatment which help us diminish the high rate of mortality of this severe complication. Setting: University Nacional Hospital. Design: Retrospective and descriptive. Population: Hospital practice. Material and method: Between 1995 and 2011, 12 patients, including seven men and five women were treated with necrotizing mediastinitis. The critical area was an abscess toothwort for 9 and tonsil' abscess for 2, abscess post-fractures of maxillary and mastoiditis in 1 respectively. They all presented cervical edema, fever and pain and they were studied by conventional radiology and cervicothoracic TAC in the beginning. The time of delay between the first consult and the visit in our hospital was over 72 h. in 75% of the cases. They all were treated with double medical approach, both cervical and thoracic. On the other hand, 4 patients faced only thoracic bilateral medical approach. Results: The medical complications arised were: respiratory distress in 7, bronchopneumonia in 3, cervical hemorrhage and urinary infection in 1. 4 were re-operated. The mortality was 33% (4 out of 12 patients). Conclusion: Though the descending necrotizing mediastinitis is a rare entity, its seriuosness forces us to consider it as a critical medical issue while tackling any cervical abscess not drained. Under these circumstances the cervicothoracic TAC, along with an aggressive therapeutic surgery, is the key factor to obtain a precocious diagnosis and an effective treatment.
Keywords : Odontogenic abscess; Mediastinitis; Thoracotomy.