Descending mediastinitis in the context of Ludwig’s Angina. Article review
Article Sidebar
Main Article Content
Abstract
Mediastinitis is defined as the usually infectious inflammatory process of the mediastinal connective tissue and the organs it surrounds. Specifically, descending mediastinitis corresponds to a rare complication, an infection of deep spaces of the neck, oropharynx or oral cavity, which extends through the facial spaces of the neck, dissecting. Less frequent, this pathology can originate from parotiditis, skin infections of the neck or epiglottitis. Also less frequent it can be generated in the context of trauma to the neck or oral cavity (3).
This pathology leads to a significant increase in mortality and treatment, although it remains controversial in certain circumstances, it must be aggressive and timely. With regard to a case handled in our service, we review the state of the art in this entity. The authors refer to the attention in particular, to the aspects that involve the specialist.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Este artículo es publicado por la Revista Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello.
Este es un artículo de acceso abierto, distribuido bajo los términos de la LicenciaCreativeCommons Atribución-CompartirIgual 4.0 Internacional.( http://creativecommons.org/licenses/by-sa/4.0/), que permite el uso no comercial, distribución y reproducción en cualquier medio, siempre que la obra original sea debidamente citada.
eISSN: 2539-0856
ISSN: 0120-8411
References
Diamantis S, Giannakopoulos H, Chou J, Foote J. Descending necrotizing mediastinitis as a complication of odontogenic
infection. Int J Surg Case Rep. 2011;2(5):65-7. doi: 10.1016/j.ijscr.2011.01.004.
Pearse HE. Mediastinitis following cervical suppuration. Ann Surg. 1938;108(4):588-611. doi: 10.1097/00000658-
-00009.
Akulian JA, Yarmus L, Feller-Kopman D. The role of cricothyrotomy, tracheostomy, and percutaneous tracheostomy
in airway management. Anesthesiol Clin. 2015;33(2):357-67.doi: 10.1016/j.anclin.2015.02.009.
Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR.Descending necrotizing mediastinitis. Surg Gynecol Obstet.
;157(6):545-52.
Ueda S, Nishio K, Minamino N, Kubo A, Akai Y, Kangawa K, et al. Increased plasma levels of adrenomedullin in
patients with systemic inflammatory response syndrome. Am J Respir Crit Care Med. 1999;160(1):132-6. doi: 10.1164/
ajrccm.160.1.9810006.
Parhiscar A, Har-El G. Deep neck abscess: A retrospective review of 210 cases. Ann Otol Rhinol Laryngol. 2001;110(11):1051-4.doi: 10.1177/000348940111001111.
Deu-Martín M, Saez-Barba M, López Sanz I, Alcaraz Peñarrocha R, Romero Vielva L, Solé Montserrat J. Factores de
riesgo de mortalidad en la mediastinitis necrosante descendente [Mortality risk factors in descending necrotizing mediastinitis].Arch Bronconeumol. 2010;46(4):182-7. doi: 10.1016/j.arbres.2010.01.008.
Abu Abeeleh M, Al Smady M, Qasem H, Ennab R, Al Bsoul N. Descending necrotising mediastinitis, a fatal disease to keep
in mind. Heart Lung Circ. 2010;19(4):254-6. doi: 10.1016/j.hlc.2009.11.010.
Crespo AN, Chone CT, Fonseca AS, Montenegro MC, Pereira R, Milani JA. Clinical versus computed tomography
evaluation in the diagnosis and management of deep neck infection. Sao Paulo Med J. 2004;122:259-63. doi: S1516-
Hasegawa T, Endo S, Sohara Y. Classification of descending necrotizing mediastinitis. Ann Thorac Surg. 2000;69(4):1296.
doi: 10.1016/s0003-4975(00)01117-6.
Lindner HH. The anatomy of the fasciae of the face and neck with particular reference to the spread and treatment of intraoral infections (Ludwig’s) that have progressed into adjacent fascial spaces. Ann Surg. 1986;204(6):705-14. doi: 10.1097/00000658-198612000-00015.
Guidera AK, Dawes PJ, Fong A, Stringer MD. Head and neck fascia and compartments: No space for spaces. Head Neck.
;36(7):1058-68. doi: 10.1002/hed.23442.
Kitamura S. Anatomy of the fasciae and fascial spaces of the maxillofacial and the anterior neck regions. Anat Sci Int.
;93(1):1-13. doi: 10.1007/s12565-017-0394-x.
Standring S. Head and neck. En: Standring S, Borley NR, Cllins P, et al (editores). Gray’s anatomy: The anatomical
basis of clinical practice. 40ª edición. Philadelphia: Churchill Livingstone Elsevier. 2000. p. 397-703.
Shah RK, Chun R, Choi SS. Mediastinitis in infants from deep neck space infections. Otolaryngology Head Neck Surg.
;140:936-8. doi: 10.1016/j.otohns.2009.02.032.
Stambuk HE, Patel SG. Imaging of the parapharyngeal space. Otolaryngol Clin North Am. 2008;41(1):77-101. doi: 10.1016/j.otc.2007.10.012.
Cruz Toro P, Callejo Castillo À, Tornero Saltó J, González Compta X, Farré A, Maños M. Cervical necrotizing
fasciitis: Report of 6 cases and review of literature. Eur Ann Otorhinolaryngol Head Neck Dis. 2014;131(6):357-9. doi:
1016/j.anorl.2013.08.006.
Mark R, Song S, Mark P. Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to
primary odontogenic infection. BMJ Case Rep. 2018;bcr-2018-225019. doi: 10.1136/bcr-2018-225019.
Sakamoto H, Aoki T, Kise Y, Watanabe D, Sasaki J. Descending necrotizing mediastinitis due to odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(4):412-9. doi: 10.1016/s1079-2104(00)70121-1.
Argintaru N, Carr D. Retropharyngeal abscess: A subtle presentation of a deep space neck infection. J Emerg Med.
;53(4):568-569. doi: 10.1016/j.jemermed.2017.06.004.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International
guidelines for management of severe sepsis and septic shock:2012. Crit Care Med. 2013;41(2):580-637. doi: 10.1097/
CCM.0b013e31827e83af.
Poveda Roda R, Bagan JV, Sanchis Bielsa JM, Carbonell Pastor E. Antibiotic use in dental practice. A review. Med Oral Patol Oral Cir Bucal. 2007;12(3):E186-92.
Storoe W, Haug RH, Lillich TT. The changing face of odontogenic infections. J Oral Maxillofac Surg. 2001;59(7):739-
doi: 10.1053/joms.2001.24285.
Velasco I, Soto R. Principles for the treatment of odontogenic infections with different levels of complexity. Rev Chil Cir.
;64:586-98. doi: 10.4067/S0718-40262012000600016.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus
definitions for sepsis and septic shock (sepsis-3). JAMA.2016;315(8):801-10. doi: 10.1001/jama.2016.0287.
Vural C, Gungor A, Comerci S. Accuracy of computerized tomography in deep neck infections in the pediatric population. Am J Otolaryngol. 2003;24(3):143-8. doi: 10.1016/s0196-0709(03)00008-5.
Levitt GW. Cervical fascia and deep neck infections. Laryngoscope. 1970;80(3):409-35. doi: 10.1288/00005537-
-00004.
Daramola OO, Flanagan CE, Maisel RH, Odland RM. Diagnosis and treatment of deep neck space abscesses.
Otolaryngol Head Neck Surg. 2009;141(1):123-30. doi:10.1016/j.otohns.2009.03.033.
Kang SK, Lee S, Oh HK, Kang MW, Na MH, Yu JH, et al. Clinical features of deep neck infections and predisposing
factors for mediastinal extension. Korean J Thorac Cardiovasc Surg. 2012;45(3):171-6. doi: 10.5090/kjtcs.2012.45.3.171.
Roccia F, Pecorari GC, Oliaro A, Passet E, Rossi P, Nadalin J, et al. Ten years of descending necrotizing mediastinitis:
Management of 23 cases. J Oral Maxillofac Surg.2007;65(9):1716-24. doi: 10.1016/j.joms.2006.10.060.
Bhatt YM, Small M. Cervical necrotising fasciitis with descending necrotising mediastinitis. Postgrad Med J.
;87(1030):570. doi: 10.1136/pgmj.2010.117010.
Sandner A, Börgermann J, Kösling S, Bloching MB. “Descending necrotizing mediastinitis” infolge tiefer
Halsinfektionen. Inzidenz und Management [“Descending necrotizing mediastinitis” due to deep neck infections.
Incidence and management]. HNO. 2006;54(11):861-7. doi:10.1007/s00106-006-1396-5.
Makeieff M, Gresillon N, Berthet JP, Garrel R, Crampette L, Marty-Ane C, et al. Management of descending necrotizing
mediastinitis. Laryngoscope. 2004;114(4):772-5. doi:10.1097/00005537-200404000-00035.
Busch RF, Shah D. Ludwig’s angina: improved treatment. Otolaryngol Head Neck Surg. 1997;117(6):S172-5. doi:
1016/S0194-59989770093-7.
Jones AE, Trzeciak S, Kline JA. The sequential organ failure assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency
department presentation. Crit Care Med. 2009;37(5):1649-54.doi: 10.1097/CCM.0b013e31819def97.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-77.doi: 10.1056/NEJMoa010307.
Ovassapian A, Tuncbilek M, Weitzel EK, Joshi CW. Airway management in adult patients with deep neck infections: a case series and review of the literature. Anesth Analg. 2005;100(2):585-9. doi: 10.1213/01.ANE.0000141526.32741.CF.
Sarna T, Sengupta T, Miloro M, Kolokythas A. Cervical necrotizing fasciitis with descending mediastinitis:
Literature review and case report. J Oral Maxillofac Surg.2012;70(6):1342-50. doi: 10.1016/j.joms.2011.05.007.
Karkos PD, Leong SC, Beer H, Apostolidou MT, Panarese A. Challenging airways in deep neck space infections.
Am J Otolaryngol. 2007;28:415e418. doi: 10.1016/j.amjoto.2006.10.012.
Poeschl PW, Spusta L, Russmueller G, Seemann R, Hirschl A, Poeschl E, et al. Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:151-6. doi:10.1016/j.tripleo.2009.12.039.
Hasegawa J, Hidaka H, Tateda M, Kudo T, Sagai S, Miyazaki M, et al. An analysis of clinical risk factors of deep neck
infection. Auris Nasus Larynx. 2011;38(1):101-7. doi:10.1016/j.anl.2010.06.001.
Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N.Deep neck infections: A retrospective review of 112 cases.
Eur Arch Otorhinolaryngol. 2009;266(2):273-7. doi: 10.1007/s00405-008-0734-5.
Osborn, T. Assael, R. Deep space neck infección: Principles of surgical management. Oral Maxillofac Surg Clinic North Am.2008;20:356-65. doi: 10.1016/j.coms.2008.04.002
Gawrychowski J, Rokicki W, Rokicki M. Martwicze zstepujace zapalenie srodpiersia--przebieg i metody leczenia
chirurgicznego [Descending necrotic mediastinitis--course and methods of surgical treatment]. Pneumonol Alergol Pol.
;71(1-2):17-23.
Wheatley MJ, Stirling MC, Kirsh MM, Gago O, Orringer MB. Descending necrotizing mediastinitis: transcervical drainage
is not enough. Ann Thorac Surg. 1990;49(5):780-4. doi:10.1016/0003-4975(90)90022-x.
Larawin V, Naipao J, Dubey SP. Head and neck space infections. Otolaryngol Head Neck Surg. 2006;135(6):889-93.
doi: 10.1016/j.otohns.2006.07.007.
Lee YQ, Kanagalingam J. Deep neck abscesses: The Singapore experience. Eur Arch Otorhinolaryngol. 2011;268(4):609-14.doi: 10.1007/s00405-010-1387-8.
Santos Gorjón P, Blanco Pérez P, Morales Martín AC, Del Pozo de Dios JC, Estévez Alonso S, Calle de la Cabanillas MI. Deep neck infection. Acta Otorrinolaringol Esp. 2012;63(1):31-41.doi: 10.1016/j.otorri.2011.06.002.
Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003;24(2):111-7.doi: 10.1053/ajot.2003.31.
Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS.Deep neck infection: Analysis of 185 cases. Head Neck.
;26(10):854-60. doi: 10.1002/hed.20014.