Descending mediastinitis: current state of the problem

Introduction. Mediastinitis is an aseptic or microbial inflammatory process in the mediastinal tissue, which can occur acutely or chronically. Descending mediastinitis is an inflammation of the mediastinal tissue with the primary focus of infection in the head and neck area, which, going down through the fascial spaces, spreads to the structures of the mediastinum.Purpose of the study. Review of the evidence base for the diagnosis and treatment of descending mediastinitis.Materials and methods of research. A literature search of primary scientific studies on descending mediastinitis was conducted in Russian, English and German in the electronic libraries eLIBRARY, Elektronische Zeitschriftenbibliothek, the Cochrane Library and the biomedical database PubMed.Results and discussion. There are three main fascial routes through which infection from the oral cavity or neck region can reach the mediastinum: pretracheal, lateropharyngeal and retropharyngeal. About 70% of cases are the retropharyngeal route. Mortality with descending mediastinitis reaches 40%. Based on computed tomography data, focal (type I) and diffuse (type II) descending mediastinitis are distinguished. The clinical manifestations of the disease are nonspecific and are similar to other systemic infections and septic conditions. The main treatment consists of antibiotic therapy and surgical debridement of the source of infection. The choice of surgical approach depends on the type of descending mediastinitis and the experience of the surgeon. There is still controversy regarding surgical treatment methods and the duration of antibiotic therapy.Conclusion. Because descending mediastinitis is a potentially life-threatening condition, it should always be considered an emergency.