DESCENDING CERVICAL MEDIASTINITIS

Descending cervical mediastinitis is an uncommonly reported presentati on of infection originating in the head or neck and descending into th e mediastinum, which is fraught with impressive morbidity and mortalit y rates of 30% to 40% or more. We present the INOVA-Fairfax-Alexandria Hospital experience with descending cervical mediastinitis, January 1 , 1986, to April 1, 1997; in addition we review the English-language m edical and surgical literature with regard to this entity. Computed to mography and magnetic resonance imaging serve to aid both diagnosis an d management. The application of broad-spectrum antibiotics should ini tially be empiric, with an eye to coverage of mixed aerobic and anaero bic infections. Definitive treatment mandates early and aggressive sur gical intervention. All affected tissue planes, cervical and mediastin al, must be widely debrided, often leaving them open for frequent pack ing and irrigation. The treating physician must remain always alert to the further extension of infection, which, if it occurs, must be furt her debrided and drained. Tracheostomy serves a dual role of further o pening cervical fascial planes and securing an often compromised airwa y. (C) 1998 by The Society of Thoracic Surgeons.