Diagnosis and treatment of descending necrotizing mediastinitis in 111 patients

doi:10.19438/j.cjoms.2018.01.013

China Journal of Oral and Maxillofacial Surgery ›› 2018, Vol. 16 ›› Issue (1): 60-63.doi: 10.19438/j.cjoms.2018.01.013

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Diagnosis and treatment of descending necrotizing mediastinitis in 111 patients

QU Lu-yao¹, JIANG Bin¹, QIAN Wen-tao¹, CAI Xie-yi¹, ZHANG Wei-jie¹, LIANG Xiang², GUAN Xin²

1.Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology. Shanghai 200011;
2.Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2017-04-24 Revised:2017-07-28 Online:2018-01-20 Published:2018-02-11

Abstract

Abstract: PURPOSE: To explore the clinical manifestation and early diagnosis and treatment of descending necrotizing mediastinitis, in order to decrease its mortality. METHODS: We retrospectively reviewed 111 patients with DNM who were treated in Shanghai Ninth People's Hospital from January 2013 to October 2016. The clinical data were recorded,including sex, age, comorbidities, original infections, imaging results, microbiological examination, treatment, and outcomes. RESULTS: A total of 111 patients were collected in the study, with an average age of 56.6±12.5 years. The male-to-female ratio was 5.6∶1. The main source of infection was odontogenic infection, followed by glandular infection. There were 52 patients (46.8%) with comorbidities, with diabetes mellitus being the most common. The main pathogen was Streptococcus. All patients received antibiotic therapy and drainage for abscess in cervical region. 106 patients underwent mediastinal drainage with transcervical incision, and 9 patients underwent thoracotomy. The mortality rate was 6.3%. CONCLUSIONS: Chest CT is an effective tool for early diagnosis of descending necrotizing mediastinitis. At the same time, early efficacious antibacterial treatment, aggressive surgical debridement and supportive therapy are the key factors in reducing mortality of descending necrotizing mediastinitis.

Key words: Descending necrotizing mediastinitis, Mediastinal drainage, Thoracotomy, Odontogenic infection

CLC Number:

R782.3

QU Lu-yao, JIANG Bin, QIAN Wen-tao, CAI Xie-yi, ZHANG Wei-jie, LIANG Xiang, GUAN Xin. Diagnosis and treatment of descending necrotizing mediastinitis in 111 patients[J]. China Journal of Oral and Maxillofacial Surgery, 2018, 16(1): 60-63.

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Diagnosis and treatment of descending necrotizing mediastinitis in 111 patients

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