A 44-year-old man was admitted to our hospital because of high fever, neck swelling, and dyspnea. He was diagnosed as descending necrotizing mediastinitis (DNM) extended from oropharyngeal infection. Descending necrotizing mediastinitis(DNM) is a lethal process originating from odontogenic. oropharyngeal, or cervical infections that descends along the fascial planes into the mediastinum. DNM is relatively rare, but it is lethal disease with high mortality. Immediate and sufficient mediastinal drainage is indispensable for the disease. The principles of the surgical approach for DNM are discussed, with a brief review of the literature following these case reports.