Clinical significance of secondary purulent mediastinitis from odontogenic and tonsillogenic origins

The aim of this study was to enhance early diagnostic methods and improve the efficacy of surgical intervention in patients with secondary purulent mediastinitis of odontogenic and tonsillogenic origin through the introduction of novel drainage techniques and surgical approaches. The study methodology involved an analysis of clinical cases of acute purulent mediastinitis of odontogenic and tonsillogenic origin, divided into two groups: the main group (40 patients treated with new methods) and the control group (20 patients treated with traditional methods). Surgical treatment in the main group included the drainage of purulent-necrotic foci via external approaches with active drainage systems. For odontogenic forms, a “P”-shaped approach was employed, facilitating effective pus drainage and providing an improved surgical field overview. For tonsillogenic forms, the Kanshin method was utilized to drain the posterior mediastinum. Treatment was further complemented by antibacterial therapy, electrolyte balance correction, and ventilatory support when required. The results demonstrated that the combined use of these surgical methods yielded high treatment efficacy. All patients who underwent timely surgical intervention and received antibacterial therapy exhibited positive outcomes, allowing their discharge from hospital in satisfactory condition. The study’s conclusions underscore the critical importance of early diagnosis, the appropriate selection of surgical techniques, and the integration of multidisciplinary treatment approaches. Emphasis is placed on the necessity of active drainage of purulent-inflammatory foci, tailored surgical approaches based on the localization of the pathology, the application of modern diagnostic methods, and close collaboration between maxillofacial and thoracic surgeons to achieve optimal therapeutic outcomes.

Neal TW, Schlieve T. Complications of severe odontogenic infections: a review. Biology 2022;11:1784. DOI: https://doi.org/10.3390/biology11121784

Avetikov DS, Lychman VO, Lokes KP, et al. Treatment of odontogenic phlegmons in patients taking into account the biorithm of life. Wiad Lek 2021;74:1346-8. DOI: https://doi.org/10.36740/WLek202106111

Li RM, Kiemeney M. Infections of the neck. Emerg Med Clin North Am 2019;37:95-107. DOI: https://doi.org/10.1016/j.emc.2018.09.003

Thompson K, Connor J. When cultures fail: postmortem decoy receptor 3 (DCR3) as a marker of antemortem sepsis. Acad Forensic Pathol 2019;9:15-23. DOI: https://doi.org/10.1177/1925362119851075

Guan X, Liang X, Liang X, et al. A new classification of descending necrotizing mediastinitis and surgical strategies. Ann Transl Med 2021;9:356. DOI: https://doi.org/10.21037/atm-21-121

Ho CY, Chin S, Chen S. Management of descending necrotizing mediastinitis, a severe complication of deep neck infection, based on multidisciplinary approaches and departmental co-ordination. Ear Nose Throat J 2024;103:572-9. DOI: https://doi.org/10.1177/01455613211068575

Almutairi DM, Alqahtani RM, Alshareef N, et al. Deep neck space infections: a retrospective study of 183 cases at a tertiary hospital. Cureus 2020;12:e6841. DOI: https://doi.org/10.7759/cureus.c29

Yano M, Numanami H, Akiyama T, et al. Distribution of descending necrotizing mediastinitis and efficacy of distribution-specific drainage. J Thorac Dis 2020;12:2380-7. DOI: https://doi.org/10.21037/jtd.2020.03.82

La Russa R, Maiese A, Di Fazio N, et al. Post-traumatic meningitis is a diagnostic challenging time: a systematic review focusing on clinical and pathological features. Int J Mol Sci 2020;21:4148. DOI: https://doi.org/10.3390/ijms21114148

Sugio K, Okamoto T, Maniwa Y, et al. Descending necrotizing mediastinitis and the proposal of a new classification. JTCVS Open 2021;8:633-47. DOI: https://doi.org/10.1016/j.xjon.2021.08.001

Gehrke T, Scherzad A, Hagen R, Hackenberg S. Deep neck infections with and without mediastinal involvement: treatment and outcome in 218 patients. Eur Arch Otorhinolaryngol 2022;279:1585-92. DOI: https://doi.org/10.1007/s00405-021-06945-9

D’erme G, Galli M, Federici FR, et al. Report of a rare case of Lemierre’s syndrome associated with a multidrug resistant dental abscess. Otorinolaringologia 2020;70:6-10. DOI: https://doi.org/10.23736/S0392-6621.19.02235-5

Kimura A, Miyamoto S, Yamashita T. Clinical predictors of descending necrotizing mediastinitis after deep neck infections. Laryngoscope 2020;130:e567-72. DOI: https://doi.org/10.1002/lary.28406

Ricciardiello F, Mazzone S, Viola P, et al. Deep neck infections: Decisional algorithm for patients with multiple spaces involvement. Rev Recent Clin Trials 2021;17;46-52. DOI: https://doi.org/10.2174/1574887116666210910153033

Pastene B, Cassir N, Tankel J, et al. Mediastinitis in the intensive care unit patient: A narrative review. Clin Microbiol Infect 2019;26:26-34. DOI: https://doi.org/10.1016/j.cmi.2019.07.005

Pesis M, Bar-Droma E, Ilgiyaev A, Givol N. Deep neck infections are life threatening infections of dental origin: a presentation and management of selected cases. Isr Med Assoc J 2019;21:806-11.

Taylor M, Patel H, Khwaja S, Rammohan K. Descending cervical mediastinitis: the multidisciplinary surgical approach. Eur Arch Otorhinolaryngol 2019;276:2075-9. DOI: https://doi.org/10.1007/s00405-019-05471-z

Cambria F, Fusconi M, Candelori F, et al. Surgical multidisciplinary approach in the management of odontogenic or non-odontogenic neck infections. Acta Otorhinolaryngologica Ital 2021;41:s138-44. DOI: https://doi.org/10.14639/0392-100X-suppl.1-41-2021-14

Ma C, Zhou L, Zhao J, et al. Multidisciplinary treatment of deep neck infection associated with descending necrotizing mediastinitis: a single-centre experience. J Int Med Res 2019;47:6027-40. DOI: https://doi.org/10.1177/0300060519879308

Rzepakowska A, Rytel A, Krawczyk P, et al. The factors contributing to efficiency in surgical management of purulent infections of deep neck spaces. Ear Nose Throat J 2021;100:354-9. DOI: https://doi.org/10.1177/0145561319877281

Del Prado Venegas Pizarro M, Téllez EM, Vintró XL, et al. Descending necrotizing mediastinitis: key points to reduce the high associated mortality in a consecutive case series. Mediastinum 2023;8:8. DOI: https://doi.org/10.21037/med-23-32

Del Duca F, Manetti A, Maiese A, et al. Death due to anaphylactic reaction: The role of the forensic pathologist in an accurate postmortem diagnosis. Medicina 2023;59:2184. DOI: https://doi.org/10.3390/medicina59122184

Yun JS, Lee CH, Na KJ, et al. Surgical experience with descending necrotizing mediastinitis: a retrospective analysis at a single center. J Chest Surg 2023;56:35-41. DOI: https://doi.org/10.5090/jcs.22.110

Galli M, De Soccio G, Cialente F, Cet al. Chronic maxillary sinusitis of dental origin and oroantral fistula: the results of combined surgical approach in an Italian university hospital. Bosn J Basic Med Sci 2020;20:524-30. DOI: https://doi.org/10.17305/bjbms.2020.4748

Vilén S, Ahde H, Puolakka T, et al. Differences in characteristics and infection severity between odontogenic and other bacterial oro-naso-pharyngeal infections. Head Face Med 2023;19:10. DOI: https://doi.org/10.1186/s13005-023-00354-5

Zhao Z, Ma D, Xu Y, et al. Surgical therapy and outcome of descending necrotizing mediastinitis in Chinese: a single-center series. Front Med 2024;10:1337852. DOI: https://doi.org/10.3389/fmed.2023.1337852

Del Fante Z, Di Fazio N, Papale A, et al. Evaluation of physical risk during necropsy and morgue activities as risk management strategy. Int J Environ Res Public Health 2021;18:8266. DOI: https://doi.org/10.3390/ijerph18168266

Prabhu S, Nirmalkumar E. Acute fascial space infections of the neck: 1034 cases in 17 years follow up. Ann Maxillofac Surg 2019;9:118-23. DOI: https://doi.org/10.4103/ams.ams_251_18

Priyamvada S, Motwani G. A study on deep neck space infections. Indian J Otolaryngol Head Neck Surg 2019;71:912-7. DOI: https://doi.org/10.1007/s12070-019-01583-4

Hassanein AG, Mohamed EEH, Hazem M, Sayed AESME. Assessment of prognosis in odontogenic descending necrotizing mediastinitis: a longitudinal retrospective study. Surg Infect 2020;21:709-15. DOI: https://doi.org/10.1089/sur.2019.302

Pucci R, Cassoni A, Di Carlo D, et al. Odontogenic-related head and neck infections: From abscess to mediastinitis: our experience, limits, and perspectives – a 5-year survey. Int J Environ Res Public Health 2023;20:3469. DOI: https://doi.org/10.3390/ijerph20043469