Cervical phlegmons are associated with a high risk of developing descending mediastinitis, which determines an unfavorable prognosis of the disease. The aim of the study was to compare the effectiveness of traditional surgical tactics with a modified treatment and diagnostic algorithm aimed at preventing mediastinitis. The study included 92 patients divided into a control group (n=35) and a main group (n=29). In the main group, a risk stratification system was applied based on clinical, laboratory, and imaging data, followed by personalized selection of the extent of surgical intervention and antibacterial therapy. The results demonstrated a significant reduction in the incidence of mediastinitis (3.4% vs. 28.6%; p<0.01), a decrease in the number of reoperations, reduced mortality, and shorter hospitalization duration in the main group. The dynamics of inflammatory markers (C-reactive protein, procalcitonin, lactate) indicated a faster resolution of systemic inflammation. The implementation of the modified algorithm improved the clinical effectiveness of treatment and reduced the risk of severe complications in patients with neck phlegmons.

neck phlegmons; descending mediastinitis; prevention; risk stratification; surgical tactics.

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