Descending Necrotizing Mediastinitis; A Report of Three Cases. In Surgical Approach.

Descending necrotizing mediastinitis (DNM) resulting from oropharyngeal abscess, is a serious and life-threatening infection. However, surgical management, by transcervical, mediastinal drainage or aggressive thoracotomic drainages remains controversial. Recently, we encountered three cases of DNM at our institution. Case 1 was a 65-year-old male with sore throat, marked neck swelling and difficulty in swallowing. CT demonstrated an abscess, extending from the right parapharyngeal and retropharyngeal space to the vascular visceral and prevertebral space, transcervical and mediastinal drainage was performed. Case 2 was a 78-year-old male who complained of neck swelling after dental treatment. CT demonstrated gases in the parapharyngeal and retropharyngeal space. Only antibiotics were given. Surgery was not performed. Case 3 was a 54-year-old male with severe sore throat, neck swelling and dyspnea. CT demonstrated several abscess, ranging from parapharyngeal and retropharyngeal space in the neck to the vascular visceral and prevertebral space at the level of the sternum. Transcervical, mediastinal and thoracotomic drainage was performed bilaterally. In cases 1 and 3, drainage and irrigation of the neck and mediastinal abscess were performed in combination with antibiotic treatment. All cases recovered. CT was very useful for determing whether to perform surgery, including transcervical, mediastinal and thoracotomic drainage. In some cases, it may be appropriate to drain the abscess during the early stage.