Descending necrotizing mediastinitis (DNM) is an infrequent clinical entity. DNM is the result of infection originating in the oropharyngeal regions and spreading along cervical fascial planes to cause mediastinal abscess and sepsis. Even with prompt recognition and treatment, the mortality and morbidity associated with DNM are appreciable. The opportunities for successful outcome are improved with liberal use of computed tomography, aggressive surgical therapy, and a multidisciplinary team approach. We report a case of DNM that illustrates how these principles were employed in the successful management of this rare and often fatal condition.