Descending necrotizing mediastinitis in patients with deep neck phlegmon due to oropharyngeal infection

Abstract

Among the diseases leading to deep neck infection (DNI) and descending necrotizing mediastinitis (DNM), odontogenic causes are the most prevalent, accounting for 40–70% of cases. Tonsillo-pharyngeal causes follow at 16–30%, while other etiologies do not exceed 6%. Materials and methods: A retrospective analysis was conducted, examining the clinical course, diagnostic measures, and treatment strategies of 139 patients with DNI due to oropharyngeal inflammatory diseases. These patients were treated at the Poltava Regional Clinical Hospital from 2012 to 2023. Based on the primary source of infectious/purulent inflammation, patients were divided into two groups. Group I included 25 patients with tonsillo-pharyngeal origin of DNI; Group II consisted of 114 patients with dental origin of DNI. The study assessed the course, diagnosis, and treatment outcomes based on the parameters of gender, age, etiological factor, underlying pathology, disease duration before hospitalization, initiation of antibiotic therapy, type of DNM based on spread pattern, causative agent, severity of condition upon admission, signs of sepsis, type of surgical intervention, postoperative complications, duration of treatment in the intensive care unit, overall hospitalization duration, and mortality. Results: Oropharyngeal infection is the predominant cause of DNI and DNM. Notably, odontogenic DNI is more frequently observed than tonsillopharyngeal DNI (82.0% vs. 18.0%). Its progression is characterized by lower mortality (13.2% vs. 24.0%) and a reduced risk of DNM onset (7.0% vs. 44.0%). However, odontogenic DNM is more often associated with adverse outcomes (50.0% vs. 9.1%). Conclusions: Thus, frequency and severity of DNM in patients with DNI depends on the etiology of the disease, but the adverse consequences of treatment are largely influenced by weak concomitant pathology and sepsis during hospitalization.