Clinical Paper
Oral Medicine
Cervical infection with descending mediastinitis: a review of six cases

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Abstract

The aim of this study was to retrospectively review cases of cervical infection with descending mediastinitis, and to analyse the clinical character, diagnosis and treatment of this infection. Six patients were identified from December 1998 to June 2005. Their aetiology, associated systemic diseases, bacteriology, radiology, treatments and outcomes were reviewed. Four cases resulted from odontogenic infection, one from upper airway infection, and one had an unknown cause. Diffuse swelling in face and neck, chest distress, tachypnea, and fever were the main symptoms. Chest radiography showed a widening of the upper mediastinal shadow in four patients. Four patients underwent computed tomographic scanning that confirmed the diagnosis of descending mediastinitis, which suggests that routine use of this scan be highly recommended for early detection. Six different pathogens were identified through pus and blood culture. All patients underwent surgical drainage. Three patients received a tracheotomy. Of the six patients, four achieved good results, and there were two deaths. Early surgical drainage remains the main treatment for cervical infection with descending mediastinitis. Delayed diagnosis, inadequate drainage and multidrug-resistant bacterial infection were responsible for the deaths.

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.

References (23)

  • J. Gawrychowski et al.

    Descending necrotizing mediastinitis—course and methods of surgical treatment

    Pneumonol Alergol Pol

    (2003)
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