Silver Eric, Bial Nicholas, Yusupov Steve
Oral and Maxillofacial Surgery, Kings County Hospital Center, Brooklyn, USA.
Head and Neck Oncology, Staten Island University Hospital, Staten Island, USA.
Cureus. 2022 May 3;14(5):e24709. doi: 10.7759/cureus.24709. eCollection 2022 May.
Descending necrotizing mediastinitis (DNM) is an uncommon and life-threatening condition that arises from an oropharyngeal infection and descends along the cervical fascial planes into the mediastinum. Without aggressive surgical management, a high mortality rate exists. We report a case of an otherwise healthy 49-year-old male who presented with an abscess formation of the right submandibular gland secondary to sialadenitis without sialolithiasis. Computed tomography revealed fluid collection around the right submandibular gland suggestive of sialadenitis without sialolithiasis with severe inflammation and leftward deviation of the aerodigestive tract. Despite multiple drainages, the infection eventually progressed inferiorly into the mediastinum, resulting in DNM. After multiple takebacks to the operating room for exploration and washout of the neck and chest, intensive care unit management, and aggressive IV antibiotic therapy, the patient eventually had a successful recovery and was discharged home. In this paper, the etiology, anatomy, pathophysiology, and management of DNM are discussed. To our knowledge, this is the first report in the literature of DNM developing from sialadenitis without sialolithiasis in the submandibular gland.
下行性坏死性纵隔炎（DNM）是一种罕见且危及生命的疾病，它源于口咽感染，并沿颈部筋膜平面下行至纵隔。若不进行积极的手术治疗，死亡率很高。我们报告一例49岁的健康男性病例，该患者因涎腺炎继发右侧下颌下腺脓肿形成，无涎石病。计算机断层扫描显示右侧下颌下腺周围有液体积聚，提示无涎石病的涎腺炎伴严重炎症及气道消化道向左移位。尽管进行了多次引流，但感染最终向下蔓延至纵隔，导致DNM。在多次返回手术室进行颈部和胸部探查及冲洗、重症监护病房管理以及积极的静脉抗生素治疗后，患者最终成功康复并出院。本文讨论了DNM的病因、解剖结构、病理生理学及治疗方法。据我们所知，这是文献中首例由下颌下腺无涎石病的涎腺炎发展而来的DNM报告。
