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Ann Thorac Surg 2004;77:306-310
© 2004 The Society of Thoracic Surgeons

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Original article: general thoracic

Descending necrotizing mediastinitis: a minimally invasive approach using video-assisted thoracoscopic surgery

^a Department of General Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
^b Department of Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

Accepted for publication July 21, 2003.

^* Address reprint requests to Dr Kim, Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, South Korea.
e-mail: jkim{at}smc.samsung.co.kr

BACKGROUND: Descending necrotizing mediastinitis is a rare but serious disease. Aggressive surgical approaches have been emphasized rather than simple medical treatment.

METHODS: Four patients with descending necrotizing mediastinitis were treated surgically in our institution between January 2001 and August 2002. Three had peritonsilar abscesses and one had an odontogenic abscess. Operative procedures included drainage and debridement through a Chamberlain incision and neck incision using video-assisted thoracic surgery.

RESULTS: The mean duration from symptoms to operation was 5.3 days (range, 3 to 7) and mean hospital stay was 28.8 days (range, 14 to 47). There was no perioperative mortality. Postoperative complications were found in three patents: two with localized pleural effusion and one with a hydropneumothorax.

CONCLUSIONS: Video-assisted thoracic surgery is feasible and effective as a less invasive method for the surgical management of patients with descending necrotizing mediastinitis, especially when applied early.

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