Interventional therapy for descending necrotizing mediastinitis caused by oral and maxillofacial infection

Background: Necrotizing mediastinitis is a life-threatening condition resulting from spread of oral and maxillofacial infections into the mediastinum. The purpose of this study was to investigate the efficacy and safety of interventional therapy of descending necrotizing mediastinitis. Methods: The data of 44 patients with descending necrotizing mediastinitis treated by fluoroscopy-guided placement of mediastinal abscess drainage tube at our hospital from September 2011 to September 2022 were retrospectively analyzed. Diagnosis was based on clinical manifestations, esophagography, and plain and enhanced computed tomography of neck and chest. Result: The mediastinal drainage tube was successfully placed in all patients. A total of 66 drainage tubes were placed (47 percutaneously and 19 via the nose). The technical success rate was 100%. One patient died of intracranial infection 15 days after interventional therapy. The abscess cavity healed completely in the other 43 patients. The mean time to removal of the drainage tube was 41.5 ± 26.0 (19–105) days. The clinical success rate was 97.8%. Conclusion: Interventional therapy appears to be a safe and effective minimally invasive treatment for descending necrotizing mediastinitis caused by spread of oral and maxillofacial infection.