Descending necrotizing mediastinitis – a surgical view

Czech version

Authors: J. Šafránek
Authors‘ workplace: Chirurgická klinika LF UK a FN Plzeň
Published in: Rozhl. Chir., 2024, roč. 103, č. 12, s. 502-507.
Category: Review
doi: https://doi.org/10.48095/ccrvch2024502

Overview

Introduction: Descending necrotizing mediastinitis (DNM) is a relatively uncommon but serious type of inflammation. Even today, the mortality is around 20%. An overview of DNM issues, recent literature and clinical practice of our department is presented.

Anatomy and etiology: The cause is the descent of an originally oropharyngeal infection from the deep neck space into the mediastinum.

Therapy: Treatment takes place in an intensive care department, with a combination of antibiotics. Elimination of the neck source of inflammation is a prerequisite. The type of surgical drainage depends on the stage and extent of mediastinal involvement. Cervicomediastinal, mediastinothoracic, or cervicomediastinothoracic “Rendezvous” drainage are options.

Conclusion: The basis of DNM treatment is adequate surgical drainage, but interdisciplinary care (surgeon, anesthesiologist, ENT and dental surgeon) is a necessary condition.

Keywords:

surgical treatment – descending necrotizing mediastinitis – types of drainage

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doc. MUDr. Jarmil Šafránek, Ph.D.

Chirurgická klinika

LF UK a FN Plzeň

alej Svobody 80

304 60 Plzeň-Lochotín

safranek@fnplzen.cz