Retrospective analysis of 59 patients with descending necrotizing mediastinitis from oral and maxillofacial space infection

A retrospective analysis aimed to identify the clinical features of patients with descending necrotizing mediastinitis (DNM) to improve the effects of treatment and prognosis.

The clinical data of 59 patients with DNM who were treated in the Department of Oncology of Oral and Maxillofacial Surgery of the Affiliated Stomatology Hospital of Xinjiang Medical University and transferred to the intensive care unit (ICU) were retrospectively analyzed from March 2010 to March 2020. Statistical analysis was performed to identify the risk factors that were associated with mortality.

A total of 59 patients were identified: 21 cases of DNM typeⅠ (35.6%), 19 cases of DNM typeⅡA (32.2%), and 19 cases of DNM type ⅡB (32.2%). All patients with DNM received emergency surgery. Patients with typeⅠ and ⅡA underwent anterior mediastinal xiphoid incision and drainage combined with thoracic drainage. The thoracic mediastinum was completely debrided, and postoperative drainage was performed in type ⅡB patients. Pus samples from all 59 DNM patients were cultured for bacteria, and 19 of them were positive. Systemic antiinflammatory therapy was administered. Five patients died (8.5%), and 54 patients survived (91.5%). Compared with the survival group, the mortality group had a higher proportion of patients aged ≥65 years, with diabetes, with an interval from admission to ICU ≥6 days, with an APACHE Ⅱ score ≥20 days, with a duration of ICU treatment ≥10 days, and with septic shock, with statistically significant differences (P < 0.05).

Timely transfer to the intensive care unit for treatment combined with early active surgery and timely treatment of systemic diseases and systemic antimicrobial therapy is the key to reducing DNM mortality.