[Descending necrotic mediastinitis--course and methods of surgical treatment].

Between 1995-2002 12 patients, (6 M and 6 F) aged 20-87, (mean 47 years), were treated surgically in our Clinic for descending necrotizing mediastinitis (DNM). The disease was caused by peridental abscess in 7 (54.5%) patients, by peritonsillar abscess in 4 (36.4%), and by retropharyngeal abscess in 1 (9.1%). Septic shock and acute respiratory failure were diagnosed in 11 (91.7%) patients on admission to the Clinic. Complains and clinical symptoms of various intensity appeared during 3-11 days, prior to admission. Extensive cervicotomy and mediastinal drainage were made in 6 patients, whereas cervicotomy and posterolateral thoracotomy in the other 6. Of the 12 patients, 2 (16.7%) survived. Postmortem eximinastions revealed in all patients gangrenous mediastinitis, pericarditis and empyema of both pleural cavities.1. No characteristic symptoms and low prevalence are essential causes of problems with proper diagnosis of DNM and related high death rate. 2. Early drainage of neck and mediastinum during thoracotomy should be considered as management of choice in patients with DNM. 3. Symptoms of septic shock, pneumonia, pericarditis or empyema diagnosed on admission to hospital are unfavourable prognostic factors.