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Grillo R, Balel Y, Brozoski MA, Ali K, Adebayo ET, Naclério-Homem MDG. A global science mapping analysis on odontogenic infections. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101513. [PMID: 37207960 DOI: 10.1016/j.jormas.2023.101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Odontogenic infections are common and a topic of core interest for dentists, and maxillofacial surgeons. The aim of this study was to conduct a bibliometric analysis of the global literature on odontogenic infection and explore the top 100 most cited papers to identify the common causes, sequelae and management trends. METHODS Following a comprehensive literature search, a list of top 100 most cited papers was created. The VOSviewer software (Leiden University, The Netherlands) was used to create a graphical representation of the data, and statistical analyses were performed to analyze the characteristics of the top 100 most cited papers. RESULTS A total of 1,661 articles were retrieved with the first article published in 1947. There is an exponential upward trend on the number of publications (R2 = 0.919) and a majority of papers are in English language (n = 1,577, 94.94%). A total of 22,041 citations were found with a mean of 13.27 per article. The highest number of publications were recorded from developed countries. There was a male predilection in the reported cases and the most common sites included the submandibular and parapharyngeal spaces. Diabetes mellitus was identified as the commonest co-morbidity. Surgical drainage was ascertained to be the preferred method of management. CONCLUSIONS Odontogenic infections remain prevalent and have a global distribution. Although prevention of odontogenic infection through meticulous dental care is ideal, early diagnosis and prompt management of established odontogenic infections is important to avoid morbidities and mortality. Surgical drainage is the most effective management strategy. There is lack of consensus regarding the role of antibiotics in the management of odontogenic infections.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Yunus Balel
- Department of Oral and Maxillofacial Surgery, Gaziosmanpasa University, Gaziosmanpasa, Turkey
| | - Mariana Aparecida Brozoski
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil
| | - Kamran Ali
- College of Dental Medicine, Qatar University, Doha, Qatar
| | - Ezekiel Taiwo Adebayo
- Department of Oral and Maxillofacial Surgery, University of Medical Sciences, Ondo, Nigeria
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil
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Petreanu CA, Constantin T, Iosifescu R, Gibu A, Zariosu A, Croitoru A. Necrotizing fasciitis of the chest wall: A clinical case report and literature review. Exp Ther Med 2022; 23:90. [PMID: 34934455 PMCID: PMC8652382 DOI: 10.3892/etm.2021.11013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/11/2021] [Indexed: 11/08/2022] Open
Abstract
Necrotizing fasciitis of the chest wall is a very rare pathology, but with significant mortality, representing a therapeutic challenge. All international reports indicate the need for early diagnosis and an aggressive medical-surgical attitude in order to improve the prognosis. In addition to a review of literature, we present a case developed secondary to a thoracic pleural drainage for pyopneumothorax associated with significant bronchopleural fistula in a destroyed tuberculous left lung. Along with medical treatment, extensive surgical debridement was required. Despite drainage incisions and negative pressure wound therapy (NPWT), the evolution of the fasciitis was difficult, due to bronchopleurocutaneous fistula. Thus, the Azorin procedure (transcervical mediastinoscopic closure of the left main bronchus) was performed. Once this procedure was completed, the inflammatory phenomena were controlled which allowed for a second step consisting of left pneumonectomy, with the application of specific methods for the prevention of bronchial fistula. The clinical case was a therapeutic challenge requiring a complex, staged, multidisciplinary approach due to both the immunocompromised terrain and the severity of the lesions. In conclusion, early recognition and aggressive and combined application of medical and surgical treatment methods can ensure therapeutic success.
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Affiliation(s)
- Cornel Adrian Petreanu
- Department of Thoracic Surgery, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania
- Department of Thoracic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Traian Constantin
- Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 061344 Bucharest, Romania
- Department of Urology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Razvan Iosifescu
- Department of General Surgery, ‘Sf. Ioan’ Clinical Emergency Hospital, 042122 Bucharest, Romania
- Department of General Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Alexandru Gibu
- Department of Thoracic Surgery, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania
| | - Alexandru Zariosu
- Department of Thoracic Surgery, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania
| | - Alina Croitoru
- Department of Pneumology, ‘Marius Nasta’ National Institute of Pneumology, 050152 Bucharest, Romania
- Department of Pneumology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Klug TE, Greve T, Hentze M. Complications of peritonsillar abscess. Ann Clin Microbiol Antimicrob 2020; 19:32. [PMID: 32731900 PMCID: PMC7391705 DOI: 10.1186/s12941-020-00375-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. Methods Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. Results Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). Conclusion Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum, the current findings suggest that viridans group streptococci, S. aureus, Prevotella, and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark.
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Hentze
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark
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4
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Clinical classification of cervical necrotizing fasciitis. Eur Arch Otorhinolaryngol 2018; 275:3067-3073. [DOI: 10.1007/s00405-018-5155-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
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5
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Flores CE, Matthews MR, Caruso DM, Foster KN, Stroschein M. A rare case of peritonsillar abscess resulting in cervical necrotizing fasciitis. OTOLARYNGOLOGY CASE REPORTS 2017. [DOI: 10.1016/j.xocr.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Taneja V, Walker RJ, Tedla M. Necrotising fasciitis of the neck: Unusual presentation with aggressive management – case report with review of literature. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2016.1266636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Virangna Taneja
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Rachel J. Walker
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Miroslav Tedla
- Otorhinolaryngology Department, Warwick University and University Hospital Coventry, Coventry, UK
- Department of ORL-HNS, Faculty of Medicine, Comenius University Bratislava, Slovakia
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Horváth T, Horváth B, Varga Z, Liktor B, Szabadka H, Csákó L, Liktor B. Severe neck infections that require wide external drainage: clinical analysis of 17 consecutive cases. Eur Arch Otorhinolaryngol 2014; 272:3469-74. [PMID: 25359195 DOI: 10.1007/s00405-014-3367-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/23/2014] [Indexed: 11/25/2022]
Abstract
Infections in the neck layers and spaces are potentially life-threatening diseases causing further complications, like mediastinitis, airway obstruction, or sepsis. Despite of the need for a conservative approach, they still regularly require surgical intervention. Records of 17 patients with severe neck infections that were treated by wide external incision and open wound management were retrospectively analyzed. The aim of the study was to clinically characterize these most serious neck infections. The most common presenting symptoms were neck pain and tense neck mass (94-94%) regularly with fever (65%), always accompanied by a marked elevation of C reactive protein level (average 192 uG/l). These findings were constant and very similar among both the deep neck infection and necrotizing fasciitis cases. More than half of the patients (53%) had at least one systemic co-morbidity. The parapharyngeal space was most commonly affected (83%), but extended disease involving more than two major neck regions was found in 13 cases (76%). Dental (29%) was the most common primary infection, followed by peritonsillar abscess (23%), Microbiological results showed a wide variety of corresponding bacteria. Mediastinitis was developed in three cases (18%), and airway obstruction requiring tracheostomy in two cases (12%). All the patients survived. Severe neck infections are a heterogenous group of diseases regarding to the primary site of infection, microbiology, localisation and host reaction. However, rapidly developed, painful, tense neck mass with a highly elevated CRP level should always alert for an extended or phlegmonous process in the layers or spaces of the neck.
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Affiliation(s)
- Tamás Horváth
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary.
| | - Barnabás Horváth
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
| | - Zsuzsa Varga
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
| | - Bálint Liktor
- Department of Otolaryngology and Head and Neck Surgery, County Hospital, Oberwart, Austria
| | - Hajnalka Szabadka
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
| | - László Csákó
- Department of Otolaryngology and Head and Neck Surgery, Jahn Ferenc Hospital, Budapest, Hungary
| | - Bálint Liktor
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
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8
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Necrotizing craniocervical soft tissue infections: clinical experience and personal considerations. Case Rep Otolaryngol 2012; 2012:489638. [PMID: 23304596 PMCID: PMC3529439 DOI: 10.1155/2012/489638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/01/2012] [Indexed: 11/21/2022] Open
Abstract
Necrotizing cervical soft tissue infections (NCSTIs) are devastating uncommon clinical entities that are often life threatening. We report two patients suffering from NCSTI and treated at our institution. Diagnosis of NCSTI has been confirmed histologically and surgically. Both patients were managed with very aggressive treatment (medical and surgical) and survived with minimal morbidity. Early diagnosis and aggressive, multimodality treatment can reduce mortality and morbidity rates. Thoracic and mediastinal involvement requires appropriate management. A strong clinical suspicion remains one of the most important aspects of the management of such shattering conditions.
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9
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Vaid N, Kothadiya A, Patki S, Kanhere H. Necrotising fasciitis of the neck. Indian J Otolaryngol Head Neck Surg 2012; 54:143-5. [PMID: 23119877 DOI: 10.1007/bf02968735] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Necrotising fasciitis is a fulminant soft tissue infection that causes necrosis of fascia and subcutaneous tissue while sparing skin and muscle initially. It is most commonly seen in adults involving the perineum, extremities and and minal wall. Immunncompromised patients are at an increased risk of developing this infection. These infections require early diagnosis, aggressive surgical debridaient and appropriate antibiotic therapy. Mortality rates have been reported to be as high as 52 and 73% in general surgery literature.(Freuschtag et al, 1985., Rouse et at 1982).Necrotising fasciitis of the head and neck is rare. The commonest cause is secondary to denial infections. We report a case of necrotising fasciitis of the neck secondary to a peritonsillar abscess in a previously healthy individual. The pathogenesis and treatment of this fulminant infection are also discussed.
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Affiliation(s)
- Neelam Vaid
- Dept of Otorhinolaryngology, Director of Surgery, Lecturer in Surgery, Dept of Surgery, K.E.M. Hospital, Pune
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10
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Necrotizing fasciitis: an unusual presentation. Indian J Otolaryngol Head Neck Surg 2012; 63:390-2. [PMID: 23024950 DOI: 10.1007/s12070-011-0225-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 10/18/2009] [Indexed: 10/18/2022] Open
Abstract
Necrotizing fasciitis (NF) is rare but life threatening multimicrobial soft tissue infection characterized by progressive, usually rapid, necrotizing process of the subcutaneous tissues and fascial planes, with resulting skin gangrene and systemic toxicity. The groin, abdomen and extremities are the most frequent sites involved by this disease and it is rarely seen in the head and neck region. NF of the head and neck region has a potentially high morbidity and mortality. Delay in diagnosis leads to poor outcome. Hence early recognition and aggressive management is imperative for successful outcome. Here we present a case of acute onset of cervical necrotizing fasciitis in a young male.
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Craniocervical Necrotizing Fasciitis Resulting from Dentoalveolar Infection. Oral Maxillofac Surg Clin North Am 2011; 23:425-32. [DOI: 10.1016/j.coms.2011.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Bakshi J, Virk RS, Jain A, Verma M. Cervical Necrotizing Fasciitis: Our Experience with 11 Cases and Our Technique for Surgical Debridement. EAR, NOSE & THROAT JOURNAL 2010. [DOI: 10.1177/014556131008900211] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a retrospective review of 11 cases of adult cervical necrotizing fasciitis that were treated at our institution over a period of 5-plus years. The most common etiology was a dental infection, which was seen in 7 of the 11 patients (64%). Most cultures were sterile because all of these patients had been referred to us after they had already been treated elsewhere with intravenous antibiotics and without surgical intervention. Under our management, patients spent an average of 21.6 days in the hospital, and they underwent an average of 1.6 debridements under general anesthesia. Aggressive wound care, broad-spectrum antibiotic therapy, and timely surgical intervention resulted in an overall survival rate of 91% (10/11), including a 75% survival (3/4) for patients with thoracic extension.
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Affiliation(s)
- Jaimanti Bakshi
- Department of Otolaryngology–Head and Neck Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ramandeep S. Virk
- Department of Otolaryngology–Head and Neck Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ajay Jain
- Department of Otolaryngology–Head and Neck Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mayuresh Verma
- Department of Otolaryngology–Head and Neck Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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13
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Mao JC, Carron MA, Fountain KR, Stachler RJ, Yoo GH, Mathog RH, Coticchia JM. Craniocervical necrotizing fasciitis with and without thoracic extension: management strategies and outcome. Am J Otolaryngol 2009; 30:17-23. [PMID: 19027508 DOI: 10.1016/j.amjoto.2007.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/24/2007] [Accepted: 12/29/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE First objective was to review cases of craniocervical necrotizing fasciitis (CCNF) at Wayne State University/Detroit Medical Center (Detroit, MI) for the last 18 years. Second was to analyze patients with and without thoracic extension for contributing factors. METHODS Retrospective review of 660 patients with necrotizing fasciitis treated at WSU/DMC from January 1989 to January 2007 was conducted. Data regarding source/extent of infection, presenting signs/symptoms, computed tomography, microbiology, antibiotics, comorbidities, number/type of operations, hyperbaric oxygen (HBO) therapy, hospital duration, complications, and overall outcome were compared/analyzed between patients with and without thoracic extension. RESULTS Twenty patients with CCNF for the past 18 years met the inclusion criteria. Ten patients had thoracic extension, and 10 patients did not have. Individuals in the thoracic extension group were likely to be older, had increased comorbidity, required more surgical debridement, experienced increased postoperative complications, and had lower overall survival. Three patients with thoracic extension underwent HBO therapy and 66% survived. CONCLUSION This is the largest single institutional review of CCNF comparing patients with and without thoracic extension. Patients with thoracic extension have a poorer outcome as follows: 60% (6/10) survival vs 100% (10/10) for those without thoracic extension (P < .05). The CCNF patients without thoracic extension treated at our institution all survived after prompt medical and surgical intervention. Overall survival of CCNF patients without thoracic extension may be attributed to rigorous wound care, broad spectrum intravenous antibiotics, aggressive surgical debridement, and vigilant care in surgical intensive care unit. The HBO therapy should be included if the patient can tolerate it.
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Affiliation(s)
- Johnny C Mao
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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14
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Necrotizing fasciitis of the chest wall with a retropharyngeal abscess: case report and literature review. Ann Plast Surg 2008; 61:544-8. [PMID: 18948783 DOI: 10.1097/sap.0b013e31816d81ff] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We herein report a case of a diabetic 49-year-old woman with anterior chest wall necrotizing fasciitis that caused a retropharyngeal abscess and discuss the literature surrounding necrotizing soft tissue infections of the chest wall. The patient was treated with serial wound debridements, antibiotic therapy, and percutaneous drainage and serial irrigation of the retropharyngeal abscess with a silicone catheter. The resulting defect was grafted with a split thickness skin graft.
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15
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Farrier JN, Kittur MA, Sugar AW. Necrotising fasciitis of the submandibular region; a complication of odontogenic origin. Br Dent J 2007; 202:607-9. [PMID: 17534319 DOI: 10.1038/bdj.2007.425] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2006] [Indexed: 11/08/2022]
Abstract
Inadequate treatment or neglect of odontogenic infections can have serious consequences. The potential for spreading through fascial planes and intracranially can cause compromise of the airway and cavernous sinus thrombosis respectively. On rare occasions this can lead to a rapidly progressing necrotising fasciitis, with destruction of soft tissue, making reconstruction difficult. Antibiotic administration without removal of the cause is inadequate and can complicate subsequent management. We report the presentation and successful management of a 13-year-old boy, who developed necrotising fasciitis in the submandibular region as a result of inadequate initial treatment of a carious, lower molar resulting in significant skin and soft tissue loss.
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Affiliation(s)
- J N Farrier
- Department of Oral & Maxillofacial Surgery, Morriston Hospital, Swansea, UK.
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16
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De Freitas RP, Fahy CP, Brooker DS, Primrose WJ, McManus KG, McGuigan JA, Hughes SJ. Descending necrotising mediastinitis: a safe treatment algorithm. Eur Arch Otorhinolaryngol 2006; 264:181-7. [PMID: 17009018 DOI: 10.1007/s00405-006-0174-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2006] [Accepted: 09/05/2006] [Indexed: 10/24/2022]
Abstract
Descending necrotising mediastinitis can complicate oropharyngeal infection and has a high associated mortality. We present three cases treated in our department and propose a treatment algorithm based on our experience and literature review. The primary oropharyngeal infection was peritonsillar abscess in two cases and odontogenic abscess in one. Two patients underwent cervicotomy and later thoracotomy. The third underwent cervicotomy with transcervical mediastinal drainage and later required pericardial drainage via a subxiphoid incision. All recovered fully and were discharged within 6 weeks. To enable successful treatment, diagnosis needs to be prompt and surgical drainage adequate. Thoracic management of the chest is essential.
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Affiliation(s)
- R P De Freitas
- Department of Otolaryngology and Head and Neck Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland.
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17
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Balbierz JM, Ellis K. Streptococcal infection and necrotizing fasciitis—implications for rehabilitation: a report of 5 cases and review of the literature. Arch Phys Med Rehabil 2004; 85:1205-9. [PMID: 15241775 DOI: 10.1016/j.apmr.2003.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Five cases are presented of patients who were diagnosed with necrotizing fasciitis secondary to (1) hip disarticulation (in a paraplegic patient); (2) tooth abscess with extensive neck dissection, complicated by sepsis and hypotension with resultant dysphagia and ischemic encephalopathy; (3) below-knee amputation, anoxia, and severe debility; (4) emergent above-knee amputation; and (5) percutaneous endoscopic gastrostomy placement. The latter patient developed abdominal and chest wall necrotizing fasciitis that required skin grafting. Four patients were treated in an acute rehabilitation setting and returned home, and the fifth was rehabilitated in a subacute facility. This report emphasizes the importance of carefully monitoring rehabilitation patients, especially those with impaired sensation.
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Affiliation(s)
- Janet M Balbierz
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132-2119, USA.
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Akman C, Kantarci F, Cetinkaya S. Imaging in mediastinitis: a systematic review based on aetiology. Clin Radiol 2004; 59:573-85. [PMID: 15208062 DOI: 10.1016/j.crad.2003.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2003] [Revised: 12/10/2003] [Accepted: 12/14/2003] [Indexed: 10/26/2022]
Abstract
Mediastinitis refers to inflammation of the tissues located in the middle chest cavity. It can be secondary to infectious or non-infectious causes and depending on the aetiology may be acute or chronic. The majority of cases of acute mediastinitis are secondary to oesophageal perforation and open chest surgery. Less common causes include tracheal, bronchial perforation or direct extension of infection from adjacent tissues. Chronic or slowly developing mediastinitis mostly arise from tuberculosis, histoplasmosis, other fungal infections, cancer, or sarcoidosis. In a minority of cases the aetiology is lymphatic obstruction or an autoimmune disease. Radiological imaging plays an essential role in the diagnosis and therapeutic approach to mediastinitis. Generally, the initial radiological work-up includes radiographic studies either with or without contrast material. However, conventional chest radiography may be misleading in the diagnosis of mediastinitis. Cross-sectional imaging techniques are generally required for diagnosis and evaluation of the site and extent of mediastinal involvement. Computed tomography and magnetic resonance imaging may also guide the choice of the optimal therapeutic approach.
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Affiliation(s)
- C Akman
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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Makeieff M, Gresillon N, Berthet JP, Garrel R, Crampette L, Marty-Ane C, Guerrier B. Management of descending necrotizing mediastinitis. Laryngoscope 2004; 114:772-5. [PMID: 15064640 DOI: 10.1097/00005537-200404000-00035] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE/HYPOTHESIS Descending necrotizing mediastinitis is caused by downward spread of neck infections and constitutes a highly lethal complication of oropharyngeal lesions. This infection previously had a much worse prognosis. In recent years, more aggressive management has been recommended. The aim of this study is to evaluate the results with the association of thoracotomy and cervicotomy, medical care in an intensive care unit, and daily washing of drained cervical and thoracic tissues. STUDY DESIGN Retrospective study of 17 patients treated from 1984 to 1998. METHOD Descending necrotizing mediastinitis was consecutive to pharyngitis (6 cases), peritonsillar abscess (3 cases), dental abscess (6 cases), foreign body infection (1 case), and laryngitis (1 case). Corticotherapy was reported in seven cases. Twelve patients had no particular medical history. Mean age was 42 years. Mean duration of signs before diagnosis was 6 days. Thoracotomy was associated with the cervical approach in 14 cases, whereas 3 patients were treated by cervicotomy only. RESULTS Fourteen patients of 17 (82.3%) were successfully treated. Three deaths occurred. The mean duration of hospitalization in the intensive care unit was 30 days, and the mean total duration of hospitalization was 45 days. CONCLUSION Descending necrotizing mediastinitis must be detected as soon as possible by computed tomography (CT) scanning in patients with persistent symptomatologia after treatment for oropharyngeal infections. Prompt surgical drainage with thoracotomy and cervicotomy in all cases of mediastinal involvement below the tracheal carena, use of CT scanning to monitor the disease evolution, and medical management in an intensive care unit significantly reduces the mortality rate to less than 20%.
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Affiliation(s)
- Marc Makeieff
- Otolaryngology Head and Neck Surgery Department, Gui de Chauliac Hospital, University of Medicine, Montpellier, France.
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20
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Umeda M, Minamikawa T, Komatsubara H, Shibuya Y, Yokoo S, Komori T. Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:283-90. [PMID: 12627098 DOI: 10.1067/moe.2003.85] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Necrotizing fasciitis of the head and neck is an uncommon, potentially fatal soft tissue infection characterized by extensive necrosis and gas formation in the subcutaneous tissue and fascia. The aims of this study were to describe the condition of this rare disease and to find factors affecting the mortality. STUDY DESIGN Nine of our new cases and 125 reported cases in the English-language literature with necrotizing fasciitis of dental origin were reviewed. RESULTS Two of our 9 patients had some form of systemic disease such as diabetes, cardiac insufficiency, renal failure, or cerebral infarction, whereas the other 7 had no particular general complications. A computed tomography examination was useful for detecting gas formation in the deep neck. All 9 patients underwent extensive debridement within 24 hours, and good results were obtained. In contrast, 24 of the 125 reviewed patients died despite therapy. Factors affecting the mortality were associated diseases such as diabetes or alcohol abuse, delay of surgery, and the complication mediastinitis. CONCLUSION Necrotizing fasciitis is still a potentially fatal disease. Early and aggressive debridement may reduce mortality.
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Affiliation(s)
- Masahiro Umeda
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kobe University.
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21
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Tsuei BJ, Lyu PE. Chest radiography. Atlas Oral Maxillofac Surg Clin North Am 2002; 10:189-211. [PMID: 12518596 DOI: 10.1016/s1061-3315(02)00006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Betty J Tsuei
- Department of General Surgery, College of Medicine, University of Kentucky, 800 Rose Street, Room C-221, Lexington, KY 40536, USA.
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22
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Ndukwe KC, Fatusi OA, Ugboko VI. Craniocervical necrotizing fasciitis in Ile-Ife, Nigeria. Br J Oral Maxillofac Surg 2002; 40:64-7. [PMID: 11883974 DOI: 10.1054/bjom.2001.0715] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sixteen cases of necrotizing fasciitis were seen at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from 1990 to 2000. Primary craniocervical involvement was recorded in seven patients (five men and two women). The clinical records of five patients were sufficiently detailed to allow us to report their age, aetiology, predisposing illness, clinical features, complications, management regimen and outcome. The patients were aged 30-75 years and in four of them odontogenic infections were the cause of the condition. Hypertension, diabetes mellitus and obesity were the underlying systemic diseases in three cases and the body/angle region of the mandible was the predominant site of the infection on the face. All five cases had involvement of the neck. Mediastinal extension was recorded in three cases. Two patients had complications: one had septicaemia and renal failure and the other developed bone necrosis. Pre-existing ill health, old age, late surgical intervention, and mediastinal and thoracic extension of infection were responsible for the only death. Treatment involved frequent and multiple surgical debridement, aggressive antimicrobial treatment and control of systemic disease. Early recognition, prompt surgical intervention, and aggressive antimicrobial treatment are essential to minimize morbidity and mortality. Rapid progression of infection, financial constraints, delayed referrals from rural clinics and distance to the tertiary hospital caused problems.
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Affiliation(s)
- K C Ndukwe
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
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23
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Bahu SJ, Shibuya TY, Meleca RJ, Mathog RH, Yoo GH, Stachler RJ, Tyburski JG. Craniocervical necrotizing fasciitis: an 11-year experience. Otolaryngol Head Neck Surg 2001; 125:245-52. [PMID: 11555761 DOI: 10.1067/mhn.2001.118182] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We review our experience and present our approach to treating craniocervical necrotizing fasciitis (CCNF). STUDY DESIGN All cases of CCNF treated at Wayne State University/Detroit Receiving Hospital from January 1989 to April 2000 were reviewed. Patients were analyzed for source and extent of infection, microbiology, co-morbidities, antimicrobial therapy, hospital days, surgical interventions, complications, and outcomes. RESULTS A review of 250 charts identified 10 cases that met the study criteria. Five cases (50%) had spread of infection into the thorax, with only 1 (10%) fatality. An average of 24 hospital days (7 to 45), 14 ICU days (6 to 21), and 3 surgical procedures (1 to 6) per patient was required. CONCLUSION Aggressive wound care, broad-spectrum antibiotics, and multiple surgical interventions resulted in a 90% (9/10) overall survival and 80% (4/5) survival for those with thoracic extension. SIGNIFICANCE This is the largest single institution report of CCNF with thoracic extension identified to date.
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Affiliation(s)
- S J Bahu
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
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24
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Shand JM, Breidahl A, Hing NR, Johnstone BR, Wiesenfeld D. Ascending necrotising fasciitis as a result of odontogenic infection: a report of two cases. Aust Dent J 2001; 46:134-8. [PMID: 11491229 DOI: 10.1111/j.1834-7819.2001.tb00568.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Necrotising fasciitis is a severe soft tissue infection which spreads rapidly through fascial planes, is characterised by soft tissue necrosis and is potentially life-threatening. It is a rare entity in the head and neck region. The management of this condition is difficult and early diagnosis and aggressive surgical and medical management are essential. This paper reports two cases of necrotising fasciitis as a result of ascending odontogenic infection involving the temporalis muscle.
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Affiliation(s)
- J M Shand
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne
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25
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Wong TY. A nationwide survey of deaths from oral and maxillofacial infections: the Taiwanese experience. J Oral Maxillofac Surg 1999; 57:1297-9; discussion 1300. [PMID: 10555793 DOI: 10.1016/s0278-2391(99)90863-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This study investigated the incidence of deaths from oral and maxillofacial infections encountered in a 3-year period. PATIENTS AND METHODS A survey was conducted nationwide. Questionnaires were constructed and sent to dental or OMS Departments of all medical centers, regional hospitals, and provincial and municipal hospitals in Taiwan. Only those infections severe enough for hospital care were studied. More than half of the departments replied, including all major hospitals. RESULTS A total of 2,790 cases were admitted to OMS or dental inpatient services because of oral and maxillofacial infections in the 3-year period. Eighteen deaths were reported by 9 departments during this period. The mortality rate in southern Taiwan was significantly higher than that in northern Taiwan (P = .017). All deaths were in patients older than 40 years of age, and 66.7% had diabetes. In the 18 cases, there were deep neck infections (5 cases), necrotizing fasciitis (3 cases), Ludwig's angina (2 cases), brain abscess (2 cases), infected osteoradionecrosis (1 case), mucormycosis (1 case), buccal cellulitis (1 case), and unknown infection (3 cases). Sepsis was the most common cause of death. CONCLUSIONS The estimated rate of death was approximately 1 in 150 cases admitted for oral and maxillofacial infections. Most of the patients who died were diabetics with deep or necrotizing infections. Particular attention should be paid to patients with these features.
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Affiliation(s)
- T Y Wong
- Department of Dentistry, College of Medicine, National Cheng Kung University, Tainan City, Taiwan, Republic of China
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26
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Skitarelić N, Mladina R, Matulić Z, Kovacić M. Necrotizing fasciitis after peritonsillar abscess in an immunocompetent patient. J Laryngol Otol 1999; 113:759-61. [PMID: 10748857 DOI: 10.1017/s002221510014513x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cervical necrotizing fasciitis (CNF) is a rapidly progressive, severe bacterial infection of the fascial planes of the head and neck. Group A beta haemolytic Streptococcus spp. (GABHS), Staphylococcus spp., or obligatory anaerobic bacteria are the most common causative pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CNF. Review of the literature reveals only seven such cases, with four successful outcomes. The authors present the case of a 50-year-old immunocompetent female with CNF arising from a peritonsillar abscess. Intravenous immunoglobulins in conjunction with surgery and antibiotics were used successfully. The authors also suggest the importance of the early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and possible usefulness of the intravenous immunoglobulins in the treatment of CNF, especially when the disease is associated with toxic shock syndrome.
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Affiliation(s)
- N Skitarelić
- Department Otolaryngology-Head and Neck Surgery, General Hospital, Zadar, Croatia
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27
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Kiernan PD, Hernandez A, Byrne WD, Bloom R, Dicicco B, Hetrick V, Graling P, Vaughan B. Descending cervical mediastinitis. Ann Thorac Surg 1998; 65:1483-8. [PMID: 9594903 DOI: 10.1016/s0003-4975(98)00142-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Descending cervical mediastinitis is an uncommonly reported presentation of infection originating in the head or neck and descending into the mediastinum, which is fraught with impressive morbidity and mortality rates of 30% to 40% or more. We present the INOVA-Fairfax-Alexandria Hospital experience with descending cervical mediastinitis, January 1, 1986, to April 1, 1997; in addition we review the English-language medical and surgical literature with regard to this entity. Computed tomography and magnetic resonance imaging serve to aid both diagnosis and management. The application of broad-spectrum antibiotics should initially be empiric, with an eye to coverage of mixed aerobic and anaerobic infections. Definitive treatment mandates early and aggressive surgical intervention. All affected tissue planes, cervical and mediastinal, must be widely debrided, often leaving them open for frequent packing and irrigation. The treating physician must remain always alert to the further extension of infection, which, if it occurs, must be further debrided and drained. Tracheostomy serves a dual role of further opening cervical fascial planes and securing an often compromised airway.
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Affiliation(s)
- P D Kiernan
- Section of Thoracic Surgery, INOVA Health Systems, Annandale, Virginia, USA
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28
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Abstract
Cervical necrotizing fasciitis (CNF) is an aggressive infection of the head and neck with high complication and mortality rates. Sixty-eight cases of CNF have been reported in the English-language literature. We present a series of 8 patients with CNF, including 5 men and 3 women ranging in age from 25 to 92 years. To the best of our knowledge, this is one of the largest case series reported. Six of the 8 patients had a predisposing odontogenic focus of infection. Four patients had mediastinal involvement. Two patients, both with significant comorbidity at the time of presentation, died of CNF.
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Affiliation(s)
- S Kantu
- Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, USA
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29
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Affiliation(s)
- M H Ali
- Department of Surgery, King Fahad Hospital, Al Baha, Saudi Arabia
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30
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Bräunig G, Mohr C, Schönfelder B, Weischer T. [Suppurative abscess-forming mediastinitis after tooth extraction. Consequences for therapeutic approach]. MUND-, KIEFER- UND GESICHTSCHIRURGIE : MKG 1997; 1:300-4. [PMID: 9410642 DOI: 10.1007/bf03043571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purulent mediastinitis is a rare but serious complication of a descending odontogenic infection with a high mortality. Diagnosis is difficult and frequently delayed. Physical examination is often nondiagnostic, but may include pronounced edema of the neck and chest. CT scan is the single most important tool for early diagnosis. The treatment is always is surgical, in combination with an extremely high dose of combined antibiotics. Ultimately, we only could save our patient with this therapy.
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Affiliation(s)
- G Bräunig
- Klinik für Gesichts- und Kieferchirurgie, Universitätsklinikum, Essen
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31
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Sugata T, Fujita Y, Myoken Y, Fujioka Y. Cervical cellulitis with mediastinitis from an odontogenic infection complicated by diabetes mellitus: report of a case. J Oral Maxillofac Surg 1997; 55:864-9. [PMID: 9251619 DOI: 10.1016/s0278-2391(97)90352-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- T Sugata
- Department of Dentistry and Oral Surgery, Hiroshima Red Cross Atomic Bomb Survivors Hospital, Japan
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32
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Corsten MJ, Shamji FM, Odell PF, Frederico JA, Laframboise GG, Reid KR, Vallieres E, Matzinger F. Optimal treatment of descending necrotising mediastinitis. Thorax 1997; 52:702-8. [PMID: 9337829 PMCID: PMC1758626 DOI: 10.1136/thx.52.8.702] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Descending necrotising mediastinitis is caused by downward spread of neck infection and has a high fatality rate of 31%. The seriousness of this infection is caused by the absence of barriers in the contiguous fascial planes of neck and mediastinum. METHODS The recent successful treatment of seven adult patients with descending necrotising mediastinitis emphasises the importance of optimal early drainage of both neck and mediastinum and prolonged antibiotic therapy. The case is also presented of a child with descending necrotising mediastinitis, demonstrating the rapidity with which the infection can develop and lead to death. Twenty four case reports and 12 series of adult patients with descending necrotising mediastinitis published since 1970 were reviewed with meta-analysis. In each case of confirmed descending necrotising mediastinitis the method of surgical drainage (cervical, mediastinal, or none) and the survival outcome (discharge home or death) were noted. The chi 2 test of statistical significance was used to detect a difference between cases treated with cervical drainage alone and cases where mediastinal drainage was added. RESULTS Cervical drainage alone was often insufficient to control the infection with a fatality rate of 47% compared with 19% when mediastinal drainage was added (p < 0.05). CONCLUSIONS Early combined drainage with neck and chest incisions, together with broad spectrum intravenous antibiotics, should be considered standard care for this disease.
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Affiliation(s)
- M J Corsten
- Department of Otolaryngology, University of Ottawa, Ontario, Canada
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33
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Gradon JD. Space-occupying and life-threatening infections of the head, neck, and thorax. Infect Dis Clin North Am 1996; 10:857-78. [PMID: 8958172 DOI: 10.1016/s0891-5520(05)70330-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Infections of the deep structures of the head and neck are polymicrobial, rapidly progressive, and frequently life-threatening. The bacteriology, clinical presentation, and the need for multidisciplinary management of these infections are stressed. In addition, this article discusses selected head and neck infections of immunocompromised hosts and postexposure prophylaxis for serious infections of the pharynx.
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Affiliation(s)
- J D Gradon
- Department of Medicine, Sinai Hospital, Baltimore, MD 21215, USA
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34
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Ris HB, Banic A, Furrer M, Caversaccio M, Cerny A, Zbären P. Descending necrotizing mediastinitis: surgical treatment via clamshell approach. Ann Thorac Surg 1996; 62:1650-4. [PMID: 8957367 DOI: 10.1016/s0003-4975(96)00683-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Descending necrotizing mediastinitis requires an early and aggressive surgical approach to reduce the high morbidity and mortality associated with this disease. The clamshell incision has provided excellent exposure of the entire mediastinum and both pleural cavities and was assessed in patients suffering from descending necrotizing mediastinitis. METHODS Three patients with descending necrotizing mediastinitis and bilateral pleural empyema due to invasive streptococcal infections were operated on with this method. Radical debridement of the mediastinum and bilateral decortication was performed through a clamshell incision, including pericardiectomy in 2 patients. All patients received initially a high dose of antibiotic regimen, 2 had bilateral chest tube drainage, and 1 had mediastinal drainage and pleural debridement via cervical mediastinotomy and thoracoscopy, respectively. All these measures alone, however, failed to control the disease. RESULTS The clamshell incision offered an excellent exposure for bilateral decortication and debridement of the entire mediastinum including pericardiectomy. One patient, who was referred in critically ill condition, died of multiorgan failure in the postoperative period. The remaining 2 patients recovered without further interventions and without evidence of phrenic nerve palsy, sternum osteomyelitis, or sternal override. CONCLUSIONS The clamshell approach offers an excellent exposure for a complete one-stage surgical treatment with mediastinal debridement and bilateral decortication in patients suffering from descending necrotizing mediastinitis in the absence of profound septic shock.
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Affiliation(s)
- H B Ris
- Department of Thoracic and Cardiovascular Surgery, University of Berne, Switzerland
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35
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Necrotizing soft tissue infections of the body wall: Computed tomographic evaluation. Emerg Radiol 1996. [DOI: 10.1007/bf01507786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Hadfield PJ, Motamed M, Glover GW. Synergistic necrotizing cellulitis resulting from peri-tonsillar abscess. J Laryngol Otol 1996; 110:887-90. [PMID: 8949306 DOI: 10.1017/s002221510013525x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This case demonstrates the rare but potentially fatal condition of synergistic necrotizing cellulitis of the head and neck. Although similar to necrotizing fasciitis, this is more extreme as it also destroys muscle. Peri-tonsillar abscess is a recognized cause, but has not previously been described in this country, however it is a condition commonly referred to otolaryngologists and awareness of the complication of synergistic necrotizing cellulitis is necessary to allow early recognition and prompt treatment. This should be by broad-spectrum intravenous antibiotics with extensive surgical debridement and drainage procedures repeated as necessary. Although this case had a successful outcome, many patients do not survive, particularly if treatment is delayed or inadequate.
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Affiliation(s)
- P J Hadfield
- Department of Otolaryngology, Northwick Park Hospital, Harrow, Middlesex, UK
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37
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Yii NW, Quinn SJ, Andersson LC, Niranjan NS, Kenyon GS. Cervical necrotising fasciitis with pharyngeal perforation: treatment and reconstruction. BRITISH JOURNAL OF PLASTIC SURGERY 1996; 49:237-41. [PMID: 8757674 DOI: 10.1016/s0007-1226(96)90058-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present a case of life-threatening necrotising fasciitis of the neck with acute pharyngeal perforation following a parapharyngeal abscess caused by tonsillitis. The joint occurrence of cervical necrotising fasciitis and acute pharyngeal perforation has not been previously reported. A new way of reconstructing the pharyngeal defect using an islanded submental perforator flap is presented.
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Affiliation(s)
- N W Yii
- Department of Plastic and Reconstructive Surgery, Royal London Hospital, London, UK
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38
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Banerjee AR, Murty GE, Moir AA. Cervical necrotizing fasciitis: a distinct clinicopathological entity? J Laryngol Otol 1996; 110:81-6. [PMID: 8745791 DOI: 10.1017/s0022215100132797] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Necrotizing fasciitis of the head and neck has previously been classified as a homogeneous group. We present two cases of necrotizing fasciitis confined to the neck and demonstrate with a review of the literature that cervical necrotizing fasciitis and craniofacial necrotizing fasciitis are two distinct clinicopathological conditions.
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Affiliation(s)
- A R Banerjee
- Department of Otorhinolaryngology, Leicester Royal Infirmary, UK
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39
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Skorina J, Kaufman D. Necrotizing Fasciitis Originating from Pinna Perichondritis. Otolaryngol Head Neck Surg 1995; 113:467-73. [PMID: 7567023 DOI: 10.1016/s0194-59989570087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
NF is a potentially lethal infectious process usually found in the abdomen, perineum, or extremities. In the head and neck it usually starts from a dental infection but can be initiated from any source. One of the more serious sequelae is extension of the infection down the deep fascial planes of the neck leading to mediastinitis; this is associated with a higher mortality rate. The presence of an associated immunocompromising disease, such as diabetes, has been said to predispose an individual to NF, and the mortality rate has been shown to be higher (although perhaps not significantly so). When first described, NF was thought to be caused only by beta-hemolytic Staphylococcus. Now it known to be a polymicrobial infection with anaerobes and facultative anaerobes found most frequently. Treatment involves broad-spectrum intravenous antibiotics as soon as possible, narrowing the coverage as the results of the gram stain and cultures become available. The importance of aggressive, prompt surgical management cannot be overemphasized in the treatment of NF. Once the diagnosis of NF is strongly suspected, debridement of the affected areas must be accomplished as soon as possible. Despite the advances in the recognition and treatment of NF, there is still significant morbidity and mortality associated with this disease. Continued vigilance must be practiced if the survival rate is to continue to increase.
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Affiliation(s)
- J Skorina
- Department of Otolaryngology, New York University School of Medicine, NY 10016, USA
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40
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Greinwald JH, Wilson JF, Haggerty PG. Peritonsillar abscess: an unlikely cause of necrotizing fasciitis. Ann Otol Rhinol Laryngol 1995; 104:133-7. [PMID: 7857015 DOI: 10.1177/000348949510400209] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cervical necrotizing fasciitis is a devastating polymicrobial soft tissue infection characterized by gas formation and extensive necrosis of subcutaneous fat and fascia with extension to skin and muscle. Involvement of the head and neck is rare and is typically dental in origin. Despite broad-spectrum antibiotics, mortality rates for this disease remain high. We report a successfully treated case of necrotizing fasciitis arising from a peritonsillar abscess. Review of the literature reveals only 6 other cases, with 3 successful outcomes. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical debridement are the cornerstones of therapy. The pathophysiology is typically a mixed aerobic and anaerobic infection. Supportive treatment options such as hyperbaric oxygen therapy and high-calorie supplemental nutrition may be of benefit. A comprehensive literature review of craniocervical necrotizing fasciitis is presented. Factors associated with poor outcomes include diabetes mellitus, mediastinitis, cardiovascular disease, and peritonsillar abscess.
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Affiliation(s)
- J H Greinwald
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, Portsmouth, Virginia
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41
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Zeitoun IM, Dhanarajani PJ. Cervical cellulitis and mediastinitis caused by odontogenic infections: report of two cases and review of literature. J Oral Maxillofac Surg 1995; 53:203-8. [PMID: 7830190 DOI: 10.1016/0278-2391(95)90404-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- I M Zeitoun
- Department of Oral & Maxillofacial Surgery, Riyadh Dental Center, Kingdom of Saudi Arabia
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Yamaoka M, Furusawa K, Uematsu T, Yasuda K. Early evaluation of necrotizing fasciitis with use of CT. J Craniomaxillofac Surg 1994; 22:268-71. [PMID: 7798356 DOI: 10.1016/s1010-5182(05)80074-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Gas bubbles are one of the important signs in the clinical diagnosis of necrotizing fasciitis, and radiographs are mandatory. An instance where gas bubbles not found on the plain radiographs were clearly shown by CT, which is a useful method for close monitoring and decompression of gas bubbles situated deeply in the spaces of the maxillo-facial and neck regions.
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Affiliation(s)
- M Yamaoka
- Oral and Maxillofacial Surgery Department II, Matsumoto Dental College, Nagano, Japan
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Affiliation(s)
- J A Odell
- Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN 55905
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Abstract
We present a case of cervical necrotizing fasciitis following quinsy in a previously fit and healthy man. This is a potentially fatal condition with few specific clinical signs that requires early diagnosis and surgical debridement. Other features of the disease are discussed.
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Goodnight JW, Sercarz JA, Wang MB. Cervical and mediastinal emphysema secondary to third molar extraction. Head Neck 1994; 16:287-90. [PMID: 8026962 DOI: 10.1002/hed.2880160314] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A dramatic case of infected emphysema involving multiple deep cervical and mediastinal fascial planes following surgical extraction of a lower third molar in an otherwise healthy man is presented. METHODS The differential diagnosis and management of this condition are discussed, specifically contrasting it to necrotizing fasciitis. RESULTS The direct cause of this complication was the use of an air turbine handpiece and air syringe for the tooth extraction. CONCLUSIONS It is advised that air turbine handpieces and air syringes not be used during minor oral surgical procedures.
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Affiliation(s)
- J W Goodnight
- Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, California 90024-1624
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Colmenero Ruiz C, Labajo AD, Yañez Vilas I, Paniagua J. Thoracic complications of deeply situated serous neck infections. J Craniomaxillofac Surg 1993; 21:76-81. [PMID: 8450077 DOI: 10.1016/s1010-5182(05)80151-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Nine cases of complicated deep neck infections, occurring during a period of twelve years are presented. Complications observed were cervico-thoracic necrotizing fasciitis in 3 cases, purulent pleural effusion in 6 cases, pericardial effusion in 2, mediastinitis in 8 cases, jugular vein thrombosis and rupture of the innominate artery in one case each. Although 2 cases were managed initially with blind endotracheal intubation, all cases finally required tracheostomy. A cervico-mediastinal approach was useful for the early mediastinal involvement. Two patients died because of inadequacy of the multiple surgical procedures resulting in persistent infection and multi-organ failure and one because of uncontrollable bleeding after innominate artery rupture.
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Affiliation(s)
- C Colmenero Ruiz
- Department of Maxillofacial Surgery, La Paz General Hospital Madrid, Spain
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