Management of Deep Neck Infection with Descending Mediastinitis using Video-Assisted Thoracoscopic Surgery

Abstract

Descending mediastinitis is defined as the spread of oropharyngeal or odontogenic infection into the mediastinum. It occurs uncommonly and has a high mortality rate. Prompt commencement of broad-spectrum antibiotics combined with surgical drainage is crucial to limit further spread of infection. We report a case of extensive deep neck infection in a 66-year-old female which rapidly progressed to the contralateral neck complicated by descending anterior mediastinitis. She underwent a combined transcervical and video-assisted thoracoscopic surgery (VATS) for drainage of abscess and was put on 3 weeks of intravenous antibiotics coupled with another 3 weeks of oral antibiotics. Deep neck infection with descending mediastinitis can be successfully treated with antibiotics and early surgical drainage via a combined transcervical and VATS approach.