Cirino Luis Marcelo Inaco, Elias Fernando Melhem, Almeida José Luiz Jesus de
Department of Surgery, Hospital Universitário, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Sao Paulo Med J. 2006 Sep 7;124(5):285-90. doi: 10.1590/s1516-31802006000500011.
Mediastinitis is an inflammation of connective tissue that involves mediastinal structures. When the condition has an infectious origin located in the cervical or oral region, it is termed "descending mediastinitis" (DM).
The subject was examined in the light of the authors' own experiences and by reviewing the literature available on the subject. The Medline, Lilacs and Cochrane databases were searched for articles, without time limits, screening for the term "descending mediastinitis". The languages used were English and Spanish.
There are three main fascial pathways by which oral or cervical infections can reach the mediastinum: pretracheal, lateropharyngeal and retropharyngeal. About 70% of DM cases occur via the retropharyngeal pathway. The mortality rate is about 50%. According to infection extent, as seen using computed tomography, DM can be classified as focal (type I) or diffuse (type II). The clinical manifestations are nonspecific and resemble other systemic infections or septic conditions. The primary treatment for DM consists of antibiotics and surgical drainage. There are several approaches to treating DM; the choice of approach depends on the DM type and the surgeon's experience. In spite of all the improvements in knowledge of the microbiology and physiopathology of the disease, controversies still exist regarding the ideal duration of antibiotic therapy and whether tracheostomy is really a necessary procedure.
Since DM is a lethal condition if not promptly treated, it must always be considered to represent an emergency situation.
纵隔炎是一种累及纵隔结构的结缔组织炎症。当病情起源于颈部或口腔区域的感染时，称为“下行性纵隔炎”（DM）。
根据作者自身经验并通过查阅该主题的现有文献对该主题进行研究。检索了Medline、Lilacs和Cochrane数据库中的文章，无时间限制，筛查“下行性纵隔炎”一词。使用的语言为英语和西班牙语。
口腔或颈部感染可通过三种主要的筋膜途径到达纵隔：气管前、咽旁和咽后。约70%的DM病例通过咽后途径发生。死亡率约为50%。根据计算机断层扫描所见的感染范围，DM可分为局灶性（I型）或弥漫性（II型）。临床表现不具特异性，与其他全身感染或脓毒症情况相似。DM的主要治疗方法包括使用抗生素和手术引流。治疗DM有几种方法；治疗方法的选择取决于DM的类型和外科医生的经验。尽管在该疾病的微生物学和生理病理学知识方面有了所有改进，但在抗生素治疗的理想持续时间以及气管切开术是否真的是必要程序方面仍存在争议。
由于DM若不及时治疗是一种致命疾病，因此必须始终将其视为紧急情况。
