Lethal Infections Controlled by Collaborative Treatment with Various Kinds of Specialties: Descending Necrotizing Mediastinitis

Abstract

Descending necrotizing mediastinitis (DNM) occurs when an infection of the oral and throat region spreads rapidly in the mediastinal direction along the gap, due to the involvement of gravity, intrathoracic negative pressure. This is considered a fatal infection, particularly in the context of delayed diagnosis and treatment.

The main goal of treatment is early surgical drainage and debridement of necrotic tissue. In Endo’s Classification, Type IIa, in which the abscess cavity advances in the anterior mediastinum, and Type IIb, in which the abscess cavity advances in the posterior mediastinum, require mediastinal drainage. This procedure requires collaborative treatment with respiratory surgery. In type I, where the abscess cavity is confined to the superior mediastinum, cervical drainage is selected; however, there are cases in which mediastinitis occurs after surgery. Thus, even in Type I, advanceconferences with respiratory doctors are required.

Difficult cases are those with multiple abscess formation and those involving necrotizing fasciitis. In such cases, it may be necessary to extensively debride the fascia and muscles. In some cases, respiratory muscle is contracted with long-term intubation and respiratory rehabilitation is required; in other cases, aspiration may occur after surgery due to necrosis or contraction of the deglutition muscle, and long-term hospitalization is required. After the infection control is achieved, collaborative treatment is necessary with a speech-language-hearing therapist and a physical therapist, as soon as possible, in order to achieve early social reintegration.

Control of DNM is mainly based on surgery and antibiotic administration, and collaborative treatment with doctors in other departments is necessary. In the context of the patient’s return to society, collaboration with other specialties is important. By performing collaborative treatment with multiple specialties, it is possible to achieve total human medical care, with respect to saving the life of the patient and supporting the patient’s return to society.