Nonoperative catheter management for cervical necrotizing fasciitis with and without descending necrotizing mediastinitis.

OBJECTIVE

To evaluate the clinical utility of catheter drainage for cervical necrotizing fasciitis (CNF) with and without descending necrotizing mediastinitis (DNM).

DESIGN

Retrospective analysis.

SETTING

Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine.

PATIENTS: Thirty-two patients with clinically and radiographically diagnosed CNF with and without DNM were included.

INTERVENTIONS: Catheters were introduced into the infected space through the patients' necks under sonographic and x-ray fluoroscopic guidance.

MAIN OUTCOME MEASURES: Treatments, clinical course, complications, and mortality were evaluated.

RESULTS

Catheter drainage was successfully performed in all patients. The CNF was due to pharyngeal infection in 14 patients (44%) and dental infection in 14 other patients (44%). Mediastinal extension occurred in 14 patients (44%). Overall mortality was 3.1%; only 1 patient with DNM died due to Clostridium sepsis. Both pharyngeal origin and diabetes mellitus were significantly associated with the development of DNM. More intensive treatment is necessary for patients with CNF with DNM than for patients with CNF without DNM.

CONCLUSION

Percutaneous catheter drainage may be used as an effective treatment for CNF with and without DNM.