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August 1988, Vol 114, No. 8 >
ARTICLE | August 1988

Poststernotomy Infections Presenting as Deep Neck Abscess FREE

L. Clark Simpson, MD; Glenn E. Peters, MD
[+] Author Affiliations

Accepted for publication March 14, 1988.

Presented on Resident's Day, University of Alabama at Birmingham, Nov 26, 1985.

Reprint requests to Division of Otolaryngology, Department of Surgery, University of South Alabama Medical Center, 2451 Fillingim St, Mobile, AL 36617 (Dr Simpson).


Arch Otolaryngol Head Neck Surg. 1988;114(8):909-912. doi:10.1001/archotol.1988.01860200093026
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References
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• A review of the world literature has failed to reveal any published reports of poststernotomy mediastinitis presenting as a deep neck infection. This article presents two such cases. Since the fascial layers of the mediastinum are a direct continuation of the cervical fascia, a number of potential pathways between the neck and mediastinum exist. Descending infection from the neck into the mediastinum is well documented. The reverse situation, an ascending infection from the mediastinum into the neck, is not described despite the potential natural pathways available for spread of infection. Our proposed mechanism for these two cases is that a surgically created pathway from the mediastinum to the lower neck allows for mediastinitis to point in the intercommunicating fascial spaces of the neck. Recognition of this clinical presentation will allow the surgeon to use prompt intervention for such a serious complication.

(Arch Otolaryngol Head Neck Surg 1988;114:909-912)

REFERENCES

1 +
Granich MS, Klotz RE, Lofgren RH, et al:  Spontaneous retropharyngeal and cervical subcutaneous emphysema in adults . Arch Otolaryngol Head Neck Surg 1983;;109:701-704.
2 +
Rabuzzi DD, Johnson JT:  Diagnosis and management of deep neck infections. Otolaryngology SIPac . Am Acad Ophthalmol Otolaryngol 1978;, pp 11-40.
3 +
Paonessa DF, Goldstein JC:  Anatomy and physiology of head and neck infections: With emphasis on the fascia of the face and neck . Otolaryngol Clin North Am 1976;;9:561-577.
4 +
Coller FA, Valk WL:  The fascial spaces of the neck in acute infection . Am J Surg 1939;; 46:500-504.
5 +
Levitt GW:  Cervical fascia and deep neck infections . Laryngoscope 1970;;80:409-435.
6 +
Magovern GJ:  The mediastinum , in Effler DB (ed): Blades Surgical Diseases of the Chest , ed 4. St Louis, CV Mosby Co, 1978;, pp 145-150.
7 +
Neuhof H, Jemerin EE:  Fundamental considerations , in Neuhof H, Jemerin EE (eds): Acute Infections of the Mediastinum . Baltimore, Williams & Wilkins, 1943;, pp 322-329.
8 +
Pearse HE Jr:  Mediastinitis following cervical suppuration . Ann Surg 1938;;108:588-611.
9 +
Coller FA, Yglesias L:  The relation of the spread of infection to fascial planes in the neck and thorax . Surgery 1937;;1:323-337.
10 +
Hood RM:  Thoracic incisions , in Hood RM (ed): Techniques in General Thoracic Surgery . Philadelphia, WB Saunders Co, 1985;, pp 68-70.
11 +
Sarr MG, Gott VL, Townsend TR:  Mediastinal infection after cardiac surgery . Ann Thorac Surg 1984;;38:415-423.
12 +
Frater RWM, Santos GH:  Sources of infection in open heart surgery . NY State J Med 1974;;74:2386-2388.
13 +
Wills PI, Vernon RP:  Complications of space infections of the head and neck . Laryngoscope 1981;;91:1129-1136.
14 +
Steiner M, Grau MJ, Wilson DL, et al:  Odontogenic infection leading to cervical emphysema and fatal mediastinitis . J Oral Maxillofac Surg 1982;;40:600-604.
15 +
Rutledge R, Applebaum RE, Kim BJ:  Mediastinal infection after open heart surgery . Surgery 1985;;97:88-92.
16 +
Palmer DL, Kuritsky JN, Lapham SC, et al:  Enterobacter mediastinitis following cardiac surgery . Infect Control 1985;;6:115-119.
17 +
Brown AH, Brainbridge MV, Panagopoulos P, et al:  The complications of median sternotomy . J Thorac Cardiovasc Surg 1969;;58:189-197.
18 +
Sanfelippo PM, Danielson GK:  Complications associated with median sternotomy . J Thorac Cardiovasc Surg 1972;;63:419-423.
19 +
Bor DH, Rose RM, Modlin JF, et al:  Mediastinitis after cardiovascular surgery . Rev Infect Dis 1983;;5:885-897.
20 +
Grmoljez PF, Barner HH, Willman VL, et al:  Major complications of median sternotomy . Am J Surg 1975;;130:679-681.
21 +
Kay HR, Goodman LR, Teplick SK, et al:  Use of computed tomography to assess mediastinal complications after median sternotomy . Ann Thorac Surg 1983;;36:706-714.

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1 +
Granich MS, Klotz RE, Lofgren RH, et al:  Spontaneous retropharyngeal and cervical subcutaneous emphysema in adults . Arch Otolaryngol Head Neck Surg 1983;;109:701-704.
2 +
Rabuzzi DD, Johnson JT:  Diagnosis and management of deep neck infections. Otolaryngology SIPac . Am Acad Ophthalmol Otolaryngol 1978;, pp 11-40.
3 +
Paonessa DF, Goldstein JC:  Anatomy and physiology of head and neck infections: With emphasis on the fascia of the face and neck . Otolaryngol Clin North Am 1976;;9:561-577.
4 +
Coller FA, Valk WL:  The fascial spaces of the neck in acute infection . Am J Surg 1939;; 46:500-504.
5 +
Levitt GW:  Cervical fascia and deep neck infections . Laryngoscope 1970;;80:409-435.
6 +
Magovern GJ:  The mediastinum , in Effler DB (ed): Blades Surgical Diseases of the Chest , ed 4. St Louis, CV Mosby Co, 1978;, pp 145-150.
7 +
Neuhof H, Jemerin EE:  Fundamental considerations , in Neuhof H, Jemerin EE (eds): Acute Infections of the Mediastinum . Baltimore, Williams & Wilkins, 1943;, pp 322-329.
8 +
Pearse HE Jr:  Mediastinitis following cervical suppuration . Ann Surg 1938;;108:588-611.
9 +
Coller FA, Yglesias L:  The relation of the spread of infection to fascial planes in the neck and thorax . Surgery 1937;;1:323-337.
10 +
Hood RM:  Thoracic incisions , in Hood RM (ed): Techniques in General Thoracic Surgery . Philadelphia, WB Saunders Co, 1985;, pp 68-70.
11 +
Sarr MG, Gott VL, Townsend TR:  Mediastinal infection after cardiac surgery . Ann Thorac Surg 1984;;38:415-423.
12 +
Frater RWM, Santos GH:  Sources of infection in open heart surgery . NY State J Med 1974;;74:2386-2388.
13 +
Wills PI, Vernon RP:  Complications of space infections of the head and neck . Laryngoscope 1981;;91:1129-1136.
14 +
Steiner M, Grau MJ, Wilson DL, et al:  Odontogenic infection leading to cervical emphysema and fatal mediastinitis . J Oral Maxillofac Surg 1982;;40:600-604.
15 +
Rutledge R, Applebaum RE, Kim BJ:  Mediastinal infection after open heart surgery . Surgery 1985;;97:88-92.
16 +
Palmer DL, Kuritsky JN, Lapham SC, et al:  Enterobacter mediastinitis following cardiac surgery . Infect Control 1985;;6:115-119.
17 +
Brown AH, Brainbridge MV, Panagopoulos P, et al:  The complications of median sternotomy . J Thorac Cardiovasc Surg 1969;;58:189-197.
18 +
Sanfelippo PM, Danielson GK:  Complications associated with median sternotomy . J Thorac Cardiovasc Surg 1972;;63:419-423.
19 +
Bor DH, Rose RM, Modlin JF, et al:  Mediastinitis after cardiovascular surgery . Rev Infect Dis 1983;;5:885-897.
20 +
Grmoljez PF, Barner HH, Willman VL, et al:  Major complications of median sternotomy . Am J Surg 1975;;130:679-681.
21 +
Kay HR, Goodman LR, Teplick SK, et al:  Use of computed tomography to assess mediastinal complications after median sternotomy . Ann Thorac Surg 1983;;36:706-714.

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