Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description

Abstract

Background: Descending necrotizing mediastinitis is a serious infection involving the neck and the chest, in which an odontogenic, pharyngeal, or cervical infection spreads rapidly to the thoracic cavity, with a high death rate by sepsis and organic failure if not treated quickly and properly.

Methods: A systematic search in the electronic database PubMed was conducted using the keywords "mediastinitis" and "descending necrotizing mediastinitis" resulting in 2560 items, filters were activated (systematic review, meta-analysis, and clinical trial) resulting in 60 articles, from which we selected relevant articles on the topic.

Results: The best available evidence we could obtain was from 26 case series with evidence level III. The overall mortality in this period was 17.5%.

Conclusion: For mediastinitis limited to the upper part of the mediastinum, transcervical drainage may be sufficient; cases that extended below the tracheal carina may require cervical and transthoracic drainage. A multidisciplinary therapeutic approach has allowed a reduction in its mortality. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2275-E2283, 2016.

Keywords: descending necrotizing mediastinitis; mediastinitis; systematic review; transcervical drainage; transthoracic drainage.