Descendentni nekrotični medijastinitis kao posljedica retrofaringealnog apscesa

Descending necrotizing mediastinitis secondary to a nontraumatic retropharyngeal abscess is very rare. This form of mediastinitis in the era of potent antibiotics often ends up with lethal outcome. It usually occurs in immunocompromised patients and requires intensive multidisciplinary treatment approach. We report a case of nontraumatic retropharyngeal abscess complicated by descending necrotizing mediastinitis in a 70-year-old man with insulin dependent diabetes mellitus. The patient was admitted to our hospital after clinical and radiological diagnosis of retropharyngeal abscess. During treatment for retropharyngeal abscess with antibiotic therapy and transoral incision, the patient showed mild clinical improvement but his condition suddenly aggravated on day 4 of hospital stay. He had high fever, chest pain with tachypnea, tachycardia, hypotension, and showed signs of occasional disorientation. Emergency computed tomography (CT) scan of the neck and thorax showed inflammation in the retropharyngeal space, as well as thickening of the upper posterior mediastinum fascia with the presence of air. Emergency surgery including cervicotomy and drainage of the retropharyngeal space and posterior mediastinum was performed. The patient promptly recovered with improvement of the clinical status and laboratory findings. After 16 days of treatment he was discharged from the hospital in good condition. Descending necrotizing mediastinitis can be a serious and life threatening complication of deep neck infection if the diagnosis is not quickly established. Besides inevitable application of antimicrobial drugs, good drainage of the mediastinum is necessary. We believe that transcervical approach can achieve high-quality drainage of the upper mediastinum, especially if it is done timely as in this case. Its efficacy can be verified by intensive monitoring of the patient clinical condition, by CT scan of the thorax, and by laboratory tests. In the case of inefficacy of this type of drainage, subsequently some other, more aggressive transthoracic methods of drainage can be done.Descendentni nekrotični medijastinitis uzrokovan netraumatskim retrofaringealnim apscesom je jako rijedak. Ovaj tip medijastinitisa i u eri jakih antimikrobnih lijekova često završava smrtnim ishodom. Obično se javlja kod imunokompromitiranih bolesnika i zahtijeva intenzivni multidisciplinarni pristup liječenja. Prikazuje se slučaj netraumatskog retrofaringealnog apscesa i njegove komplikacije, descendentnog nekrotičnog medijastinitisa, u 70-godišnjeg muškarca s dijabetesom ovisnim o inzulinu. Bolesnik je primljen na bolničko liječenje nakon klinički i radiografski postavljene dijagnoze retrofaringealnog apscesa. Tijekom liječenja retrofaringealnog apscesa antimikrobnim lijekovima i transoralnom incizijom, uz kratkotrajno kliničko poboljšanje, četvrtog dana liječenja nastupilo je pogoršanje općeg stanja bolesnika. Postao je opet visoko febrilan, tahipneičan s bolovima u prsima, tahikardičan uz hipotenziju te je pokazivao znakove dezorijentiranosti. Kompjutorska tomografija (CT) vrata i toraksa pokazala je i dalje prisutnu upalu retrofaringealnog prostora uz zadebljanje fascijalnih prostora gornjega stražnjeg medijastinuma uz prisutnost zraka. Napravljen je hitan kirurški zahvat u smislu cervikotomije i drenaže retrofaringealnog prostora i medijastinuma. Stanje bolesnika se ubrzo popravilo u kliničkom smislu i laboratorijskim nalazima te je 16. dana liječenja otpušten na kućnu njegu u dobrom općem stanju. Descendentni nekrotični medijastinitis je ozbiljna komplikacija dubokih upala vrata i predstavlja opasnost za život bolesnika, naročito ako se dijagnoza ne postavi rano. Uz primjenu antimikrobnih lijekova osobito je važna visoko kvalitetna drenaža medijastinuma, pogotovo ako je napravljena pravodobno, kao u ovom slučaju. Njenu učinkovitost se može procijeniti pojačanim praćenjem kliničkog stanja bolesnika, primjenom CT toraksa i laboratorijskim testovima. U slučaju kad ovaj tip drenaže nije učinkovit moguće je uvijek napraviti mnogo agresivnije transtorakalne metode drenaže

Necrotic ulcerative stomatitis in a patient with long-standing celiac disease: a case report

Celiac disease is the most common chronic gastroenterological disease. One of the extraintestinal manifestations of this multifaceted disease are changes in the oral mucosa. However, ulceration leading to the destruction of the soft and hard tissues of the orofacial region has not been reported so far. We report on the development of necrotizing ulcerative stomatitis in a 41-year-old woman with celiac disease. The initial ulcerative lesion was located in the lower lip mucosa. Necrosis of all layers of the left side of the lip and oral commissure progressed very quickly. The resulting defect required plastic reconstructive surgery. We successfully compensated for the defect by applying a combination of two flaps from the remaining tissue of the lower lip. Oral competence was established immediately after the operation, and a very good esthetic appearance two months later

Reconstruction of the lateral defect of the lower lip by a combination of two advancement flaps

Funkcionalni i estetski rezultat rekonstrukcije donje usne nakon uklanjanja tumora ovisi o pravilnom izboru operacijske tehnike. S obzirom na činjenicu da je njihov broj velik, izbor nije lak. U ovom radu autori su uključili 5 bolesnika kojima su izvršili rekonstrukciju defekta donje usne s kombinacijom dvaju režnjeva, elastičnim vermilion režnjem i otočnim V-Y mentalnim klizajućim režnjem. Svi bolesnici su imali planocelularni karcinom postraničnog dijela donje usne ≥ 2 cm (T2). Primijenjen je vermilion elastični režanj po Goldsteinu i otočni V-Y klizajući režanj mentalne regije koji su uveli u kiruršku praksu Bayamicli, et al. Spajanjem ovih dvaju neurovaskularnih režnjeva postignut je kvalitetan nadomjestak donje usne, njena voluminoznost, dužina, visina, širina, prirodan izgled i potpuna funkcija. Ova kombinacija dvaju etabliranih režnjeva ozbiljna je alternativa drugim kirurškim tehnikama u rekonstrukciji defekta donje usne koji nije pogodan za izravnu sanaciju primarnim zatvaranjem. Kirurška tehnika formiranja režnjeva nije teška, može se izvesti pod lokalnom anestezijom i ne zahtijeva dugo kirurško vrijeme

INCIDENCE AND SURGICAL IMPORTANCE OF PYRAMIDAL LOBE AND TUBERCLE OF THE THYROID GLAND: A PROSPECTIVE STUDY

Piramidalni režanj i tuberkul česte su anatomske varijacije oblika štitne žlijezde te je njihova učestalost visoka. Dok piramidalni režanj nalaže dodatnu pozornost pri identifikaciji i njegovu odstranjenju, osobito kod bolesnika s hipertireozom i karcinomom štitne žlijezde, prisutnost tuberkula je poželjna. On redovito pokriva povratni živac grkljana i usmjerava kirurga pri njegovu traženju, a služi i za lakše otkrivanje gornje paratiroidne žlijezde. U ovoj prospektivnoj studiji obradili smo ukupno 342 bolesnika kojima je izvršena totalna tiroidektomija u razdoblju od siječnja 2009. do ožujka 2015. godine. Promatrali smo incidenciju i anatomske karakteristike piramidalnog režnja i tuberkula štitne žlijezde. Piramidalni režanj nađen je kod 52,3% bolesnika s čestim centralnim i ljevostranim smještajem. Obostrano prisutni tuberkul nađen je kod 14,9% bolesnika, njegova jednostrana desna pojava bila je zastupljena u 39,5%, a lijeva kod 18,5% bolesnika (ukupno 64,3% / 220 bolesnika). Njihova učestalost prema spolu nije pokazivala značajnu razliku (p = 0,59; p = 0,2). Udružena prisutnost piramidalnog režnja i tuberkula s jedne ili obje strane u našoj je grupi bolesnika visoko zastupljena (34%), također bez razlike prema spolu (p = 0,29). Dužina piramidalnog režnja kretala se od 1,3 do 4,7 cm (srednja vrijednost 2,3 cm), a veličina tuberkula bila je u 36% bolesnika veća od 1 cm. Povratni živac grkljana bio je u samo 1,8% postavljen ­lateralno od tuberkula, a gornja paratiroidna žlijezda nalazila se iznad tuberkula u 95,4%. S obzirom na to da samo 16,5% naših bolesnika nije imalo nijednu od ovih anatomskih varijacija, njihova prisutnost tijekom operacije može se smatrati pravilom, a ne izuzetkom.The pyramidal lobe and tubercles are common anatomic variations of the thyroid gland, and their frequency is highly represented. While pyramidal lobe requires additional seriousness in identifying and its removal, especially in ­patients with hyperthyroidism and thyroid cancer, the presence of tubercles is desirable. Tubercle is covered by recurrent laryngeal nerve and directs the surgeon in his search and besides this, serves to facilitate detection of the upper parathyroid glands. In this prospective study we analysed 342 patients who underwent total thyroidectomy in the period from January 2009 to March 2015. We looked at the incidence and anatomic characteristics of pyramidal lobe and tubercles of the thyroid gland. The pyramidal lobe was present in 52.3% of the patients with more frequent central and left placement. Bilateral tubercles were present in 14.9%, while position right-sided phenomenon was represented in 39.5% and 18.5% in lower left (64.3% patients). Their prevalence by gender showed no significant difference (p = 0.59; p = 0.2). Associated presence of pyramidal lobe and tubercles on one or both sides is highly represented in our group of patients (34%), also with no differences by gender (p = 0.29). Length of the pyramidal lobe ranged from 1.3 to 4.7 cm (average 2.3 cm), and the size of tubercles in 36% of patients was over 1 cm. Recurrent laryngeal nerve was only in 1.8% placed laterally of tubercles, and the upper parathyroid gland in 95.4% was located above tubercle. Considering that only 16.5% of our patients did not have any of these anatomical variations, their presence during surgery is the rule, not the exception

INCIDENCE AND SURGICAL IMPORTANCE OF PYRAMIDAL LOBE AND TUBERCLE OF THE THYROID GLAND: A PROSPECTIVE STUDY

Piramidalni režanj i tuberkul česte su anatomske varijacije oblika štitne žlijezde te je njihova učestalost visoka. Dok piramidalni režanj nalaže dodatnu pozornost pri identifikaciji i njegovu odstranjenju, osobito kod bolesnika s hipertireozom i karcinomom štitne žlijezde, prisutnost tuberkula je poželjna. On redovito pokriva povratni živac grkljana i usmjerava kirurga pri njegovu traženju, a služi i za lakše otkrivanje gornje paratiroidne žlijezde. U ovoj prospektivnoj studiji obradili smo ukupno 342 bolesnika kojima je izvršena totalna tiroidektomija u razdoblju od siječnja 2009. do ožujka 2015. godine. Promatrali smo incidenciju i anatomske karakteristike piramidalnog režnja i tuberkula štitne žlijezde. Piramidalni režanj nađen je kod 52,3% bolesnika s čestim centralnim i ljevostranim smještajem. Obostrano prisutni tuberkul nađen je kod 14,9% bolesnika, njegova jednostrana desna pojava bila je zastupljena u 39,5%, a lijeva kod 18,5% bolesnika (ukupno 64,3% / 220 bolesnika). Njihova učestalost prema spolu nije pokazivala značajnu razliku (p = 0,59; p = 0,2). Udružena prisutnost piramidalnog režnja i tuberkula s jedne ili obje strane u našoj je grupi bolesnika visoko zastupljena (34%), također bez razlike prema spolu (p = 0,29). Dužina piramidalnog režnja kretala se od 1,3 do 4,7 cm (srednja vrijednost 2,3 cm), a veličina tuberkula bila je u 36% bolesnika veća od 1 cm. Povratni živac grkljana bio je u samo 1,8% postavljen ­lateralno od tuberkula, a gornja paratiroidna žlijezda nalazila se iznad tuberkula u 95,4%. S obzirom na to da samo 16,5% naših bolesnika nije imalo nijednu od ovih anatomskih varijacija, njihova prisutnost tijekom operacije može se smatrati pravilom, a ne izuzetkom.The pyramidal lobe and tubercles are common anatomic variations of the thyroid gland, and their frequency is highly represented. While pyramidal lobe requires additional seriousness in identifying and its removal, especially in ­patients with hyperthyroidism and thyroid cancer, the presence of tubercles is desirable. Tubercle is covered by recurrent laryngeal nerve and directs the surgeon in his search and besides this, serves to facilitate detection of the upper parathyroid glands. In this prospective study we analysed 342 patients who underwent total thyroidectomy in the period from January 2009 to March 2015. We looked at the incidence and anatomic characteristics of pyramidal lobe and tubercles of the thyroid gland. The pyramidal lobe was present in 52.3% of the patients with more frequent central and left placement. Bilateral tubercles were present in 14.9%, while position right-sided phenomenon was represented in 39.5% and 18.5% in lower left (64.3% patients). Their prevalence by gender showed no significant difference (p = 0.59; p = 0.2). Associated presence of pyramidal lobe and tubercles on one or both sides is highly represented in our group of patients (34%), also with no differences by gender (p = 0.29). Length of the pyramidal lobe ranged from 1.3 to 4.7 cm (average 2.3 cm), and the size of tubercles in 36% of patients was over 1 cm. Recurrent laryngeal nerve was only in 1.8% placed laterally of tubercles, and the upper parathyroid gland in 95.4% was located above tubercle. Considering that only 16.5% of our patients did not have any of these anatomical variations, their presence during surgery is the rule, not the exception

SURGICAL TREATMENT OF THYROID GLAND IN ELDERLY PATIENTS: OUR EXPERIENCES

Udio osoba starije dobi u populaciji neprekidno i ubrzano raste. Zahtjevi za njihovim kirurškim liječenjem su sve veći kao i broj objavljenih radova koji analiziraju sigurnost i uspjeh pojedinih kirurških postupaka učinjenih na tim bolesnicima. U ovom radu od ukupno 897 bolesnika kirurški liječenih zbog bolesti štitne žlijezde izdvojeno je 183 koji su bili u dobi od 65 i više godina. Podijelili smo ih u dvije skupine (G 1: 65-69 godina i G 2: 70 i više godina) s ciljem utvrđivanja razlika između njih u indikacijama, kirurškoj strategiji, konačnom patohistološkom nalazu, prijeoperacijskom fi zičkom statusu, broju komorbidnih bolesti i poslijeoperacijskim komplikacijama. Analizom dobivenih rezultata potvrdili smo ispravnost odluke o podjeli bolesnika starije dobi na dvije skupine: mlađi i stariji. Indikacije za kirurški zahvat u G 1 bile su pretežno benigne promjene (93,2 %), dok su maligne, verifi cirane i suspektne bolesti u G 2 bile zastupljeni znatno više (21,8 %). Bolesnici su se značajno razlikovali i u fi zičkom prijeoperacijskom statusu (G 2: ASA: III i IV; 73,8 %; 5 %), kao i po broju urađenih totalnih tireoidektomija (G 1: 56,2 %; G 2: 77,3 %) i sekundarnih hemitireoidektomija. Razlika je također zabilježena u broju operacijskih i neoperacijskih komplikacija. Odsutnost većeg postotka trajnih komplikacija, hipokalcemije i kljenuti povratnog živca, ukupno i prema skupinama, potvrđuje da se kirurško liječenje bolesti štitne žlijezde može smatrati sigurnim i uspješnim i u starijim dobnim skupinama bez obzira na razlike unutar formiranih skupina.The share of elderly persons in the population is growing rapidly and continuously. Requirements for their surgical treatment are increasing and so is the number of published papers on the safety and success of some surgical procedures performed in these patients. The present study included 183 patients aged ≥65 out of 897 patients surgically treated for thyroid gland diseases. They were divided into two groups (group 1 aged 65-69 and group 2 aged ≥70) in order to determine betweengroup differences in the indications, surgical strategy, final histopathologic analysis, preoperative physical status, number of comorbid diseases and postoperative complications. Analysis of the results justifi ed our decision to divide our patients into two groups of younger and older ones. In group 1, the indications for surgery were mostly benign changes (93.2%), whereas malignant, verifi ed and suspected disease was considerably more frequent in group 2 (21.8%), with a significantly higher percentage of compressive syndrome. Significant between-group differences were recorded in the preoperative physical status (group 2: ASA III and IV, 73.8% and 5%, respectively), number of thyroidectomies performed (group 1, 56.2% vs. group 2, 77.3%) and secondary hemithyroidectomy. A difference was also found in the number of surgical and non surgical complications. The absence of a higher percentage of permanent complications, hypocalcemia and recurrent laryngeal nerve paralysis, in total and by groups, confirmed that surgical treatment of thyroid gland diseases can be considered safe and successful in older age groups, regardless of the between-group differences observed

TOTAL THYROIDECTOMY AS A SURGICAL METHOD FOR TREATING HYPERTHYROIDISM: OUR EXPERIENCES

Liječenje hipertireoze može se postići na dva načina: sprječavanjem same sinteze hormona antitiroidnim lijekovima ili obavljanjem trajne destrukcije tkiva štitne žlijezde radiojodnom terapijom ili kirurškim zahvatom. Danas se kirurgijom rješavaju odabrani slučajevi hipertireoze, redovito nakon neuspjeha i/ili nuspojava farmakološke i radiojodne terapije. Kirurgija kao inicijalna metoda liječenja ove bolesti dosta je rijetka. S obzirom na opseg kirurškog zahvata, razlikujemo suptotalnu, gotovo totalnu i totalnu tiroidektomiju. U ovom radu iznosimo svoja iskustva u liječenju bolesnika s hipertireozom metodom totalne tiroidektomije. Analizirali smo indikacije za kirurški zahvat i ocijenili njegovu uspješnost i sigurnost kod 163 bolesnika s hipertireozom. Od ukupnog broja prema uzroku bolesti formirali smo dvije grupe. U grupi G1 bili su bolesnici s Gravesovom bolesti (GB), njih 102 (62,5%), a u drugoj grupi (G2) 61 bolesnik (37,5%) s toksičnom multinodoznom strumom (tMNS). Liječenje antitiroidnim lijekovima prije operacije provedeno je kod 83% bolesnika, u G1 100%, a u G2 54%. Kirurški zahvat, kao jedina metoda liječenja u G2, bio je zastupljen u 46% (ukupno 17%). Osnovna indikacija za operacijsko liječenje u G1, osim povratka bolesti, bile su nuspojave antitiroidnih lijekova i oftalmopatija, a u G2 velika struma s kompresivnim sindromom ili bez njega, kao i njezina retrosternalna lokalizacija. Tijekom kirurškog zahvata kod svih su bolesnika obostrano prikazani povratni živac grkljana i dvije do četiri paratiroidne žlijezde. Revizijski je zahvat, zbog krvarenja, obavljen kod dvije bolesnice s GB-om, a kod jedne od njih učinjena je i traheotomija. Nijedan bolesnik nije imao obostranu ozljedu povratnog živca. Jednostrana kljenut neposredno nakon kirurškog zahvata zabilježena je kod troje bolesnika, od kojih je u njih dvoje došlo do potpunog oporavka pokretljivosti glasnice. Prolazne niske vrijednosti kalcija u krvi neposredno nakon zahvata nalazimo u 29% bolesnika (G1 26% : G2 36%), bez statistički značajne razlike po grupama. Tijekom prvoga poslijeoperacijskog tjedna vrijednosti su se kalcija normalizirale kod 67% bolesnika. Trajnu hipokalcemiju nije imao nijedan bolesnik. Incidencija papilarnog karcinoma ukupno je iznosila 8%, a nešto je viša bila u G2 (10%) nego u G1 (5%) ali bez statistički značajne razlike. S obzirom na uzrok bolesti, GB i tMNS, totalna tiroidektomija primijenjena je iz različitih razloga, ali je njezin rezultat za sigurnost i učinkovitost bio isti. Možemo je smatrati sigurnom i efikasnom metodom u selektivno izabranih i prijeoperacijski dobro pripremljenih bolesnika. Ovaj zahvat iskusnog kirurga ima nizak postotak trajnih komplikacija i treba ga prezentirati bolesnicima kao opciju liječenja sa svim rizicima i prednostima u odnosu prema drugim metodama liječenja hipertireoze.Treatment of hyperthyroidism can be achieved in two ways, prevent the synthesis of hormones by antithyroid drugs or carry out permanent destruction of the thyroid tissue by radioiodine therapy or surgical intervention. Today, surgical treatment of selected cases of hyperthyroidism usually follows the failure andor side effects of medication and radioiodine treatment. Surgery as an initial method of treatment of this disease is quite rare. Considering the scope of the surgical procedure, we distinguish subtotal, almost total and total thyroidectomy. In this paper we present our experience in the treatment of patients with hyperthyroidism with total thyroidectomy method. We analyzed the indications for surgery and evaluated its effectiveness and safety in 163 patients with hyperthyroidism. Out of the total number we formed two groups according to the cause of the disease. G1 group included 102 (62.5%) patients with Graves’ disease (GD), and the second group (G2) 61 patients (37.5%) with toxic multinodular goiter (TMNG). Prior to surgical treatment, 83% of patients were treated with antithyroid drugs, in G1-100%, and in G2 54%. The surgical procedure as the only treatment method in G2 was 46% (total 17%). The main indications for surgical treatment in G1, except recurrences, were side effects of antithyroid drugs and ophthalmopathy, and in G2 large goiters with or without compression syndrome, as well as their retrosternal localization. During the surgery, in all patientsa recurrent laryngeal nerve and two to four parathyroid glands were seen on both sides. Revision procedure, due to bleeding, was done in two patients with GD. One of them also underwent tracheotomy. None of the patients had bilateral recurrent laryngeal nerve injury. One sided paralysis, immediately after surgery, was observed in three patients, and in two of themthere was a complete recovery of the mobility of vocal cords. Transient low calcium levels in blood immediately after the procedure were observed in 29% of patients (G1 – 26%: G2 – 36%) with no statistically significant differences across groups. During the first postoperative week 67% of calcium levels were normalized. None of the patients had permanent hypocalcemia. The total incidence of papillary carcinoma was 8%, slightly higher in G2 (10%) than in G1 (5%), but without significant differences. With regard to the cause of the disease, GD and TMNG, total thyroidectomy was applied for various reasons, but it achieved identical scores of treatment safety and efficacy. We might consider it a safe and effective method in selectively chosen and before surgery well prepared patients. This surgery, performed by an experienced surgeon, has a low percentage of permanent complications and should be presented to patients as a treatment option with all risks and benefits compared to other methods of treating hyperthyroidism

DESCENDENDING NECROTIZING MEDIASTINITIS SINGLE CENTER EXPERIENCE

Descendentni nekrotični medijastinitis rijetka je, ali za život opasna upala, koja nastaje kao komplikacija dubokih upala vrata. Mortalitet bolesnika i dalje je visok (do 40%), bez obzira na upotrebu raznovrsnih antimikrobnih lijekova i kirurških intervencija. U ovom radu opisujemo 7 bolesnika s descendentnim nekrotičnim medijastinitisom, liječenih u našoj bolnici tijekom posljednjih 12 god. Kod 5 bolesnika primarno mjesto upale bile su tonzile i ždrijelo, a u ostala 2 bolesnika odontogena upala donjih molara. Većina bolesnika pripadala je rizičnim skupinama (dijabetes, alkoholizam), prosječne životne dobi od 60,4 god. Nakon dijagnoze postavljene kompjutoriziranom tomografijom (CT) kirurški smo intervenirali kod svih bolesnika. Duboke upale vrata tretirane su kirurški agresivnom cervikotomijom, a kvalitetna medijastinalna drenaža napravljena je kod svih bolesnika transcervikalnim putem. Perioperativna traheotomija (n = 3) izvršena je zbog otoka gornjega dišnog puta, a postoperativna zbog produžene intubacije (n = 1). Samo kod jednog bolesnika naknadno smo izvršili sekundarni kirurški zahvat, odnosno lateralnu torakotomiju radi dekortikacije pleure. Svi su bolesnici uspješno izliječeni, s prosječnom dužinom bolničkog liječenja od 24,6 dana. Za uspješno liječenje descendentnoga nekrotičnog medijastinitisa što prije se mora postaviti dijagnoza, i to uz primjenu kompjutorizirane tomografije. Liječenje zahtijeva istodobnu primjenu snažnih antimikrobnih lijekova, agresivni kirurški debridman vrata i kvalitetnu drenažu medijastinuma, koja se može ostvariti, osim standardnim torakalnim pristupima, i transcervikalnim putemThe descending necrotizing mediastinitis is a rare but life-threatening inflammation, and occurs as a complication of deep inflammation of the neck. The mortality rate is still high by 40% despite the use of a variety of potent antimicrobial drugs. We describe 7 patients with the descending necrotizing mediastinitis treated in our hospital during the last 12 years. The primary site of infection in 5 patients were tonsils and pharynx, and in the other two patients odontogenic inflammation of the lower molars. Most of the patients belonged to the risk groups (diabetes mellitus, alcoholism), the average age of 60.4 years. After the diagnosis with computed tomography (CT), we surgically intervened in all patients. Deep neck infections are treated with aggressive surgical cervicotomy and high quality mediastinal drainage was performed with transcervical approach in all patients. Perioperative tracheotomy (n=3) was performed for the upper airway edema and postoperative tracheostomy for extended intubation (n=1).Only in one case, we subsequently conducted a secondary surgical procedure, lateral thoracotomy because of pleural decortication. All patients were successfully cured with an average length of hospitalization was 24.6 days. For successful treatment of the descending necrotizing mediastinitis diagnosis must be set as early as possible and with the use of computed tomography scanning. Treatment requires the simultaneous application of potent antimicrobial drugs, aggressive surgical debridement of the neck and high-quality drainage of the mediastinum, which can be achieved through the transcervical approach