Simpson L C, Peters G E
Division of Otolaryngology, University of South Alabama Medical Center, Mobile 36617.
Arch Otolaryngol Head Neck Surg. 1988 Aug;114(8):909-12. doi: 10.1001/archotol.1988.01860200093026.
A review of the world literature has failed to reveal any published reports of poststernotomy mediastinitis presenting as a deep neck infection. This article presents two such cases. Since the fascial layers of the mediastinum are a direct continuation of the cervical fascia, a number of potential pathways between the neck and mediastinum exist. Descending infection from the neck into the mediastinum is well documented. The reverse situation, an ascending infection from the mediastinum into the neck, is not described despite the potential natural pathways available for spread of infection. Our proposed mechanism for these two cases is that a surgically created pathway from the mediastinum to the lower neck allows for mediastinitis to point in the intercommunicating fascial spaces of the neck. Recognition of this clinical presentation will allow the surgeon to use prompt intervention for such a serious complication.
对世界文献的回顾未能发现任何已发表的关于胸骨切开术后纵隔炎表现为深部颈部感染的报告。本文介绍了两例此类病例。由于纵隔的筋膜层是颈筋膜的直接延续，颈部和纵隔之间存在许多潜在的通道。颈部感染向下蔓延至纵隔已有充分记载。尽管存在感染传播的潜在自然通道，但从纵隔向上蔓延至颈部的相反情况却未见描述。我们对这两例病例提出的机制是，手术造成的从纵隔到下颈部的通道使纵隔炎指向颈部相互连通的筋膜间隙。认识到这种临床表现将使外科医生能够对这种严重并发症进行及时干预。
