Abstract
Objective
To emphasize the salient features of surgical management of Mediastinitis occurring secondary to deep neck infections.
Study design
Case series. Retrospective analysis
Setting
Institutional teaching department
Patients Four consecutive cases of mediastinal abscess treated between 1990 to 1996. Selection criteria were presence of deep neck infection radiological evidence of widening of mediastinum and confirmation of mediastinal infection at surgery. Computerized tomography of neck and thorax was done in one case to document the extent of abscess.
Sargical management
All the patients underwent transcervical drainage of neck abscess and superior mediastintomy. The involved spaces in the neck and mediastinum were irrigated with betadine antimicrobial solution and negative suction drains put in the superior mediastinum ta facilitate contituous drainage of the mediastinum. One patient required intercostal chest drainage for associated empyema. Tracheotomy was done in all the patients.
Results
All the patients survived and discharged after a hospital stay of around three weeks.
Conclusions
Mediastinal complication of deep neck infections can he alarmingly rapid and can be effectively managed by early recognition and aggressive surgical drainage combined with antibiotic therapy after appropriate aerobic and anaerobic cultures.
Similar content being viewed by others
References
Barratt GE, Koopmann CF, Coulthard SW. (1984). Retropharyngeal abscess. A ten-year experience. Laryngoscope. 94:455–463.
Bartlett JG, Gorback SL. (1976). Anaerobic infections of head and neck. Otolayngol Clin North Am. 9: 655–678.
Brook I, Hirokawa R. (1989). Microbiology of wound infection after Head and neck cancer surgery. Ann. Otol. Rhinol. Laryngol. 98:323–325.
Brunelli A, Sabbatini A, Catalini G, Fianchini A. (1996). Descending necrotizing mediastinitis. Surgical drainage and Tracheostomy. Arch. Otolaryngol Head Neck Surg. 122:1326–1329.
Dean LW. (1919) The proper procedure for External drainage of retropharyngeal abscess secondary to caries of the vertebrae. Ann. Otol. Rhinol. Laryngol. 28:566–572.
Estera AS, Landay MJ, Grisham MJ. (1983) Descending necrotizing mediastinitis. Surg. Gynecolm, Obstet. 157:545–547.
Gianoli GJ, Espinola TE, Guarisco JL et.al. (1991). Retropharyngeal space infection. Changing trends. Otolaryngol Head Neck Surg. 105:92–100.
Horn J, Bender BS, Bartlett JG. (1991). Role of anaerobic bacteria in perimandibular space infections. Ann. Otol. Rhinol. 100(Supp 154): 34–39.
Howell HS, Prinz RA, Pickleman JR.(1976) Anaerobic mediastinitis. Surg Gynecol Obstet. 143:353–359.
Levine TM, Wurster CF, Krespi YP (1986) Mediastinitis occurring as a complication of odontogenic infections. Laryngoscope. 96:747–750.
Marty-Ane CH, Alauen M, Alnc P, Serrescousine O, Mary H. (1994) Descending necrotizing mediastinitis. Advantage of mediastinal drainage with thoracotomy J. Thorac. Cardiovasc. Surg. 107:55–61.
Sethi DS, Stanley RE. (1994) Deep neck abscesses. Changing trends. JL Laryngol. Otol. 108:138–143.
Shumrick KA, Sheft SA.(1991) Deep neck infections. In: Paparella MM, Shumrick DA, Gluckman JL et.al. Eds Otolaryngology 3rd Ed. Philadelphia:WB Saunders:2545–2563.
Snow N, Lucas A E, Grau M, Steiner M. (1983) Purulent mediastinal abscess secondary to Ludwig’s angina. Arch. Otolaryngol. 109:53–55.
Spankus EM, Flint PW, Smith RJH et.al. (1984) Craniocervical necrotizing fasciitis. Otoalryngol Head Neck Surg. 92:261–265.
Stone HH, Martin JD (1972) Synergistic necrotizing cellulitis. Ann. Surg. 175:702.
Tom MB, Rice DH. (1988) Presentation and management of neck abscess: a retrospective analysis. Laryngoscope. 98:877–881.
Watanabe M, Ohshika Y, Aoki T, Takagi K, Tanaka S, Ogata T. (1994) Empyema and mediastinitis complicating retropharyngeal abscess. Thorax 49:1179–1180.
Wheatley MJ, Stirling MC, Kirsh MM, Gago O, Orringer MB. (1990) Descending necrotizing mediastinitis. Trans cervical drainage is not enough. Ann Thorac. Surg. 49:780–784.
Willis PI, Vemon RP. (1981) Complications of space infections of the head and neck. Laryngoscope. 91:1129–1136.
Yousry El-Sayed, Dousary SA. (1996). Deep neck space abscesses. Jl. Of otoiaryngol. 25(4):227–233.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Panda, N.K., Mann, S.B.S. & Sharma, S.C. Mediastinitis following deep neck infections : A therapeutic challenge. Indian J Otolaryngol Head Neck Surg 52, 391–395 (2000). https://doi.org/10.1007/BF02991489
Issue Date:
DOI: https://doi.org/10.1007/BF02991489