Introduction
Descending necrotizing mediastinitis (DNM) is a rare but serious,
life-threatening disease. It is usually caused by downward spread of
deep neck infection (DNI) through the cervical fascial planes. Its
mortality rate is as high as 40%. Mortality can be attributed to a
delay in diagnosis because of nonspecific symptoms until clinical
deterioration occurs or inadequate drainage of the
mediastinum.1 Therefore, prompt diagnosis and early
surgical treatment are very important for reducing its mortality. A
multi-disciplinary approach involving head and neck surgeon, thoracic
surgeon, anesthesiologist, radiologist, and physician should be used to
reduce its mortality and morbidity.
It has been widely known that maintenance of a safe and secure airway
remains the most important therapeutic goal in the management of
DNI.2 When airway compromise seems imminent, an
optimal preventive airway management such as intubation or tracheotomy
can avoid more dangerous situations in a suboptimal setting. Although
tracheotomy has been considered the gold standard of airway management
in patients with deep neck infection, it has not yet been established
for patients with DNM. There has been no consensus on when or how best
to manage airway in DNM secondary to DNI. No standard protocol has been
established for managing the airway in DNM patients because of large
variations in causes and rarity of this disease. Therefore, optimal
airway management should be designed to decrease mortality of DNM
patients.
The objective of this study was to review our experiences of treating
patients with DNM and establish an algorithm for airway management in
DNM secondary to DNI.