Acute descending necrotizing mediastinitis: four years of experience at a hospital center in Madagascar.

Acute mediastinitis, also called descending necrotizing mediastinitis and cervicomediastinal necrotizing fasciitis, is a disease due to the spread of severe cervical or oropharyngeal infection. Our retrospective study examined clinical records of patients admitted to the surgical intensive care unit for the management of acute mediastinitis during the four-year period 2009-2012. The records showed 14 cases admitted during these four years. The patients' mean age was 30 years and 8 months, and the M/F sex-ratio was 1.33. The main predisposing factors found were the presence of a severe cervical infection, such as fasciitis, of odontogenic origin or the administration of anti-inflammatory drugs. The diagnosis is based on clinical data findings of thoracic pain with dyspnea or orthopnea, fever, or even septic shock and is confirmed by radiologic findings. The patient's multidisciplinary management combines medical management (supportive medical care in an intensive care unit and broad-spectrum antibiotic therapy) and surgical treatment by bilateral cervicotomy with mediastinal drainage. The mortality rate was high at 71.42%. In Madagascar, neglect of dental health can cause odontogenic fasciitis, which plays an important role in descending mediastinitis, a disease that still has a catastrophic prognosis today.