Descending necrotizing mediastinitis in patients with neck phlegmons

V.O. Shaprynskyi, V.F. Kryvetskyi, V.G. Suleimanova, B.O. Mityuk, Nasr Zaki Nageeb

Abstract


Objective: to study the results of treatment in patients with descending necrotizing mediastinitis, depending on the etiology and spread of suppuration. Materials and methods. 137 patients with deep neck phlegmons have been included. Descending necrotizing media­stinitis was diagnosed in 67 (48.9 %) of them. Results. In most cases, suppuration in the mediastinum arose from odontogenic neck phlegmons (34 patients, or 50.8 %). In 17 (25.4 %) cases of perforation of cervical esophagus and hypopharynx, pus extended downward into the posterior mediastinum. Paratonsillar and retropharyngeal abscesses were complicated by descending necrotizing mediastinitis in 13 (19.4 %) patients, and in 10 cases pus spread into the posterior mediastinum. In 56 (82 %) of the 67 observations, mediastinitis limited to the upper parts, and it was the same lesion of anterior-upper (27 persons, or 40.3 %) and posterior-upper (28, or 41.7 %) mediastinum. Spread to the inferior mediastinum was found in 7 (10.5 %) patients. Synchronous suppuration in the anterior-upper and posterior-upper parts of mediastinum was observed in 5 (7.5 %) cases. Surgical debridement of deep neck phlegmons has been always finished with the revision of the mediastinum through cervicomediastinotomy. During the surgery, a target search for directions of pus spread was performed according to their origin. Conclusions. Among the descending necrotizing mediastinitis, odontogenic neck phlegmons are the most common — a half of the cases (34 patients, or 50.8 %). Perforations of cervical esophagus are observed in 25.4 % of cases of descending necrotizing mediastinitis, and paratonsillar abscesses — in 19.4 %. Incision and drainage of deep neck phlegmons would always include a target revision of suppurations in the mediastinum, depending on their origin.

Keywords


mediastinitis; neck phlegmon; cervicotomy; media­stinotomy

References


Вижинис Е. И. Выбор тактики хирургического лечения глубоких флегмон шеи и перфораций пищевода, осложненных медиастинитом: автореф. дис... канд. мед. наук: 14.01.17 / Е. И. Вижинис; Гос. учреждение образования «Белорусская медицинская академия последипломного образования». — Минск, 2015. — 26 с.

Сніжко С.С. Причини та діагностика хворих із гнійним низхідним медіастинітом / С.С. Сніжко // Збірник наукових праць співробітників НМАПО ім. П. Л. Шупика. — 2015. — Вип. 24(1). — С. 159-166.

Флегмоны шеи и торакальные инфекционные осложнения / В.П. Быков, М.А. Калинин, О.В. Собинин [и др.] // Российская отоларингология. — 2011. — № 2. — С. 54-61.

Acute mediastinitis: evaluation of clinical risk factors for death in surgically treated patients / S. Jabłoński, M. Brocki, J. Kordiak [et al.] // ANZ J. Surg. — 2013. — № 83. — P. 657-663.

Descending necrotizing mediastinitis of oropharyngeal origin — a retrospective 15 years study / C. Roman, M. Lazar, M. Ghergie [et al.] // HVM Bioflux. — 2015. — Vol. 7. — № 4. — P. 381-386.

Descending necrotizing mediastinitis: surgical therapy and outcome in a single-centre series / G.J. Kocher, B. Hoksch, J. Wiegand [et al.] // European Journal of Cardio-thoracic Surgery. — 2012. — № 42. — P. 66-72.

Esophageal perforation and acute bacterial mediastinitis: other causes of chest pain that can be easily missed / M.R. Cross, F. Miles, M.F. Greenwald [et al.] // Medicine. — 2015. — Vol. 94. — № 32. — P. 56-61.

Sokouti M. Descending necrotizing mediastinitis of oropharyngeal infections / M. Sokouti, S. Nezafati // J. Dent. Res. Dent. Clin. Dent. Prospect. — 2009. — Vol. 3. — № 3. — P. 82-85.




DOI: https://doi.org/10.22141/1997-2938.1.32.2017.98489

Refbacks

  • There are currently no refbacks.


Copyright (c) 2017 UKRAINIAN JOURNAL OF SURGERY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru