International Journal of Oral and Maxillofacial Surgery
Clinical Paper
Oral MedicineCervical infection with descending mediastinitis: a review of six cases
Oral Medicine
Section snippets
Patients and methods
A retrospective review was conducted of patients who were diagnosed with cervical infection and descending mediastinitis from December 1998 to June 2005. Ultimately, six patients were included in this study. Their demographics, aetiology, associated systemic diseases, bacteriology, radiology, treatments, duration of hospitalization, complications and outcomes were reviewed. The diagnosis of acute descending mediastinitis was confirmed through clinical manifestations, chest radiography, or
Results
The demography, aetiology, underlying systemic factors and duration of hospital stay of the six patients are shown in Table 1. The delay between onset of primary infection and hospitalization varied from 1 to 30 days (mean, 16 days). Predominant symptoms on hospitalization were recorded (Table 2, Fig. 1).
Diagnostic imaging was used to diagnose, confirm and anatomically delineate cervical and mediastinal infections. Chest radiography was applied in all patients, and a widening of the upper
Discussion
Descending mediastinitis is an acute infection secondary to severe cervical infection. The most common primary infection is odontogenic. Infections in the head and neck can spread down into the mediastinum along the retropharyngeal space (71% of cases) or carotid sheath (21% of cases), facilitated by gravity, breathing and negative intrathoracic pressure7, 17.
Descending mediastinitis is an uncommonly reported but potentially highly lethal entity. It was reported that 49% of patients died during
Acknowledgements
This study is supported by grant of Shanghai leading academic discipline fund (Y0203). We would like to express our thanks to Professor Harry C. Schwartz, Department of Maxillofacial Surgery, Southern California Permanente Medical Group, for his helpful comments on this manuscript.
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