Risk factors affecting the prognosis of descending necrotizing mediastinitis from odontogenic infection

Publication date: Available online 13 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Luyao Qu, Xiang Liang, Bin Jiang, Wentao Qian, Weijie Zhang, Xieyi Cai
PurposeDescending necrotizing mediastinitis (DNM) is a serious complication of head and neck infections, and has an excessively high mortality rate due to the lack of understanding of DNM. Assessing the clinical characteristics, diagnosis, treatment, outcomes of odontogenic DNM, and evaluating the risk factors affecting the prognosis of DNM to provide an up-to-date overview for clinical practice.MethodsThis research was based on a retrospective cohort study that enrolled a sample of patients with DNM due to odontogenic infection who were referred from January 2013 to December 2016. The patients were classified into the survivors and the deceased groups. The primary predictor in this study were multiple comorbidities, complications, demographic (age, gender), laboratory tests (white blood cell, percentage of neutrophils )and time (duration before diagnosis, hospital stay). The primary outcome variable was outcome of patients (dead or alive). The continuous variables were evaluated by Student's t test or the t' test ,and the categorical and binary variables were compared by the χ² test or the Fisher exact test.ResultsA total of 81 patients were included. The 68 males and 13 females had a median age of 57.2 ± 12.2 years. The mortality was 4.9%. The most frequent cause of DNM was periapical periodontitis (66.7%). The lower posterior molars were involved in 39.5% of the cases. Treatments consisted of antibiotic therapy, aggressive transcervical mediastinal drainage (74 cases) and thoracotomy (7 cases). The associated risk factors for mortality were complications (P<0.005) and severe sepsis or septic shock (P<0.001) by bivariate analysis.ConclusionSeptic shock and complications, which are risk factors correlated with poor prognosis. We considered that timely diagnosis and aggressive mediastinal drainage are fundamental to reduce the incidence of complications and septic shock in odontogenic DNM patients.



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