Successful Nonsurgical Resolution of Descending Necrotizing Mediastinitis: A Case-Based Illustration of Clinical Management.

Abstract

Background: Descending necrotizing mediastinitis (DNM) is a relatively uncommon complication of deep neck infections. However, with inappropriate use of antibiotics, steroids, or underlying medical problems such as immunocompromised conditions, this type of infection can become life-threatening.

Methods: We report a case of Ludwig Angina with DNM, diagnosed at the end of December 2019. The subject was a 17-year-old female admitted to the pediatric intensive care unit after two weeks of clinically significant distress and swelling in her neck, tongue, and lips. The predominant underlying oropharyngeal infection originated from the mandibular 3rd molar.

Results: The patient was successfully treated due to early diagnosis and adequate medical intervention. Supportive medications were highly effective, including bronchodilators to assist in breathing and improve lung air entry, intravenous glucocorticoids like dexamethasone for their anti-inflammatory effect, and a regimen of antibiotics. No surgical intervention was necessary; the only procedures performed were percutaneous drainage of an abscess in the submandibular area and chest tube insertion for pleural effusion.

Conclusions: Early diagnosis and appropriate medical treatment are critical in managing DNM. Supportive medications and minimally invasive procedures can effectively manage the condition, avoiding the need for extensive surgical intervention. This case highlights the importance of vigilant diagnosis and comprehensive medical management in improving patient outcomes.