Possible predictive factors for the development of acute mediastinitis based on an epidemiological study of deep neck infections at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Plzeň, between 2015 and 2024

Czech version

Authors: P. Klail ¹; T. Kostlivý ¹ ; P. Škopek ¹; L. Hauer ² ; C. Micopulos ² ; J. Šafránek ³ ; J. Amlerová ⁴ ; D. Slouka ¹
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku LF UK a FN Plzeň ¹; Stomatologická klinika LF UK a FN Plzeň ²; Chirugická klinika LF UK a FN Plzeň ³; Ústav mikrobiologie LF UK a FN Plzeň ⁴
Published in: Otorinolaryngol Foniatr, 75, 2026, No. 1, pp. 27-36.
Category: Original Article
doi: https://doi.org/10.48095/ccorl202627

Overview

Introduction: Deep neck infections are inflammatory conditions affecting fascially defined areas of the neck, which arise from many causes, but most commonly from odontogenic etiology. Diagnosis, which is often very difficult, is based on symptomatology, thorough clinical examination followed by a computed tomography (CT) scan with contrast agent administration. Treatment consists of careful surgical drainage of the inflammatory focus under general anesthesia, together with immediate initiation of parenteral antibiotic therapy. Aims of the study: The aim of the study was to identify possible risk factors for the development of acute mediastinitis based on data from our retrospective study. We assumed that a poor immune system or metabolic disorders and the associated high BMI in obese patients were potential risk factors. Material and methods: A retrospective analytical study included 72 patients, 68 of whom met the inclusion criteria, including 42 men (61.8%) and 26 women (38.2%). These data were then statistically analyzed. Results: In the study group of 68 patients, CRP was shown to be the strongest possible predictive factor for the development of acute mediastinitis in patients suffering from deep neck inflammation (P < 0.0001). Other statistically significant factors were leukocytosis (P = 0.0013), serum urea concentration (P = 0.0030), inflammation affecting more than one cervical space (P = 0.0002), and thrombocytosis (P = 0.0032). Mediastinitis was recorded in a total of 12 patients (17.6%), of whom 2 (16.7%) died, while the remaining 56 patients (82.4%) did not develop this complication. Conclusion: Out of the possible risk factors for the development of acute mediastinitis, high CRP proved to be the most statistically significant. Interestingly, a statistically significant risk factor for the development of acute mediastinitis is a combination of two factors, namely high CRP and a relatively low increase in leukocyte levels, which do not differ significantly from those in patients with deep neck infection without complicated acute mediastinitis. Therefore, it is necessary to perform repeated blood tests on each patient with deep neck infection and observe the dynamics of inflammatory parameters, specifically CRP and leukocytosis, and always take active measures in the event of a life-threatening complication –⁠ acute mediastinitis.

Keywords:

antibiotic therapy – mediastinitis – deep neck inflammation – neck fascia

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