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Hung TY, Tseng CW, Wen CS, Yu SH, Chen HL, Lee CW, Su YC, Lin CH. Video-stylet vs. channeled hyperangulated videolaryngoscope: Efficacy in simulated Ludwig's angina randomized cadaver trial. Am J Emerg Med 2024; 76:63-69. [PMID: 37995525 DOI: 10.1016/j.ajem.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Ludwig's angina (LA) is a life-threatening infection that can affect the floor of the mouth and neck, potentially causing serious airway obstruction. In such cases, rescue airway management and oxygenation can be challenging due to swelling of the mouth floor, trismus, and limited mouth opening. The aim of this study was to assess the efficacy of the Trachway video-stylet (VS) and Pentax AWS hyperangulated videolaryngoscope with channel (HAVL-C) compared to the standard geometric video-laryngoscope (SGVL, Macintosh 3, Trachway) in simulating Ludwig's angina with cadavers. METHODS Three fresh frozen cadavers were prepared with varying degrees of difficulty to simulate the airway conditions of patients with LA, including mouth floor swelling, restricted mouth opening, and trismus. Fifty-five second-year resident physicians from various specialties participated in the study and received training in airway management using SGVL, VS, and HAVL-C devices. Participants were randomly assigned to intubate simulated LA with cadavers using the three devices in a random order, and intubation times and success rates were recorded. Participants also rated the difficulty of intubation using a visual analogue scale (VAS) score. The primary outcome assessed the first-pass intubation success or failure, while the secondary outcomes measured the intubation time and subjective difficulty using a visual analogue scale with different laryngoscopes. RESULTS The success rates for intubation within 90 s were 40% for SGVL, 82% for VS, and 76% for HAVL-C. VS and HAVL-C had significantly higher success rates than SGVL, with hazard ratios of 3.4 and 2.7, and 95% confidence intervals (CI) of 2.0-5.7 and 1.6-4.6, p < 0.001, respectively. The odds ratios of successful intubation for VS and HAVL-C were 8.1 and 6.3, respectively, with a 95% CI of 3.7-17.8 and 2.4-16.7, p < 0.001, compared to SGVL. The VAS score was significantly correlated with intubation success rate and time. CONCLUSIONS In cases of LA, the use of VS and HAVL-C is preferable over SGVL. These findings suggest that using VS and HAVL-C can improve intubation success rates and reduce intubation time in patients with LA.
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Affiliation(s)
- Tzu-Yao Hung
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan; CrazyatLAB (Critical Airway Training Laboratory), Taipei City, Taiwan.
| | - Cheng-Wei Tseng
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Chung-Shiung Wen
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Sheng-Han Yu
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Hsin-Ling Chen
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Chen-Wei Lee
- CrazyatLAB (Critical Airway Training Laboratory), Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien County, Taiwan; Department of Emergency, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi City, Taiwan.
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien County, Taiwan; Department of Emergency, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Chieh-Hung Lin
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
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Kakkat S, Lohiya S, Maheswara Y, Vagha JD, Taksande A, Meshram RJ. Rare Case of Ludwig's Angina in a Child. Cureus 2023; 15:e40446. [PMID: 37456434 PMCID: PMC10349334 DOI: 10.7759/cureus.40446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/24/2023] [Indexed: 07/18/2023] Open
Abstract
The parents of an 11-month-old infant presented her to the hospital due to her persistent fever and the presence of a swollen neck over a period of four days. Inflammation and discomfort were observed on both sides of her neck, particularly around the parotid glands. Notably, a localized collection of pus was identified beneath her left jaw while both sides of her jaw exhibited swelling, albeit with less sensitivity. A neck scan revealed an infection in the jaw region, accompanied by swelling in the facial skin and underlying tissue. The diagnosis rendered was Ludwig's angina, for which the prescribed course of treatment involved administering intravenous antibiotics such as amikacin, vancomycin, and Meropenem. The patient exhibited improvement after the treatment and was subsequently discharged from the hospital.
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Affiliation(s)
- Shikha Kakkat
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sham Lohiya
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yarraiahgari Maheswara
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Nagaura M, Saitoh K, Tsujimoto G, Yasuda A, Shionoya Y, Sunada K, Kawai T. Usefulness of preoperative computed tomography findings for airway management in patients with acute odontogenic infection: a retrospective study. Odontology 2023; 111:499-510. [PMID: 36279070 DOI: 10.1007/s10266-022-00756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
Odontogenic infection is more likely to affect the airway and interfere with intubation than non-odontogenic causes. Although anesthesiologists predict the difficulty of intubation and determine the method, they may encounter unexpected cases of difficult intubation. An inappropriate intubation can cause airway obstruction due to bleeding and edema by damaging the pharynx and larynx. This study was performed to determine the most important imaging findings indicating preoperative selection of an appropriate intubation method. This retrospective study included 113 patients who underwent anti-inflammatory treatment for odontogenic infection. The patients were divided into two groups according to the intubation method: a Macintosh laryngoscope (45 patients) and others (video laryngoscope and fiberscope) (68 patients). The extent of inflammation in each causative tooth, the severity of inflammation (S1-4), and their influence on the airway were evaluated by computed tomography. The causative teeth were mandibular molars in more than 90%. As the severity of inflammation increased, anesthesiologists tended to choose intubation methods other than Macintosh laryngoscopy. In the most severe cases (S4), anesthesiologists significantly preferred other intubation methods (33 cases) over Macintosh laryngoscopy (9 cases). All patients with S4 showed inflammation in the parapharyngeal space, and the airway was affected in 41 patients. The mandibular molars were the causative teeth most likely to affect the airway and surrounding region. In addition to clinical findings, the presence or absence of inflammation that has spread to the parapharyngeal space on preoperative computed tomography was considered an important indicator of the difficulty of intubation.
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Affiliation(s)
- Madoka Nagaura
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan.
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan.
| | - Keisuke Saitoh
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Gentaro Tsujimoto
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Asako Yasuda
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Yoshiki Shionoya
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Katsuhisa Sunada
- Department of Dental Anesthesiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan
| | - Taisuke Kawai
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
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Inflammatory Markers as Predictors for Prolonged Duration of Hospitalization in Maxillofacial Infections. J Clin Med 2023; 12:jcm12030871. [PMID: 36769517 PMCID: PMC9917481 DOI: 10.3390/jcm12030871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Despite the progress made in diagnosing and treating maxillofacial infections, the course of infection can be unpredictable, leading to severe complications, prolonged hospitalization, and substantial financial costs to health care services. It is important to determine whether various serum inflammatory marker levels on admission may predict a prolonged hospital stay in these patients. To analyze the role of CRP, white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR) in predicting the prolonged duration of hospitalization in maxillofacial infections, we performed a retrospective study by collecting paper records data from 108 patients who met our inclusion criteria. The patients were divided into two groups according to the duration of hospitalization (group A < 5 days and group B ≥ 5 days). The predictor variables were CRP, WBC, and NLR, and the outcome variable was the duration of hospitalization. This study confirmed a positive linear correlation (p < 0.001) between the predictors and the outcome variable. The optimal cut-off values for WBC are 11,030 white blood cells/μL and 63 mg/L for CRP. Levels that exceed these optimal values predict a duration of hospitalization of over (≥) 5 days. Serum WBC and CRP on admission may predict the duration of hospitalization in patients with MFI.
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Almadhi G, Alkathlan M, Alharbi O, Almeman A. Severe Ludwig's angina caused by an unknown insect bite. BMJ Case Rep 2021; 14:e243566. [PMID: 34417239 PMCID: PMC8381310 DOI: 10.1136/bcr-2021-243566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/04/2022] Open
Abstract
Hereby, we report a case of a 75-year-old man who presented with a 3-day history of facial swelling and choking sensation. The only history of note was an insect bite on the left parotid gland area 3 days prior. The patient was later diagnosed with insect-bite-induced Ludwig's angina. Enterococcus faecalis was detected on blood cultures and was presumed the source of infection. Intravenous antibiotics and corticosteroids were initiated. The patient was intubated and was subsequently made to undergo a tracheostomy insertion to establish a definitive airway. He was admitted to the intensive care unit and when his condition improved, he was transferred to the ward for full recovery. The patient spent a total of 66 days in hospital before being discharged. This case suggests that Ludwig's angina can be caused by insect bites. However, further similar cases are needed to be documented to explore this theory.
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Affiliation(s)
- Gihad Almadhi
- College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
| | - Mohammed Alkathlan
- Infectious Diseases, King Fahad Specialist Hospital, Buraydah, Qassim, Saudi Arabia
| | - Othman Alharbi
- College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
| | - Ahmad Almeman
- College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
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Osaghae IP, Adebola AR, Amole IO, Olaitan AA, Salami YA, Kuye O, Ayoub A. Ludwig's angina in Nigeria: The disease of the poor and health inequality! Surgeon 2021; 20:e129-e133. [PMID: 34187738 DOI: 10.1016/j.surge.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/23/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
AIM highlight the health inequality and identify opportunities to improve the care delivered to the patients who suffer from Ludwig's angina which could have national and international clinical impact. MATERIALS AND METHODS Data was collected from three major oral and maxillofacial centers, in Nigeria including Benin, Lagos and Kano. A protocol was developed for data collection which included demographic details, socio-economic status, management of the air way, the associated morbidities and mortalities. RESULTS Forty-nine were managed in Benin, 57 in Lagos and 66 in Kano. Diabetes was the most prevalent underlying systematic condition, affecting 21% of the Ludwig's angina patients in Lagos. Poverty was a common denominator, 90% of the patients from Kano were unemployed compared to 23% and 8% from Lagos and Benin respectively. For most of the patients, the airway was monitored. Incision and drainage were carried out in most of the cases at Benin and Lagos, but it was only considered in 50% of the cases in Kano. Mortality ranged from 4% in Benin to 12% in Lagos and it was as high as 19% in Kano. CONCLUSION poor access to oral healthcare, unemployment and low socio-economic status are important predisposing factors of Ludwig's angina.
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Affiliation(s)
| | | | - Ibiyinka Olusola Amole
- Oral & Maxillofacial Surgery, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ademola Abayomi Olaitan
- Oral & Maxillofacial Surgery, Lagos State University Teaching Hospital, Ikeja Lagos State, Nigeria
| | - Yussuf Ajibola Salami
- Oral & Maxillofacial Surgery, Lagos State University Teaching Hospital, Ikeja Lagos State, Nigeria
| | - Olasunkanmi Kuye
- Oral & Maxillofacial Surgery, Lagos State University Teaching Hospital, Ikeja Lagos State, Nigeria
| | - Ashraf Ayoub
- Oral & Maxillofacial Surgery, The University of Glasgow Dental Hospital & School, United Kingdom.
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7
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Ludwig's angina and steroid use: A narrative review. Am J Otolaryngol 2020; 41:102411. [PMID: 32035654 DOI: 10.1016/j.amjoto.2020.102411] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ludwig's angina, a rapidly progressive cellulitis causing airway obstruction, has traditionally been managed with antibiotics and surgical intervention. More controversial is the use of steroids in the management of patients with this condition. This article summarizes the literature of steroid use in the management of Ludwig's angina. METHODS The study used a narrative review method alongside the PRISMA guidelines for systematic reviews. PubMed, Ovid Medline, Cochrane, and Web of Science were searched for cases of Ludwig's angina with documented steroid use in patient management. Inclusion criteria were articles in the English language with direct patient outcomes. There were 17 articles selected with 31 patient cases. RESULTS Most reports of steroid use in Ludwig's angina in the literature are case reports, with one retrospective review, and one letter to the editor. Dexamethasone was the steroid of choice in most cases reviewed. All patient cases reported used antibiotics alongside their steroid use, and 27 out of 31 patient cases required surgery. Most patients recovered with no further sequelae or complications. Three (9.68%) patients suffered mortality due to unrelated causes. CONCLUSIONS Primary literature reporting the use of steroids in the management of Ludwig's angina includes few cases. While the role steroids have in these cases remains uncertain, the articles summarized do not suggest an adverse influence, and may suggest a benefit.
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8
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Paediatric dento-facial infections - a potential tool for identifying children at risk of neglect? Br Dent J 2019; 225:757-761. [PMID: 30361599 DOI: 10.1038/sj.bdj.2018.862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/09/2022]
Abstract
Introduction Child neglect has a significant impact on children's physical and emotional health and development with lifelong consequences. Dental decay can lead to maxillofacial space infections which can have life-threatening complications and may indicate that a child has suffered dental neglect. Aims and method In this retrospective audit, we reviewed children below sixteen years who were admitted under oral and maxillofacial surgery for incision and drainage of a dental/facial abscess, under general anaesthesia, between January 2015 and January 2017, to understand if they had experienced dental neglect. We also assessed if they were or had been known to Children's Social Services (SS) before hospital admission. Results Twenty-seven children were included in the study, eleven children (40%), were known to social services (SS). On average 3.2 teeth were extracted with an average hospital stay of 2.5 days. Discussion Our data indicate that a significant number of children admitted for maxillofacial space infection are already known to social services. Conclusion Our recommendation is that all children admitted with dental/maxillofacial space infections, where dental neglect may be present, should be discussed with the local safeguarding team.
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Ghotane SG, Challacombe SJ, Gallagher JE. Fortitude and resilience in service of the population: a case study of dental professionals striving for health in Sierra Leone. BDJ Open 2019; 5:7. [PMID: 31098298 PMCID: PMC6513870 DOI: 10.1038/s41405-019-0011-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/05/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Sierra Leone (SL), with a population of over 7 million people, has a critical health workforce shortage. This research explores the views of key players on population oral health needs and demands, the challenges of oral and dental care delivery, and professional careers in dentistry, in order to inform future capacity building. MATERIALS AND METHODS Semi-structured interviews were conducted with a purposive sample of key players in dentistry and healthcare, both in-country and externally. An interpretive phenomenological approach was used in exploring views of key-players on the oral needs and demands of population, challenges in the delivery of oral and dental care, professional careers of dental professionals in SL, and future workforce capacity building based on a topic guide drawn from the available literature. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed using QSR NVivo 10 for data management and reported in accordance to the consolidated criteria for reporting qualitative research. RESULTS Twenty-one informants, of whom 18 were male, 17 were in-country and 16 were dental professionals, participated in the research. Dental professionals reported clear consensus on a considerable level of unmet oral health needs, most notably dental caries and periodontal disease, together with life threatening oral conditions such as osteomyelitis, Ludwig's Angina and Burkitt's Lymphoma. Challenges associated with the delivery of dental care revolved around five themes: patients' predisposition for traditional remedies and urgent care; practical hindrances to the delivery of care; professional isolation and weak governance; and place with pressing local crises and lack of political will. An emerging typology of dental professionals included: demonstrating loyalty to their nation and family; exhibiting resilience in challenging circumstances; embracing opportunity most notably amongst expatriates; and striving to serve the needs of the population. There was support for innovative future capacity building developments. CONCLUSION This paper provides important insights to the delivery of dental care in a low-income country with significant oral health needs and multiple challenges in the delivery of dental care, whilst also providing a vision for developing, building and retaining future human resources for oral health.
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Affiliation(s)
- Swapnil G. Ghotane
- Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, SE5 9RS UK
| | - Stephen J. Challacombe
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, Centre for Host Microbiome Interactions, Floor 22, Guys Tower, Guys Hospital, London, SE1 9RT UK
| | - Jennifer E. Gallagher
- Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, SE5 9RS UK
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Alegbeleye BJ. Deep neck infection and descending mediastinitis as lethal complications of dentoalveolar infection: two rare case reports. J Med Case Rep 2018; 12:195. [PMID: 29980234 PMCID: PMC6035394 DOI: 10.1186/s13256-018-1724-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background We report two cases of innocuous dentoalveolar infections which rapidly progressed to deep neck abscesses complicated by descending mediastinitis in a resource-constrained rural mission hospital in the Cameroon. Case presentation The clinical presentations of a 35-year-old man and a 32-year-old woman both of Fulani origin in the Northern region of Cameroon were similar with submandibular fluctuant and tender swelling and differential warmth to palpation. The patients had tachycardia, high grade pyrexia, and normal blood pressure. Further physical and neurological examinations were unremarkable. An ultrasound scan of the neck swellings showed submandibular turbid collections. Plain chest radiographs confirmed empyema thoraces. Our patients had serial drainage of the neck abscesses as well as closed thoracostomy tube drainage which were connected to pleurovac and suctioning machines, with significant amount of pus drainage. Both patients were admitted to our intensive care unit for close monitoring. The first patient continued to make satisfactory clinical progress and was discharged by the fourth week of admission. The patient who had human immunodeficiency viral infection died on the fifth postoperative day. Conclusions The possibility of lethal complications and the associated morbidity and mortality portray this clinical entity as an important public health concern. Clinicians taking care of patients with dentoalveolar and oropharyngeal infections need to be sensitized to these potentially fatal complications. Alternatively, strategies to improve oral health and reduce the incidence of dental caries, the main cause of dental abscess, would maximize use of resources; especially in resources-constrained centers like ours in Banso Baptist Hospital.
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Maciag M, Sediva I, Alexander-Scott N. Submandibular Swelling and Fever Following Frenulectomy in a 13-Day-Old Infant. Clin Pediatr (Phila) 2016; 55:990-2. [PMID: 26810622 DOI: 10.1177/0009922815627014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michelle Maciag
- Hasbro Children's Hospital, Brown University, Providence, RI, USA
| | - Ivona Sediva
- Hasbro Children's Hospital, Brown University, Providence, RI, USA
| | - Nicole Alexander-Scott
- Hasbro Children's Hospital, Brown University, Providence, RI, USA Rhode Island Department of Health, Providence, RI, USA
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An unusual case of life-threatening airway compromise complicating a neck dissection. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-015-1134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Eunice E Dixon
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Russell W Steele
- Tulane University School of Medicine, New Orleans, LA, USA University of Queensland School of Medicine, New Orleans, LA, USA
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Bali RK, Sharma P, Gaba S, Kaur A, Ghanghas P. A review of complications of odontogenic infections. Natl J Maxillofac Surg 2015; 6:136-43. [PMID: 27390486 PMCID: PMC4922222 DOI: 10.4103/0975-5950.183867] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Life-threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous sinus thrombosis, sepsis, thoracic empyema, Lemierre's syndrome, cerebral abscess, orbital abscess, and osteomyelitis. The incidence of these "space infections" has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. This study reviews complications of odontogenic infections. The search done was based on PubMed and Google Scholar, and an extensive published work search was undertaken. Advanced MEDLINE search was performed using the terms "odontogenic infections," "complications," and "risk factors."
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Affiliation(s)
- Rishi Kumar Bali
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Parveen Sharma
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Shivani Gaba
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Avneet Kaur
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Priya Ghanghas
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
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Mahajan RK, Sharma S, Madan P, Sharma N. Ludwig's angina by Salmonella Typhi: a clinical dilemma. Indian J Med Microbiol 2015; 33:300-2. [PMID: 25865990 DOI: 10.4103/0255-0857.154889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Salmonella Typhi has rarely been associated with focal abscesses; and in literature, there is no evidence of its association with abscesses in the neck spaces. Ability of Salmonella Typhi to invade and localise in the neck spaces not only poses a diagnostic challenge but also underscores the necessity to understand the mechanisms that facilitate Salmonella Typhi to establish infections at sites completely non-traditional to the organism.
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Affiliation(s)
| | - S Sharma
- Department of Microbiology, Dr. Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
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16
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Presentation and management of facial swellings of odontogenic origin in children. Eur Arch Paediatr Dent 2014; 15:259-68. [DOI: 10.1007/s40368-014-0110-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
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Candamourty R, Venkatachalam S, Babu MRR, Kumar GS. Ludwig's Angina - An emergency: A case report with literature review. J Nat Sci Biol Med 2012; 3:206-8. [PMID: 23225990 PMCID: PMC3510922 DOI: 10.4103/0976-9668.101932] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ludwig's angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Early diagnosis and immediate treatment planning could be a life-saving procedure. Here we report a case of wide spread odontogenic infection extending to the neck with elevation of the floor of the mouth obstructing the airway which resulted in breathlessness and stridor for which the patient was directed to maintain his airway by elective tracheostomy and subsequent drainage of the potentially involved spaces. Late stages of the disease should be addressed immediately and given special importance towards the maintenance of airway followed by surgical decompression under antibiotic coverage. The appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection remains the standard protocol of treatment in advanced cases of Ludwig's angina.
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Affiliation(s)
- Ramesh Candamourty
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Mahatma Gandhi Medical College and Research Institute Campus, Pillaiyarkuppam, Pondicherry, India
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Pediatric infectious disease: unusual head and neck infections. Oral Maxillofac Surg Clin North Am 2012; 24:469-86. [PMID: 22739434 DOI: 10.1016/j.coms.2012.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Infections in children in the head and neck regions are common, leading to frequent use and overuse of antibiotics. This review includes common as well as diverse and unusual infectious diseases, such as PFAPA (Periodic Fever Aphthous stomatitis, Pharyngitis, Adenitis) syndrome, Lemierre Syndrome, Arcanobacterium infection, and tuberculous and nontuberculous adenitis, which occur in infants, children, and adolescents. In addition, the first pediatric vaccines available with the potential to prevent oropharyngeal cancers are reviewed.
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Abstract
The use of eponyms has long been contentious, but many remain in common use, as discussed elsewhere (Editorial: Oral Diseases. 2009: 15; 185). The use of eponyms in diseases of the head and neck is found mainly in specialties dealing with medically compromised individuals (paediatric dentistry, special care dentistry, oral and maxillofacial medicine, oral and maxillofacial pathology, oral and maxillofacial radiology and oral and maxillofacial surgery) and particularly by hospital-centred practitioners. This series has selected some of the more recognised relevant eponymous conditions and presents them alphabetically. The information is based largely on data available from MEDLINE and a number of internet websites as noted below: the authors would welcome any corrections. This document summarises data about Ludwig angina.
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Affiliation(s)
- C Scully
- UCL-Eastman Dental Institute, University College London, London.
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Ludwig BJ, Foster BR, Saito N, Nadgir RN, Castro-Aragon I, Sakai O. Diagnostic Imaging in Nontraumatic Pediatric Head and Neck Emergencies. Radiographics 2010; 30:781-99. [DOI: 10.1148/rg.303095156] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
PURPOSE The purpose was to describe pathologic paediatric conditions associated with airway compromise adversely affecting dental treatment with sedation and general anaesthesia. METHODS A review of available literature was completed, identifying pathologic paediatric conditions predisposing to airway compromise. RESULTS Airway-related deaths are uncommon, but respiratory complication represents the greatest cause of morbidity and mortality during the administration of general anaesthesia. Differences in anatomy and physiology of the paediatric and adult airway contribute to the child's predisposition to rapid development of airway compromise and respiratory failure; juvenile rheumatoid arthritis, cervical spine injury, morbid obesity, and prematurity represent only a few conditions contributing to potential airway compromise of which the paediatric clinician needs to be aware. In all cases, thorough physical examination prior to treatment is mandated to affect a positive treatment outcome. CONCLUSIONS Successful management of children and adolescents with a compromised airway begins with identification of the problem through a detailed medical history and physical examination. Due to the likely fragile nature of many of these patients, and possibility of concomitant medical conditions affecting airway management, dental treatment needs necessitating pharmacological management are best treated in a controlled setting such as the operating room, where a patent airway can be maintained.
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Affiliation(s)
- Suher Baker
- Section of Pediatric Dentistry, Yale-New Haven Hospital, New Haven, CT 06519, USA.
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Coca Pelaz A, Llorente Pendás JL, Suárez Nieto C. Ludwig's angina as an extremely unusual complication for direct microlaryngoscopy. Am J Otolaryngol 2010; 31:117-9. [PMID: 20015713 DOI: 10.1016/j.amjoto.2008.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 09/08/2008] [Accepted: 09/10/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND An extremely rare case that to our knowledge has not been reported before is described, in which a patient had a Ludwig's angina as a complication of direct microlaryngoscopy. METHODS We report a Ludwig's angina after a direct microlaryngoscopy for a Reinke's edema, due to erosion on the internal face of the mandible produced by compression of the laryngoscope. RESULTS The patient underwent placement of 2 drainages, intraoral and cervical, and several incisions on the floor of the mouth, with intravenous corticosteroids and antibiotics and with resolution of the illness without performing tracheostomy. CONCLUSIONS Ludwig's angina is an extremely rare complication of microlaryngoscopy, but it is potentially life-threatening. Early diagnosis and treatment resulted in survival of the patient without complications.
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Affiliation(s)
- Andrés Coca Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, c/Valdés 10, Oviedo Asturias, Spain.
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Lin HW, O'Neill A, Rahbar R, Skinner ML. Ludwig's angina following frenuloplasty in an adolescent. Int J Pediatr Otorhinolaryngol 2009; 73:1313-5. [PMID: 19560216 DOI: 10.1016/j.ijporl.2009.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 05/26/2009] [Indexed: 11/26/2022]
Abstract
Ludwig's angina is a rapidly progressive cellulitis of the submandibular space and has the potential for significant upper airway obstruction. Most reported cases follow an odontogenic infection. We present the case of a 13-year-old girl who underwent a frenuloplasty to correct speech disturbances and subsequently developed a life-threatening infection of the floor of mouth. Immediate intubation, surgical decompression and antibiotic therapy successfully resolved the episode. To our knowledge, this is the first report of an iatrogenic Ludwig's angina attributable to a frenuloplasty performed for ankyloglossia. We briefly review the literature on ankyloglossia, pediatric Ludwig's angina and postoperative infections.
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Affiliation(s)
- Harrison W Lin
- Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Boston, MA 02114, USA.
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Abstract
As many as 1 in 3 of cases of Ludwig's angina occur in children and adolescents, and pediatricians are therefore ideally situated to detect these individuals at an early stage of their potentially life-threatening disease. The early identification and referral of children afflicted with Ludwig's angina to tertiary care centers allows for the rapid initiation of medical therapy and the consultation of those emergency services critical to providing such patients with optimal diagnostic and therapeutic interventions. This review provides an overview of the anatomical and pathophysiological considerations in Ludwig's angina and describes practical management principles to assist pediatricians in the diagnosis and treatment of this disease. Included in this review is an evidence-based algorithm for airway management.
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Affiliation(s)
- Harrison W Lin
- Department of Otology and Laryngology, Harvard Medical School; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachussetts, USA.
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Abstract
Ludwig angina remains a potentially lethal disease, rapidly spreading bilateral cellulitis of the submental, sublingual, and submandibular spaces, which bears the threat for rapid airway obstruction. Since the introduction of antibiotics in 1940s, the mortality was reduced significantly. This resulted in the rare occurrence of the disease, leaving many physicians with limited experience of Ludwig angina. Although the occurrence of Ludwig angina in adults is rare, its presence in the pediatric edentulous population is even more uncommon. Because the unfamiliarity with this disease is now increasing, unnecessary delaying diagnosis or inadequate management may occur and may result in serious complications. This presentation will consist of a historical review, discussion of pathophysiology, followed by clinical presentation, etiology, bacteriology, and management. With early diagnosis, airway observation and management, aggressive intravenous antibiotic therapy, and judicious surgical intervention, the disease should resolve without complications. In addition, the source of infection should be determined and eliminated if possible. A thoughtful, individualized management strategy seems to be the most reasonable approach to the disease.
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Ludwig’s Angina in a 4 Month Old Infant. Ann Emerg Med 2006. [DOI: 10.1016/j.annemergmed.2005.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Although systematic reviews are the backbone of evidence-based dentistry, they have appeared infrequently in the clinical dental literature and their importance may not be recognized by dentists. The authors describe the steps taken in systematic reviews and perform a literature survey to identify published systematic reviews of topics relevant to clinical dentistry. METHODS The authors searched MEDLINE and the Cochrane databases of systematic reviews and abstracts of reviews of effectiveness, as well as identified reviews that were known to the authors but not found in the searches. Systematic reviews included in this survey stated the intention to identify all relevant articles within predefined limitations, applied defined exclusion and inclusion criteria, and presented complete raw or synthesized data from included studies. RESULTS This literature survey identified 131 systematic reviews, 96 of which had direct clinical relevance. During the past 14 years, clinically relevant systematic reviews have been published with increasing frequency. These reviews vary in the types of studies included and the assessment of those studies. The results of the reviews also varied in their definitiveness, with 17 percent finding the evidence to be insufficient to answer the key question. An additional 50 percent of the 96 reviews hedged in answering the key question, by noting that the supporting evidence was weak in quality or limited in quantity. CONCLUSION The number of systematic reviews that address clinical topics in dentistry is small but growing. However, the authors of more than one-half of these reviews believed that the evidence available to answer the key question was not strong. CLINICAL IMPLICATIONS As systematic reviews continue to grow, dentistry will become better informed about the adequacy and congruence of the scientific evidence underpinning clinical practice.
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Affiliation(s)
- James Bader
- Department of Operative Dentistry, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA.
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Sýkora J, Varvarovská J, Stozický F, Vondráková R, Svecová M, Siala K, Schwarz J. Adolescent herpes simplex viral infection related Ludwig's angina in ulcerative colitis. J Pediatr Gastroenterol Nutr 2004; 38:221-3. [PMID: 14734889 DOI: 10.1097/00005176-200402000-00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Josef Sýkora
- Department of Paediatrics, Charles University Hospital, Pilsen, Czech Republic.
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Srirompotong S, Art-Smart T. Ludwig's angina: a clinical review. Eur Arch Otorhinolaryngol 2003; 260:401-3. [PMID: 12937916 DOI: 10.1007/s00405-003-0588-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2002] [Accepted: 01/10/2003] [Indexed: 11/30/2022]
Abstract
Ludwig's angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by a brawny induration of the floor and suprahyoid region (bilaterally), with an elevation of the tongue potentially obstructing the airway. In the pre-antibiotic era, Ludwig's angina was frequently fatal; however, antibiotics and aggressive surgical intervention have significantly reduced mortality. We reviewed nine patients with Ludwig's angina between July 1996 and June 2002, all of whom presented with fever, neck swelling, bilateral submandibular swelling and elevation of the tongue. In eight patients (89%) a dental infection appeared to be the underlying cause. High-dosage intravenous antibiotics directed towards the suspected causative microorganisms were given to all of the patients: two were treated successfully with conservative medical management, while seven underwent surgical drainage (a tracheotomy was necessary in one patient). Routine aerobic cultures were done on samples of drained material and the predominant microorganisms were Streptococcus species in two patients; there were none in the other five. Two patients had post-operative complications, but all recovered.
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Affiliation(s)
- Somchai Srirompotong
- Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, 40002 Khon Kaen, Thailand.
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Abstract
In this chapter we have reviewed the complicated medical conditions that exist in many head and neck surgical patients. Common surgical procedures that frequently require postoperative monitoring and several infectious disorders requiring intensive care unit admission were also reviewed. Intensivists need to be familiar with these procedures and diseases. Collaboration with the surgical specialist is required to optimize patient care.
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Affiliation(s)
- Arvind Bansal
- Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York NY 10128, USA
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Potter JK, Herford AS, Ellis E. Tracheotomy versus endotracheal intubation for airway management in deep neck space infections. J Oral Maxillofac Surg 2002; 60:349-54; discussion 354-5. [PMID: 11928085 DOI: 10.1053/joms.2002.31218] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of the present study was to compare costs and outcomes for patients with deep neck infections who were treated with either tracheotomy or endotracheal intubation. MATERIALS AND METHODS The charts of 85 patients with deep neck space infections were retrospectively studied. Requirements for inclusion in the study were incision and drainage in the operating room, involvement of more than 1 deep anatomic space, impending airway compromise, and maintenance of a postoperative artificial airway. The 85 patients were divided into 2 groups based on the type of airway used for treatment. Group 1 (n = 34) included patients who received a tracheotomy, and group 2 (n = 51) included patients whose airways were maintained with endotracheal intubation until the swelling had resolved sufficiently for extubation. RESULTS Patients in group 1 had a shorter overall hospital stay (4.8 vs 5.9 days, NS) and spent less time in the intensive care unit (1.1 vs 3.1 days, P <.05). The overall incidence of complications was 6% for group 1 and 10% for group 2. The rate of complications secondary to loss of airway was 3% for group 1 and 6% for group 2. Average costs associated with intensive care resources were 5 times greater and overall hospital stay costs were 60% greater for group 2. CONCLUSIONS Although both methods of airway control are useful and have a unique set of complications, the use of tracheotomy allowed earlier movement to a noncritical care unit and was associated with fewer intensive care costs and less overall cost of hospitalization. Tracheotomy may therefore provide better utilization of critical care resources in this group of patients.
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Affiliation(s)
- Jason K Potter
- Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9109, USA
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Ariji Y, Gotoh M, Kimura Y, Naitoh M, Kurita K, Natsume N, Ariji E. Odontogenic infection pathway to the submandibular space: imaging assessment. Int J Oral Maxillofac Surg 2002; 31:165-9. [PMID: 12102414 DOI: 10.1054/ijom.2001.0190] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aims of this study were to determine the pathways of odontogenic infection spread into the submandibular space and their relationship to the clinical symptoms. Computerized tomography (CT) and magnetic resonance (MR) images of 33 patients with submandibular involvement were analyzed. The spread of infection was evaluated by lateral asymmetry of the shape and density of the fascial spaces and tissues, and by obliteration of the interfascial fat spaces. Imaging findings were classified into three types: in 19 patients (57.6%), infection spread through the mylohyoid muscle or sublingual space (type I). In five patients (15.2%), infection spread through the bony structures of the mandible with periosteal reaction or perforation of the cortical plate (type II) and was associated with relatively mild symptoms. In four patients (12.1%), infection spread from the masticatory space (type III). Seven of 11 patients with dysphagia or fever showed submandibular involvement spreading into the parapharyngeal space. CT and MR imaging clearly demonstrated different pathways of the spread of odontogenic infection into the submandibular space, which influenced the manifestation of clinical symptoms.
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Affiliation(s)
- Y Ariji
- Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Nagoya, Japan.
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