{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T17:28:19Z","timestamp":1793986099443,"version":"4.8.0"},"reference-count":31,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Cervical space infection could also extend to the mediastinum due to the anatomical vicinity. The mortality rate of descending necrotizing mediastinitis is 85% if untreated. The aim of this study was to identify risk factors for the progression of deep neck abscesses to descending necrotizing mediastinitis. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing surgical treatment of deep neck abscesses from August 2017 to July 2022. Computed tomography (CT) was performed in all patients. Before surgery, lab data including hemoglobulin (Hb), white blood cell count, neutrophil percentage, C-reactive protein (CRP) level, and blood glucose were recorded. Patients\u2019 characteristics including gender, age, etiology, and presenting symptoms were collected. Hospitalization duration and bacterial cultures from the wound were also analyzed. Results: The C-reactive protein (CRP) level was higher in patients with a mediastinal abscess than in patients without a mediastinal abscess (340.9 \u00b1 33.0 mg\/L vs. 190.1 \u00b1 72.7 mg\/L) (p = 0.000). The submandibular space was more commonly affected in patients without a mediastinal abscess (p = 0.048). The retropharyngeal (p = 0.003) and anterior visceral (p = 0.006) spaces were more commonly affected in patients with a mediastinal abscess. Conclusions: Descending necrtotizing mediastinitis results in mortality and longer hospitalization times. Early detection of a mediastinal abscess on CT is crucial for treatment. Excluding abscesses of the anterior superior mediastinum for which transcervical drainage is sufficient, other mediastinal abscesses require multimodal treatment including ENT and thoracic surgery to achieve a good outcome.<\/jats:p>","DOI":"10.3390\/medicina58121758","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T02:21:57Z","timestamp":1669774917000},"page":"1758","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Risk Factors of Descending Necrotizing Mediastinitis in Deep Neck Abscesses"],"prefix":"10.3390","volume":"58","author":[{"given":"Chih-Yu","family":"Hu","sequence":"first","affiliation":[{"name":"Division of Otology, Department of Otolaryngology\u2013Head and Neck Surgery, Chang Gung Memorial Hospital, 5 Fuxing Street, Taoyuan 33305, Taiwan"},{"name":"School of Medicine, Chang Gung University, 259 Wenhua 1st Road, Taoyuan 33323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5986-2148","authenticated-orcid":false,"given":"Kuang-Hsu","family":"Lien","sequence":"additional","affiliation":[{"name":"Division of Otology, Department of Otolaryngology\u2013Head and Neck Surgery, Chang Gung Memorial Hospital, 5 Fuxing Street, Taoyuan 33305, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Taoyuan 33323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4051-4009","authenticated-orcid":false,"given":"Shih-Lung","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Otology, Department of Otolaryngology\u2013Head and Neck Surgery, Chang Gung Memorial Hospital, 5 Fuxing Street, Taoyuan 33305, Taiwan"},{"name":"School of Medicine, Chang Gung University, 259 Wenhua 1st Road, Taoyuan 33323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1372-0229","authenticated-orcid":false,"given":"Kai-Chieh","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Otology, Department of Otolaryngology\u2013Head and Neck Surgery, Chang Gung Memorial Hospital, 5 Fuxing Street, Taoyuan 33305, Taiwan"},{"name":"School of Medicine, Chang Gung University, 259 Wenhua 1st Road, Taoyuan 33323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"key":"ref_1","unstructured":"Hedge, A., Mohan, S., and Lim, W.E. (2012). Infections of the deep neck spaces. Singap. Med. J., 53."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.emc.2018.09.003","article-title":"Infections of the Neck","volume":"37","author":"Li","year":"2019","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/00000658-193810000-00009","article-title":"Mediastinitis following Cervical Suppuration","volume":"108","author":"Pearse","year":"1938","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1378\/chest.73.4.497","article-title":"Mediastinitis from odontogenic and deep cervical infection Anatomic pathways of propagation","volume":"73","author":"Moncada","year":"1978","journal-title":"Chest"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/0003-4975(90)90022-X","article-title":"Descending necrotizing mediastinitis: Transcervical drainage is not enough","volume":"49","author":"Wheatley","year":"1990","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1007\/s00405-019-05471-z","article-title":"Descending cervical mediastinitis: The multidisciplinary surgical approach","volume":"276","author":"Taylor","year":"2019","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1007\/s00405-011-1761-1","article-title":"Deep neck infections: A study of 365 cases highlighting recommendations for management and treatment","volume":"269","author":"Stellin","year":"2012","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1002\/hed.20014","article-title":"Deep neck infection: Analysis of 185 cases","volume":"26","author":"Huang","year":"2004","journal-title":"Head Neck"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.otohns.2005.07.001","article-title":"Spectrum and management of deep neck space infections: An 8-year experience of 234 cases","volume":"133","author":"Ridder","year":"2005","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s00405-019-05742-9","article-title":"Deep neck space infections: An upward trend and changing characteristics","volume":"277","author":"Velhonoja","year":"2020","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.joms.2006.06.287","article-title":"Descending necrotizing anterior mediastinitis: Analysis of survival and surgical treatment modalities","volume":"65","author":"Misthos","year":"2007","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"E567","DOI":"10.1002\/lary.28406","article-title":"Clinical predictors of descending necrotizing mediastinitis after deep neck infections","volume":"130","author":"Kimura","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"754","DOI":"10.3389\/fimmu.2018.00754","article-title":"Role of C-Reactive Protein at Sites of Inflammation and Infection","volume":"9","author":"Sproston","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1007\/s00405-012-2182-5","article-title":"Descending necrotizing mediastinitis from deep neck infection","volume":"270","author":"Ishinaga","year":"2013","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2641","DOI":"10.1007\/s00405-021-07081-0","article-title":"Prognostic factors for descending necrotizing mediastinitis development in deep space neck infections-a retrospective study","volume":"279","author":"Brajkovic","year":"2022","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.joms.2019.11.017","article-title":"A Retrospective Cohort Study of Risk Factors for Descending Necrotizing Mediastinitis Caused by Multispace Infection in the Maxillofacial Region","volume":"78","author":"Qu","year":"2020","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/ams2.56","article-title":"Descending necrotizing mediastinitis: 5 years of published data in Japan","volume":"2","author":"Sumi","year":"2015","journal-title":"Acute Med. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1177\/0145561320933964","article-title":"Descending Necrotizing Mediastinitis: Analysis of 9 Cases in Our Hospital","volume":"100","author":"Wu","year":"2021","journal-title":"Ear Nose Throat J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s10140-007-0606-0","article-title":"CT features of descending necrotizing mediastinitis--a pictorial essay","volume":"14","author":"Scaglione","year":"2007","journal-title":"Emerg. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1093\/ejcts\/ezw326","article-title":"European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis","volume":"51","author":"Kocher","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/j.1445-2197.2012.06252.x","article-title":"Acute mediastinitis: Evaluation of clinical risk factors for death in surgically treated patients","volume":"83","author":"Brocki","year":"2013","journal-title":"ANZ J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/BF03217934","article-title":"Guideline of surgical management based on diffusion of descending necrotizing mediastinitis","volume":"47","author":"Endo","year":"1999","journal-title":"Jpn. J. Thorac. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"356","DOI":"10.21037\/atm-21-121","article-title":"A new classification of descending necrotizing mediastinitis and surgical strategies","volume":"9","author":"Guan","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1016\/S0003-4975(03)01260-8","article-title":"Successful thoracoscopic debridement of descending necrotizing mediastinitis","volume":"77","author":"Isowa","year":"2004","journal-title":"Ann. Thorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jtcvs.2008.01.009","article-title":"Descending necrotizing mediastinitis: A 10-year surgical experience in a single institution","volume":"136","author":"Chen","year":"2008","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1093\/ejcts\/ezs385","article-title":"Diffuse descending necrotizing mediastinitis: Surgical therapy and outcome in a single-centre series","volume":"42","author":"Kocher","year":"2012","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/S0003-4975(03)01333-X","article-title":"Descending necrotizing mediastinitis: A minimally invasive approach using video-assisted thoracoscopic surgery","volume":"77","author":"Min","year":"2004","journal-title":"Ann. Thorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1177\/0218492311408641","article-title":"Successful management of descending necrotizing mediastinitis","volume":"19","author":"Wakahara","year":"2011","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1053\/ajot.2003.31","article-title":"Characterizations of lifethreatening deep cervical space infections: A review of one hundred ninety-six cases","volume":"24","author":"Wang","year":"2003","journal-title":"Am. J. Otolaryngol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/adj.12325","article-title":"Bacteriology of deep neck infections: Analysis of 634 patients","volume":"60","author":"Celakovsky","year":"2015","journal-title":"Aust. Dent. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1515\/med-2016-0080","article-title":"Descending necrotizing mediastinitis in the elderly patients","volume":"11","author":"Mazzella","year":"2016","journal-title":"Open Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/12\/1758\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:30:00Z","timestamp":1760146200000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/12\/1758"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,30]]},"references-count":31,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["medicina58121758"],"URL":"https:\/\/doi.org\/10.3390\/medicina58121758","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,30]]}}}