Early Surgical Intervention as A Crucial Management Strategy for Descending Necrotizing Mediastinitis: A Case Report and Literature Review

Abstract

Descending necrotizing mediastinitis (DNM) is a rare yet life-threatening complication primarily originating from oropharyngeal and odontogenic infections. The objective of this study is to highlight the critical role of early surgical intervention and multidisciplinary management in successfully treating complex DNM cases. This study employs a descriptive observational design, specifically combining a clinical case report with a comprehensive literature review. Primary clinical data were retrospectively collected from the patient’s medical records, including diagnostic imaging, surgical reports, and clinical follow-up observations. Concurrently, secondary data were gathered through a structured literature search to compare management strategies and clinical outcomes documented in previous studies. A 32-year-old male presented with progressive neck pain, fever, and dysphagia following a carious right mandibular molar infection. Computed tomography confirmed mediastinitis with right-sided empyema. Initial management involved intravenous antibiotics, cervical incision, debridement, chest tube placement, and extraction of the odontogenic source. Due to persistent pleural infection, a subsequent thoracotomy was performed to evacuate approximately 400 mL of purulent fluid, followed by rigorous irrigation and lung decortication. Post-surgical wound care utilized negative-pressure wound therapy combined with medical-grade honey. Effective management of DNM mandates a prompt diagnosis, aggressive source control, and vigilant reassessment of the thoracic cavity when pleural infections stubbornly persist. Surgical approaches must be meticulously tailored to the anatomical spread of the infection and the patient's evolving clinical course to prevent fatal outcomes.