THORACOSCOPIC MANAGEMENT OF DESCENDING NECROTIZING MEDIASTINITIS

Descending necrotizing mediastinitis (DNM) is a lethal process origina ting from odontogenic, pharyngeal, or cervical infectious sources that descends along fascial planes into the mediastinum. Despite earlier u se of antibiotics and surgical drainage, the mortality (>50%) has chan ged little since the first large series reported in the preantibiotic era. The surgical management remains controversial, with support rangi ng from cervical drainage alone to cervical drainage and routine thora cotomy. We report a case of thoracoscopic drainage and debridement of a mediastinal abscess resulting from descending necrotizing mediastini tis. The decreased morbidity of this approach compared with posterolat eral thoracotomy and the improved drainage of the mediastinum compared with cervical drainage support this method as an attractive managemen t of patients with DNM.