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Ann Thorac Surg 2004;77:1834-1837
© 2004 The Society of Thoracic Surgeons

Case report

Successful thoracoscopic debridement of descending necrotizing mediastinitis

Noritaka Isowa, MDa, Tetsu Yamada, MDa, Takeshi Kijima, DDSb, Kazuki Hasegawa, DDSb, Koji Chihara, MD*a

a Division of Thoracic Surgery, Shizuoka City Hospital, Shizuoka, Japan
b Division of Oral and Maxillofacial Surgery, Shizuoka City Hospital, Shizuoka, Japan

Accepted for publication June 5, 2003.

* Address reprint requests to Dr Chihara, Division of Thoracic Surgery, Shizuoka City Hospital, 10-93 Ohtemachi, Shizuoka 420-8630, Japan
e-mail: echihara{at}mb.infoweb.ne.jp

Descending necrotizing mediastinitis results from odontogenic, deep neck infection that spreads along fascial planes into the mediastinum. Although the optimal surgical approach remains controversial, nearly half of the cases require mediastinal debridement by thoracotomy. We report a case of successful thoracoscopic debridement for descending necrotizing mediastinitis due to odontogenic infection that failed to be drained by transcervical approach. Because of less invasiveness as compared with standard thoracotomy, the thoracoscopic approach should be used as early as possible in case of unsuccessful transcervical approach.




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