Descending necrotizing mediastinitis (DNM) is a primary complication of cervical or odontoiatric infections that can spread to the mediastinum through the anatomic cervical spaces. The delay of the diagnosis or under assessment of the disease, with no adequate draining techniques, results in high mortality up to 20%. We report our experience about 9 clinical cases of DNM observed and surgically treated in our unit from 2000 to 2006; five of these patients were admitted in the last two years. We stress the differences of management of this affection that needs a close cooperation between surgeon, intensive care unit and infectious disease specialist.