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.