Prognostic factors for descending necrotizing mediastinitis development in deep space neck infections-a retrospective study

Abstract

Objectives: Descending necrotizing mediastinitis (DNM) is the most serious complication of deep neck infections (DNI). The objective of this retrospective study was to evaluate prognostic factors for DNM development in deep space neck infections.

Methods: The study enrolled patients admitted to the Emergency Center of Vojvodina with the diagnosis of multispace DNI with or without DNM either as the primary diagnosis or with discharged diagnosis after surgical treatment during 7-year period. The data were obtained from patient medical records.

Results: After final analysis total of 141 charts were randomized for statystical analysis, 124 charts in DNI and 17 in DNI + DNM groups. The most common cause of infection in both groups was odontogenic. On multivariate regression analysis of collected data infection of retropharyngeal, pretracheal and carotid space, C-reactive protein and procalcitonine values were statistically significant predictors for DNM development.

Conclusions: Treatment and diagnosis of DNM requires multidisciplinary approach, with prompt clinical and radiological examinations, empirical broad spectrum antibiotic therapy and radical surgical debridement. Multispace neck infection and especially infection of retropharyngeal, carotid and pretracheal spaces are the most sensitive predictors for DNM development in deep space neck infections.

Clinical relevance: If the infection from deep neck spaces reach retropharyngeal, carotid or pretracheal space, the DNM is probable to occur.

Trial registration: ClinicalTrials.gov ID NCT04865003. Date of registration 27.4.2021.

Keywords: Deep space neck infection; Descending necrotozing mediastinitis; Odontogenic infection; Pharyngeal infection; Risk factors.