Surgical treatment of descending necrotising mediastinitis caused by odontogenic infection: a retrospective analysis of 20 patients

Abstract

OBJECTIVES: Analysing the results of patients with odontogenic descending necrotising mediastinitis (DNM) treated predominantly by transcervical approach. BACKGROUND: Odontogenic DNM is a rare but serious complication of dental disease and dental procedures. METHODS: Retrospective evaluation of 20 patients who underwent surgery for odontogenic DNM. RESULTS: The mean age was 33.95±12.24 years, and 18 patients (90 %) were men. Type I and diffuse form of DNM were identifi ed in 8 (40 %) and 12 (60 %) patients, respectively. The mean time between the onset of symptoms and surgery was 7.16±4.23 days. The transcervical approach was used in 16 patients, combined cervicotomy and subxiphoid incision in three patients, and cervicotomy and posterolateral thoracotomy was used in one patient. Four patients were reoperated. The mean mediastinal drainage duration and postoperative length of stay (LOS) were 17.05±10.27 days and 20.70±10.87 days, respectively. Fourteen (70 %) patients received mechanical ventilation with a mean duration of 8.86±9.55 days. Comorbidities were present in fi ve (26 %) patients; there were complications in 17 (85 %) patients. In-hospital mortality reached 5 % (1 patient). Thirty-fi ve teeth were extracted. Lower mandibular molars represented 21 (62 %) of extracted teeth. Submandibular and submental spaces were the most affected by the presence of deep neck infection (fi ve and four cases, respectively). CONCLUSION: This study supports the role of transcervical mediastinal drainage as an alternative approach in the surgical treatment of odontogenic DNM (Tab. 4, Fig. 2, Ref. 30). Text in PDF www.elis.sk