Mediastinitis is serious, life-threating infection. Desceding necrotizing mediastinitis is a form of mediastinitis with mortality rate of 40%. It develops as a complication of odontogenic and deep cervical infection. Early diagnosis and therapy are the most important issues. Computed tomographic scan is suggested if odontogenic infection is complicated with dyspnea. Mediastinitis is usually polymicrobial infection. Transcervical mediastinal drainage and intravenous antibiotic therapy are suggested. In some [figure: see text] cases aggressive mediastinal drainage by thoracotomy approach is performed.