Descending necrotizing mediastinitis (DNM), which is caused by a downward spread of a deep neck infection, is a rare complication that can be secondary to peritonsillar abscess or dental infection. Between January 2006 and April 2013, we treated 7 cases of descending necrotizing mediastinitis in our department and in the general intensive care unit at our hospital. Four cases of DNM arose from the inferior pole of a peritonsillar abscess, two cases from the superior pole of a peritonsillar abscess, and one case from a retropharyngeal abscess. Usually peritonsillar abscess occurs in the superior pole of the tonsil. However, in our series of DNM patients, inferior pole peritonsillar abscess was the most common underlying cause. This may be explained by the fact that the diagnosis can be relatively delayed and a lower abscess of the tonsil can easily reach the mediastinum due to gravity. One patient died of sepsis and the other 6 patients are surviving without complications.
It is essential for patient survival to perform aggressive surgical neck drainage.
