Mora Renzo, Jankowska Barbara, Catrambone Ugo, Passali Giulio Cesare, Mora Francesco, Leoncini Giacomo, Passali Francesco Maria, Barbieri Marco
ENT Department, University of Genoa, Italy.
Ear Nose Throat J. 2004 Nov;83(11):774, 776-80.
Descending necrotizing mediastinitis is a rare disease that is usually caused by a spreading, diffuse inflammatory reaction (phlegmon) to an odontogenic infection or peritonsillar abscess. Reported mortality rates range from 25 to 40%. The use of antibiotics and advances in resuscitation procedures and critical care techniques have not essentially improved survival, and an effective treatment has not been clearly established. We report the findings of our 10-year study of 21 patients affected by phlegmon and/or fasciitis of the neck. The aim of our contribution is to help define the clinical criteria and diagnostic procedures that will improve the early diagnosis of mediastinal sepsis secondary to neck fasciitis and to suggest optimal treatment approaches. Our experience indicates that (1) cervical drainage alone is sufficient for cases of cervical phlegmon or mediastinal involvement that are limited to a single superior mediastinal space and (2) thoracotomy and drainage of mediastinal collections is necessary when mediastinal sepsis is more extensive.
下行性坏死性纵隔炎是一种罕见疾病，通常由牙源性感染或扁桃体周围脓肿引发的弥漫性炎症反应（蜂窝织炎）蔓延所致。报告的死亡率在25%至40%之间。抗生素的使用以及复苏程序和重症监护技术的进步并未从根本上提高生存率，且尚未明确确立有效的治疗方法。我们报告了对21例颈部蜂窝织炎和/或筋膜炎患者进行的为期10年的研究结果。我们的研究目的是帮助确定临床标准和诊断程序，以改善对颈部筋膜炎继发纵隔败血症的早期诊断，并提出最佳治疗方法。我们的经验表明：（1）对于仅限于单个上纵隔间隙的颈部蜂窝织炎或纵隔受累病例，单纯颈部引流就足够了；（2）当纵隔败血症范围更广时，开胸手术和纵隔积液引流是必要的。
