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Cervical necrotizing fasciitis (CNF) is the name for a group of bacterial infections characterized by necrosis of the fascia and subcutaneous cellular tissue of the neck. Descending necrotizing mediastinitis (DNM) is a well-known and feared complication of CNF that severely affects the prognosis. Abdominal involvement is rare. The mainstay of treatment is prompt and aggressive medical therapy and surgical debridement of all involved sites. The role of video-assisted thoracoscopic surgery (VATS) in this setting, even if already reported i