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Sudri S, Pharayra M, Ghantous Y, Abu El-Naaj I, Laviv A. Pediatric Maxillofacial Infections During COVID-19: What Have We Learned? J Oral Maxillofac Surg 2024:S0278-2391(24)00277-5. [PMID: 38744420 DOI: 10.1016/j.joms.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The coronavirus (COVID-19) pandemic significantly affected health care systems worldwide, and the field of dentistry is no exception. Odontogenic infections in pediatric patients pose unique challenges to treatment and diagnosis. PURPOSE The purpose of this study was to evaluate the incidence, characteristics, and treatment of pediatric maxillofacial odontogenic infections during COVID-19 compared to pre-COVID-19. STUDY DESIGN, SETTING, SAMPLE This retrospective cohort study included all pediatric patients (0-18 years old) who visited the emergency department (ED) at Tzafon Medical Center, Israel, between March 2020 and February 2021 (COVID-19), or between March 2018 and February 2020 (pre-COVID-19), and were diagnosed with maxillofacial odontogenic infections. Patients with missing demographic data and patients who did not complete the medical examination were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The exposure variable was the date of presentation, categorized as COVID-19 or pre-COVID-19. MAIN OUTCOME VARIABLE(S) The main outcome variables were the proportion of patients diagnosed with odontogenic infections, hospitalization rate, treatment methods, and length of hospital stay. COVARIATES Covariates included patient demographics, involved dentition and associated spaces, and the administration of antibiotics before ED arrival. ANALYSES The Fisher exact test and Pearson's χ2 test were applied to assess differences in categorical variables. The Wilcoxon rank-sum test was used for independent variables. A logistic regression model was used to predict outcome variables. P values were two-tailed, and statistical significance was defined as P < .05. RESULTS The study sample comprised 471 patients: 357 (76%) in the pre-COVID-19 period and 114 (24%) during COVID-19. The relative risk of visits to the ED out of total oral and maxillofacial ED visits was lower during COVID-19 (relative risk = 0.65, P = .0001). The hospitalization rate increased from 72% (257 patients) pre-COVID-19 to 86.8% (99 patients) during the COVID-19 period (P = .001). Length of hospital stay during COVID-19 was significantly shorter than pre-COVID-19 (P < .001). CONCLUSION AND RELEVANCE The findings of this study reveal a significant reduction in odontogenic infection incidents referred to the ED during the pandemic. This implies that many of these incidents can be successfully treated in community health care settings without referral to the ED.
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Affiliation(s)
- Shiran Sudri
- Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel.
| | - Maisa Pharayra
- Dental Student, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv
| | - Yasmin Ghantous
- Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel; Post Doctoral at Johns Hopkins Medicine (2017), Maxillofacial Surgeon, Tzafon Medical Center, Poria, Israel
| | - Imad Abu El-Naaj
- Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel; Head Department of Oral and Maxillofacial Surgery, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amir Laviv
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv
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Lee SH, Oh JS, Choi YH, Lim JY. Predictive Performance Neutrophil-to-Lymphocyte Ratio of Acute Tonsillitis with Deep Neck Space Infection in Adult Patients. Emerg Med Int 2023; 2023:8456427. [PMID: 37790946 PMCID: PMC10545454 DOI: 10.1155/2023/8456427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/08/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
The aim of this study was to examine the neutrophil-to-lymphocyte ratio (NLR) in patients diagnosed with a deep neck infection (DNI) to identify helpful indicators for the initial differential diagnosis. This study was conducted as a single-center, retrospective cohort study that utilized data from the electronic medical records of patients who visited the emergency department in a tertiary university hospital between February 2018 and April 2022. The study enrolled patients aged ≥18 years who were diagnosed with tonsillitis with or without DNI during the study period. The NLR of patients without DNI was 6.1 ± 5.03, and the NLR of patients with acute tonsillitis with DNI was 8.0 ± 5.67, showing significant differences. The rate of admission in the general wards (GWs) and ICUs was significantly higher in patients with DNI, and the length of hospital stay was also significantly longer in patients with DNI. Older age, male, lower body temperature, C-reactive protein, and NLR were significant independent risk factors for DNI in patients with tonsillitis. The cutoff value for predicting DNI in patients with body temperature <37.5 was 3.09. The NLR of patients with tonsillitis, especially those with normal body temperature, can be used to predict their prognosis.
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Affiliation(s)
- Sun Hwa Lee
- Department of Emergency Medicine, Ewha Womans University Mokdong Medical Center, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Jong Seok Oh
- Seoul National University, Economics, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Yun Hyung Choi
- Department of Emergency Medicine, Ewha Womans University Mokdong Medical Center, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Ji Yeon Lim
- Department of Emergency Medicine, Ewha Womans University Seoul Medical Center, Ewha Womans University, 260, Gonghang-daero, Gangseo-gu, Seoul 07804, Republic of Korea
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Hsiao FY, Ho CY, Chan KC, Wang YC, Chin SC, Chen SL. Assessment of the Elderly Adult Patients with Deep Neck Infection: A Retrospective Study. EAR, NOSE & THROAT JOURNAL 2023:1455613231177184. [PMID: 37278212 DOI: 10.1177/01455613231177184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Background: Deep neck infection (DNI) is a potentially lethal infectious disease affecting middle-aged adults and can compromise the airway. There are limited data on the prognosis and outcomes of elderly (aged > 65 years) DNI patients, who tend to be immunocompromised. This study analyzed the clinical characteristics of elderly and adult (aged 18-65 years) DNI patients. Methods: Between November 2016 and November 2022, 398 patients with DNIs, including 113 elderly patients, were admitted to our hospital and enrolled in this study. The relevant clinical variables were investigated and compared. Results: The elderly DNI patients had longer hospital stays (P < .001), higher C-reactive protein levels (P = .021), higher blood sugar levels (P = .012), and a higher likelihood of diabetes mellitus (P = .025) than the adult patients. The higher blood sugar level is an independent risk factor for elderly (odds ratio = 1.005, 95% confidence intervals 1.002-1.008, P < .001). Moreover, the rates of intubation to protect the airway (P = .005) and surgical incision and drainage (I&D; P = .010) were higher in the elderly group. However, there were no group differences in pathogen distributions. Conclusion: The elderly DNI patients in this study had a more severe disease course, and poorer prognosis than the adult patients, as well as higher rates of intubation and I&D. However, the pathogen distributions did not differ significantly between the groups. Prompt intervention and treatment are important for elderly DNI patients.
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Affiliation(s)
- Fu-Yuan Hsiao
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kai-Chieh Chan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chien Wang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Lung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Dudhe P, Burse K, Kulkarni S, Bhardwaj C, Patel R. Clinical Profile and Outcome of Head and Neck Abscesses in 68 Patients at a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2023; 75:668-674. [PMID: 37275021 PMCID: PMC10235303 DOI: 10.1007/s12070-022-03409-2] [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: 09/16/2021] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
An abscess in head and neck region causes life threatening complications which may result in death. Because of challenging early recognition and wide range of its presenting features the present study was carried out to study in detail the clinico- demographic profile of the patients with head and neck abscesses. An observational cross sectional study was carried out on 68 cases of head and neck abscesses in a tertiary care center in Maharashtra. Out of 68 cases, 43(63.23%) were males and 25(36.77%) were females. Around 57% of the cases were in the age group of 11 to 40 years. 36(52.94%) cases had abscesses in the neck region while 32(47.06%) cases had it in the head region. Majority of the cases were of submandibular abscesses (18; 26.47%) followed by mastoid abscess (11;16.18%), Ludwig's angina (9;13.24%) and others. Most common etiology was odontogenic in origin (24; 35.29%) followed by otogenic (23; 33.82%). Pain and swelling (56; 82.35%) were the most common presenting features followed by fever (32, 47.06%) and others. 25% cases had history of diabetes mallitus. Incision and drainage was the most common mode of treatment used. Majority abscesses can be treated successfully by incision and drainage with the cover of antibiotics. Diabetic cases of abscesses can be managed successfully without any complications or prolonged hospital stay with good sugar control.
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Affiliation(s)
- Preeti Dudhe
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
| | - Kirankumar Burse
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
| | - Shreeya Kulkarni
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
| | - Chaitanya Bhardwaj
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
| | - Rushika Patel
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
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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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Sellami M, Kharrat I, Kharrat O, Hammami B, Mnejja M, Zouche I, Chaabouni MA, Charfeddine I. Acute Retropharyngeal and Parapharyngeal Abscesses: A Case Series. EAR, NOSE & THROAT JOURNAL 2023:1455613231169232. [PMID: 37019663 DOI: 10.1177/01455613231169232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the diagnosis circumstances, predisposing factors, investigations, and therapeutic management of retropharyngeal and parapharyngeal abscesses. METHODS A retrospective chart review of patients diagnosed with retropharyngeal or parapharyngeal abscess from 2001 to 2021 was performed. Epidemiological characteristics, clinical signs, investigations, medical treatment, and surgical interventions were analyzed for each patient. RESULTS A total of 30 patients with retropharyngeal or parapharyngeal abscess were identified. Computed tomography was performed in all cases, and magnetic resonance imaging was performed in three cases. Twelve patients had a "pure" retropharyngeal abscess, nine patients had a prestyloid abscess, one patient had a prestyloid abscess associated with a peritonsillar abscess, three patients had a retrostyloid abscess, and five patients had a prestyloid abscess associated with a retropharyngeal abscess or a retrostyloid abscess. The median long axis of the abscess was 42 cm. All patients received intravenous antibiotics for a median period of 8 days [4-30]. Seventeen patients required surgical trans-cervical drainage. Other patients underwent transoral or transnasal drainage. The pus culture revealed no growth in six cases, streptococcus (four cases), methicillin-sensitive Staphylococcus aureus (two cases), Klebsiella (two cases), Enterobacter (one case), Fungi (two cases), and Mycobacterium tuberculosis (a twelve-year-old boy). It was not documented in twelve cases. Histological examination revealed caseofollicular tuberculosis in a 53-year-old man. In 25 patients, no adverse events were observed during follow-up. Five patients had an unfavorable outcome. CONCLUSION We have found an increase in the incidence of these infections in recent years. Computed tomography is the best imaging examination for the diagnosis and follow-up of retropharyngeal and parapharyngeal abscess. Early drainage and antimicrobial therapy are essential for rapid recovery and prevention of complications of these abscesses.
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Affiliation(s)
- Moncef Sellami
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Ines Kharrat
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Ons Kharrat
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Boutheina Hammami
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Malek Mnejja
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Imen Zouche
- Department of anesthesiology Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Mohamed Amine Chaabouni
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
| | - Ilhem Charfeddine
- Department of otorhinolaryngology-Head and Neck Surgery Habib Bourguiba, University Hospital. Sfax, Sfax, Tunisia
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Bhardwaj R, Makkar S, Gupta A, Khandelwal K, Nathan K, Basu C, Palaniyappan G. Deep Neck Space Infections: Current Trends and Intricacies of Management? Indian J Otolaryngol Head Neck Surg 2022; 74:2344-2349. [PMID: 36452761 PMCID: PMC9702214 DOI: 10.1007/s12070-020-02174-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022] Open
Abstract
This study aims to describe the current epidemiological and etiological trends for deep neck space infections (DNIs) with an objective to understand the intricacies of their management. In this retrospective analytical study records of 52 patients with DNIs were reviewed. Patients having superficial abscess, peritonsillar abscess and abscess due to trauma/surgical procedure were excluded. Various epidemiological and etiological parameters (Demography, site, presentation, etiology, association with co-morbidities, bacteriology) and management guidelines (need for surgical interventions for DNIs and airway management, hospital stay duration, treatment outcome and complications) were reviewed and analyzed. Study recorded preponderance of DNIs in males (male:female = 1.6:1) and in younger generation (50% of patients presenting in first 2 decades). Commonest etiology being odontogenic infections (38.46%) followed by URTIs and tonsillopharyngitis (19.23%). Submandibular space involvement was noted in 42.3% cases followed by parapharyngeal space involvement in 21.15%. Nearly 55% cases of submandibular space involvement were because of odontogenic causes. 69.23% culture specimens reported no growth. 61.53% patients were diagnosed with anaemia. Up to 80% required open surgical drainage. All received broad spectrum antibiotics as a starting regime. No severe complications were recorded. Understanding the current epidemiological and etiological trends can help in early and definitive diagnosis of DNIs. Empirical starting treatment regime including broad spectrum antibiotics (till sensitivity pattern is availed) and maintaining low threshold for required surgical intervention are required to manage DNIs satisfactorily. Selected cases should be given conservative trials with close monitoring.
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Affiliation(s)
- Rohit Bhardwaj
- Department of Otorhinolaryngology and Head and Neck Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Saurabh Makkar
- Department of Otorhinolaryngology and Head and Neck Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Ankur Gupta
- Department of Otorhinolaryngology and Head and Neck Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Kirti Khandelwal
- Department of Otorhinolaryngology and Head and Neck Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Karthika Nathan
- Department of Otorhinolaryngology and Head and Neck Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Chirayata Basu
- Department of Otorhinolaryngology and Head and Neck Surgery, VMMC and Safdarjung Hospital, New Delhi, India
| | - Gowtham Palaniyappan
- Department of Otorhinolaryngology and Head and Neck Surgery, VMMC and Safdarjung Hospital, New Delhi, India
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Swain S, Nahak B, Acharya S. A migratory sharp foreign body from the hypopharynx to the deep neck space – A case report. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_160_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Fiorella ML, Greco P, Madami LM, Giannico OV, Pontillo V, Quaranta N. New laboratory predictive tools in deep neck space infections. ACTA ACUST UNITED AC 2021; 40:332-337. [PMID: 33299222 PMCID: PMC7726647 DOI: 10.14639/0392-100x-n0790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
Introduction Deep neck space infections (DNSIs) are a group of infective suppurative diseases involving deep neck spaces and cervical fascia. Necrotising and septic evolutions are rare, but severe complications can dramatically affect the prognosis and should be promptly managed. Clinical examination often has low sensitivity, although instrumental diagnosis may delay te treatment. We investigated two laboratory tools, LRINEC (Laboratory Risk Indicator for the Necrotizing fasciitis) and NLR (neutrophil to lymphocyte ratio), in the expectation to find a rapidly available predictive indicator that may help in distinguishing necrotising complications and/or systemic septic involvement. Methods A retrospective observational cohort study was performed on 118 patients who had underwent surgical treatment for DNSIs at our Surgical Unit. LRINEC, NLR and the product LRINEC x NLR were calculated. Results Statistical analysis showed that these scores may have utility in rapidly predicting the risk of necrotising fasciitis and systemic involvement at an early diagnostic stage. Conclusions Further studies with a larger cohort may be necessary in order to increase the sensitivity and specificity.
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Affiliation(s)
- Maria Luisa Fiorella
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Paolo Greco
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Luigi Maria Madami
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Orazio Valerio Giannico
- Section of Hygiene, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Vito Pontillo
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | - Nicola Quaranta
- Unit of Otorhinolaryngology, Department of Biomedical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
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Experiential learning in simulated parapharyngeal abscess in breathing cadavers. J Anesth 2021; 35:232-238. [PMID: 33555433 PMCID: PMC7868878 DOI: 10.1007/s00540-021-02904-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
Purpose Education in airway management is a fundamental component of anesthesiology training programs. There has been a shift towards the use of simulation models of higher fidelity for education in airway management. The goal of this study was to create a novel cadaveric model of a simulated parapharyngeal abscess with features of a difficult airway such as distorted anatomy and narrow airway passages presenting as stridor. The model was further assessed for its suitability for enhanced experiential learning in the management of difficult airways. Methods Cadaver heads were modified surgically to simulate parapharyngeal abscess. Airtight torso of the cadaver was connected to an Oxylog ventilator to simulate respiratory movements—the opening and closing of air channels with breaths in a patient with parapharyngeal abscess. Advanced airway workshop facilitators conducted directed one-to-one learning, and provided feedback to participants. A paper-based feedback was obtained from 72 participants on their confidence level, and the realism, attractiveness, beneficial, and difficulty levels of the simulated cadaveric models. Results The modified cadavers were reliable in simulating difficult airways. The majority of participants (91%) reported an increase in confidence level for management of the difficult airway after the experience with the modified cadavers and found the models realistic (93%), attractive (92%), beneficial (93%), and difficult (85%). Conclusions Surgical modifications of cadavers to simulate difficult airways such as parapharyngeal abscess with edema and stridor can be incorporated into advanced airway management courses to enhance experiential learning in airway management by awake fibreoptic intubation, and promote patient safety. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-021-02904-0.
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Jevon P, Abdelrahman A, Pigadas N. Management of odontogenic infections and sepsis: an update. BDJ TEAM 2021. [PMCID: PMC7891927 DOI: 10.1038/s41407-021-0520-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jevon P, Abdelrahman A, Pigadas N. Management of odontogenic infections and sepsis: an update. Br Dent J 2020; 229:363-370. [PMID: 32978579 PMCID: PMC7517749 DOI: 10.1038/s41415-020-2114-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
Abstract
The management of odontogenic infections has improved over recent decades, but further improvements are still required. The ongoing education of GDPs and their dental teams on this issue continues to be important, especially during the current COVID-19 pandemic, where remote triage poses additional difficulties and challenges.Odontogenic infections can lead to sepsis, a potentially life-threatening condition caused by the body's immune system responding in an abnormal way. This can lead to tissue damage, organ failure and death. A patient with non-odontogenic-related infection could also present with sepsis at a dental practice. Early recognition and prompt management of sepsis improves outcomes. GDPs and their dental teams should be trained in the recognition and management of sepsis. Age-specific sepsis decision support tools have been developed by the UK Sepsis Trust to help dental staff recognise and manage patients with suspected sepsis.The aim of this article is to provide an update on the management of odontogenic infections and sepsis.
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Affiliation(s)
- Phil Jevon
- Academy Tutor, Medical Education, Manor Hospital Walsall, UK.
| | | | - Nick Pigadas
- Consultant Maxillofacial/Head and Neck Surgeon, Manor Hospital Walsall, UK
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Zhao N, Liu Y, Yue J, Xu YX, Fu ZZ, Ding Q, Xiao WL. Negative pressure drainage-assisted irrigation for maxillofacial space infection. Oral Dis 2020; 26:1586-1591. [PMID: 32430987 DOI: 10.1111/odi.13421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/24/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In this study, the clinical effect of negative pressure drainage-assisted irrigation (NPDI) technique was evaluated in treating maxillofacial space infection (MSI) by comparing with traditional technique. METHOD A prospective study was conducted in 58 patients with MSI. The patients were randomly divided into two groups based on different treatment techniques. Thirty patients receiving NPDI were included in NPDI group, and 28 patients receiving traditional technique were included in traditional group. Case data (gender, age, etiology, concurrent illness, diabetes, involved spaces, preoperative white cell count, airway control method) and clinical effect (postoperative hospital stay, total cost of admission) for the two groups were analyzed. RESULTS Patients in both groups were cured clinically. There were no significant differences in gender, age, etiology, concurrent illness, diabetes, involved spaces, preoperative white cell count, and airway control method in NPDI group and traditional group (p > .05). The postoperative hospital stay and the total cost of admission in the NPDI group were significantly lower than the traditional group (p < .001). CONCLUSION Negative pressure drainage-assisted irrigation used in the treatment of MSI can shorten the postoperative hospital stay, reduce the total cost of admission, and show favorably clinical effect. It is a clinically recommended method for MSI.
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Affiliation(s)
- Ning Zhao
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China.,School of Stomatology, Qingdao University, Qingdao, China
| | - Yi Liu
- School of Stomatology, Qingdao University, Qingdao, China
| | - Jin Yue
- School of Stomatology, Qingdao University, Qingdao, China
| | - Yao-Xiang Xu
- School of Stomatology, Qingdao University, Qingdao, China
| | - Zhen-Zhen Fu
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Ding
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wen-Lin Xiao
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China.,School of Stomatology, Qingdao University, Qingdao, China
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Sideris G, Nikolopoulos T, Papadimitriou N. Spontaneous, Non-Traumatic Retropharyngeal Abscess Complicated by Spinal Osteomyelitis and Epidural Abscess in Immunocompetent Adult: Management and Proposal Pathophysiological Mechanism. Cureus 2020; 12:e9028. [PMID: 32775107 PMCID: PMC7406186 DOI: 10.7759/cureus.9028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Retropharyngeal abscess (RPA) in adults is a potentially life-threatening condition that relates in most of the cases with local trauma. Non-traumatic RPA complicated by spinal osteomyelitis and epidural abscess is a rare entity in immunocompetent adults and represents an emergency medical condition when the patient develops neurologic symptoms. This article presents a case of non-traumatic RPA complicated by spinal osteomyelitis and epidural abscess in a 77-year-old male with the free past medical history. We highlight the importance of early and meticulous daily drainage as well as sequential MRI scanning for early diagnosis, treatment and follow-up for signs of vertebral involvement. The patient had a full recovery and was subsequently discharged with per os four-month antibiotic treatment. The definitive mechanism is unclear for non-traumatic cases with “hematogenous path” being the closest description. Spontaneous RPA can develop from bacteria infection spread of adjacent structures, local inflammatory process and microthrombosis formation can impair the blood supply of vertebral and intervertebral disks.
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A Perspective of Clinical Behaviour and Management of Deep Neck Space Infections (DNSI): The Clinical Conundrum. Indian J Otolaryngol Head Neck Surg 2019; 71:594-604. [PMID: 31742027 DOI: 10.1007/s12070-018-1423-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022] Open
Abstract
The diagnosis and management of deep neck space infections remain a challenging task for otolaryngologists. A retrospective observational analysis of 137 cases of deep neck infections at a tertiary care centre was reviewed. We present 137 treated cases of DNSIs in a retrospective 5 years clinical study conducted in the department of otolaryngology at a tertiary care center from January 2012 to December 2016. Demographic information, Socio-economic data, etiopathogenesis, clinical presentation, spaces involved, diagnosis, and treatment strategies, associated morbidities, course and complications were analysed and compared with past experiences. Odontogenic and salivary gland infections causes were the most common source of DNIs. Major complication observed was skin defect. In this study, submandibular space infection was found to be the most common space involved in DNSI. Pain (100%) was the most common clinical complaint followed by neck swelling (65.69%). Staphylococcus aureus (38 cases) was the most common micro-organism isolated. Surgical intervention was the main modality of treatment and there was one mortality. DNSIs are fairly common challenging and potentially lethal entities which can lead to severe complications in a very short time, should there be delay in its prompt diagnosis and management. Computerized Tomography Scan (CT scan) with contrast is the investigation of choice in diagnosing DNSIs. Assessment of airway control must take precedence.
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16
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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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17
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Iwanaga J, Watanabe K, Anand MK, Tubbs RS. Air dissection of the spaces of the head and neck: A new teaching and dissection method. Clin Anat 2019; 33:207-213. [DOI: 10.1002/ca.23454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation Seattle Washington USA
- Division of Gross and Clinical Anatomy, Department of AnatomyKurume University School of Medicine Kurume Fukuoka Japan
- Dental and Oral Medical CenterKurume University School of Medicine Kurume Fukuoka Japan
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of AnatomyKurume University School of Medicine Kurume Fukuoka Japan
| | | | - R. Shane Tubbs
- Seattle Science Foundation Seattle Washington USA
- Department of Anatomical SciencesSt. George's University St. George's Grenada
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18
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Maharaj S, Ahmed S, Pillay P. Deep Neck Space Infections: A Case Series and Review of the Literature. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619871274. [PMID: 31496858 PMCID: PMC6716171 DOI: 10.1177/1179550619871274] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022]
Abstract
Deep neck spaces are regions of loose connective tissue filling areas between the
3 layers of deep cervical fascia, namely, superficial, middle, and deep layers.
The superficial layer is the investing layer, The pretracheal layer is the
intermediate layer and the prevertebral layer is the deepest layer. Deep neck
space infection (DNI) is defined as an infection in the potential spaces and
actual fascial planes of the neck. Once the natural resistance of fascial planes
is overcome, spread of infection occurs along communicating fascial boundaries.
More recent trends include the increasing prevalence of resistant bacterial
strains, a decline in DNIs caused by pharyngitis or tonsillitis, and a relative
increase in DNIs of odontogenic origin. Most DNIs are polymicrobial. Only 5% are
purely aerobic and 25% with isolated anaerobes. The epidemiology of DNIs needs
to be monitored for changing trends and the impact of underlying host immunity
and developing microbial multidrug resistance is established. Surveillance at
laboratory level should include mandatory susceptibility testing of all empiric
antibiotics against microbes commonly identified in adult DNI microscopy,
culture, and sensitivity (MC&S) specimens. The role of susceptibility
testing of microbes not commonly identified in adult DNI MC&S specimens
needs further review, on a clinical case-by-case basis.
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Affiliation(s)
- Shivesh Maharaj
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Sumaya Ahmed
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Preba Pillay
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
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Tent PA, Juncar RI, Onisor F, Bran S, Harangus A, Juncar M. The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections. Drug Metab Rev 2019; 51:340-355. [PMID: 30999773 DOI: 10.1080/03602532.2019.1602630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.
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Affiliation(s)
- Paul Andrei Tent
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Raluca Iulia Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Florin Onisor
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Simion Bran
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Antonia Harangus
- Spitalul Clinic de Pneumoftiziologie Leon Daniello Cluj-Napoca , Cluj-Napoca , Romania
| | - Mihai Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
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20
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Priyamvada S, Motwani G. A Study on Deep Neck Space Infections. Indian J Otolaryngol Head Neck Surg 2019; 71:912-917. [PMID: 31742093 DOI: 10.1007/s12070-019-01583-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/04/2019] [Indexed: 11/29/2022] Open
Abstract
Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. These are commonly seen in low socioeconomic group with poor oral hygiene, and nutritional disorders. These are bacterial infections originating from the upper aerodigestive tract. The incidence of this disease was relatively high before the advent of antibiotics. Treatment of DNSI includes antibiotic therapy, airway management and surgical intervention. Management of DNSI is traditionally based on prompt surgical drainage of the abscess followed by antibiotics or nonsurgical treatment using appropriate antibiotics in the case of cellulitis. This study was conducted to investigate the age and gender, clinical symptoms, site involved, etiology, co-morbidities, bacteriology, complications and outcomes in the patients of DNSI. A prospective study of deep neck space infections was conducted during the period July 2017 to July 2018 on the patients who attended the outpatient department and were admitted as inpatient in Safdarjung hospital, New Delhi. 40 Cases with DNSI all ages and both genders were included in the study. Patients who didn't require surgical intervention to drain pus were excluded. All parameters including age, gender, co-morbidities, presentation, site, bacteriology, complications, and investigations were studied. Due to advent of antibiotics, deep neck space infections are in decreasing trend. The common age group found to be affected is in 2nd and 3rd decade in our study. Out of all deep neck space infections, submandibular space infections were common (37.5%) followed by peritonsillar infections (12.5%). Infection of deep neck space remains fairly common and challenging disease for clinicians. Prompt recognition and treatment of DNSI are essential for an improved prognosis. Odontogenic and tonsillopharyngitis are the commonest cause. Key elements for improved results are the prompt recognition and early intervention. Special attention is required to high-risk groups such as diabetics, the elderly and patients with underlying systemic diseases as the condition may progress to life-threatening complications.
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Affiliation(s)
- Shaili Priyamvada
- Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Gul Motwani
- Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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21
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Prabhu SR, Nirmalkumar ES. Acute Fascial Space Infections of the Neck: 1034 cases in 17 years follow up. Ann Maxillofac Surg 2019; 9:118-123. [PMID: 31293939 PMCID: PMC6585228 DOI: 10.4103/ams.ams_251_18] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim The aim of this study was to provide insight about all the common fascial space infections of the neck, their presentation, their etiology, complaints, length of stay, and the treatment given. Patients and Methods It was conducted in a tertiary center in Nadiad, Gujarat, India. A total of 1034 patients were treated for fascial space infections of the neck in the hospital from 2001 to 2017. There were 63.24% male and 36.75% female with age ranging from 21 days to 96 years having the mean age of 31.4 years. Results Odontogenic infection with poor oral hygiene as a cause was found in most (78.43%) of the abscesses. Diabetes was the most common comorbid condition found in 98 (9.47%) patients along with HIV found in ten (0.96%) patients. Pain (99.41%), fever (86.07%), swelling (86.94%), and dysphagia/odynophagia (67.21%) were the most common presenting symptoms. Ludwig's angina and submandibular abscess were found to be the most common deep head-and-neck space infection making up for 52% cases. The most common group of microorganisms isolated were Streptococcus sp. (19.82%) and Staphylococcus aureus (18.66%). Conclusion Treatment was given in the form of incision and drainage of the abscesses (83.69%) and systemic antibiotics (100%). The most common space infection among the deep neck infections is the submandibular space infection (52%). If the etiological factor was not removed which mostly was carious teeth, high chances of recurrence were found (27.27%). Four patients required tracheostomy, and there was one mortality in the entire series.
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Affiliation(s)
- Supreet Ratnakar Prabhu
- Department of Otorhinolaryngology, Dr. N D Desai Faculty of Medical Science and Research, Nadiad, Gujarat, India
| | - Enosh Steward Nirmalkumar
- External Faculty, Department of Otorhinolaryngology, Knowledge Institute of Physiotherapy, Anand, Gujarat, India
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22
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Chang GH, Ding MC, Yang YH, Lin YH, Liu CY, Lin MH, Wu CY, Hsu CM, Tsai MS. High Risk of Deep Neck Infection in Patients with Type 1 Diabetes Mellitus: A Nationwide Population-Based Cohort Study. J Clin Med 2018; 7:jcm7110385. [PMID: 30366374 PMCID: PMC6262288 DOI: 10.3390/jcm7110385] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 01/17/2023] Open
Abstract
Objective: To investigate the risk of deep neck infection (DNI) in patients with type 1 diabetes mellitus (T1DM). Methods: The database of the Registry for Catastrophic Illness Patients, affiliated to the Taiwan National Health Insurance Research Database, was used to conduct a retrospective cohort study. In total, 5741 patients with T1DM and 22,964 matched patients without diabetes mellitus (DM) were enrolled between 2000 and 2010. The patients were followed up until death or the end of the study period (31 December 2013). The primary outcome was the occurrence of DNI. Results: Patients with T1DM exhibited a significantly higher cumulative incidence of DNI than did those without DM (p < 0.001). The Cox proportional hazards model showed that T1DM was significantly associated with a higher incidence of DNI (adjusted hazard ratio, 10.71; 95% confidence interval, 6.02–19.05; p < 0.001). The sensitivity test and subgroup analysis revealed a stable effect of T1DM on DNI risk. The therapeutic methods (surgical or nonsurgical) did not differ significantly between the T1DM and non-DM cohorts. Patients with T1DM required significantly longer hospitalization for DNI than did those without DM (9.0 ± 6.2 vs. 4.1 ± 2.0 days, p < 0.001). Furthermore, the patients with T1DM were predisposed to DNI at a younger age than were those without DM. Conclusions: T1DM is an independent risk factor for DNI and is associated with a 10-fold increase in DNI risk. The patients with T1DM require longer hospitalizations for DNI and are younger than those without DM.
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Affiliation(s)
- Geng-He Chang
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Meng-Chang Ding
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Yung-Hsiang Lin
- Division of Endocrinology and Metabolism, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Ching-Yuan Wu
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Cheng-Ming Hsu
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Ming-Shao Tsai
- Department of Otolaryngology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
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Sharma K, Das D, Joshi M, Barman D, Sarma AJ. Deep Neck Space Infections-A Study in Diabetic Population in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2018; 70:22-27. [PMID: 29456938 PMCID: PMC5807292 DOI: 10.1007/s12070-017-1196-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022] Open
Abstract
This study is intended to analyze the clinical profile and outcomes of deep neck space infection in diabetic patients in our tertiary care centre. A prospective study of 1 year duration from 30th September 2015 to 30th September 2016 at department of Otorhinolaryngology, Gauhati Medical College and Hospital, Guwahati. A total of 45 diabetic patients who presented with DNSI are included in this study. Their demographic profile, etiology, bacteriology, treatment, duration of hospital stay, complications and outcomes have been analyzed. 45 patients were recorded; 32 (71.11%) were men, and 13 (45%) were women, with a mean age of 63.27 ± 7.55 years. There were 30 patients (66.67%) who had associated systemic diseases apart from diabetes mellitus. The parapharyngeal space in 13 patients (28.89%) was the most commonly involved space. Odontogenic infections in 18 patients (40%) and upper airway infections 9 patients (20%) were the two most common causes. Klebsiella pneumonia in 29 patients (64.44%), was the commonest organism isolated through pus cultures. All the patients except one (97.78%) came with abscess and underwent surgical drainage. One patient (2.22%) with carbuncle underwent regular dressing. Six patients (13.33%) had major complications. Those patients with other underlying systemic diseases or complications tended to have a longer hospital stay and were older. No cases of death has been reported. (mortality rate, 0%). DNSI patients with diabetes have a more severe clinical course. They are likely to have complications more frequently and a longer duration of hospital stay. In clinical practices while dealing with these patients more vigilance is required. On admission empirical antibiotics should cover K. pneumonia. Early surgical drainage remains the main method of treatment. Primary prevention can be achieved by orodental hygiene, regular dental check ups and in this part of the country by avoidance of substance abuse like tobacco chewing.
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Affiliation(s)
- Kalpana Sharma
- Department of Ent and Head and Neck Surgery, Gmch, Room No-311, P G GIRLS HOSTEL NO-6, Bhangagarh, Guwahati, 781032 India
| | - Devjani Das
- Department of Ent and Head and Neck Surgery, Gmch, Room No-311, P G GIRLS HOSTEL NO-6, Bhangagarh, Guwahati, 781032 India
| | - Manish Joshi
- Department of Ent and Head and Neck Surgery, Gmch, Room No-311, P G GIRLS HOSTEL NO-6, Bhangagarh, Guwahati, 781032 India
| | - Dipjyoti Barman
- Department of Ent and Head and Neck Surgery, Gmch, Room No-311, P G GIRLS HOSTEL NO-6, Bhangagarh, Guwahati, 781032 India
| | - A. J. Sarma
- Department of Ent and Head and Neck Surgery, Gmch, Room No-311, P G GIRLS HOSTEL NO-6, Bhangagarh, Guwahati, 781032 India
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24
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Lee JM, Park IS, Lee CH, Lee KH, Chun DH, Kim JY, Lee YS. Tracheal Infection Resulting from High Endotracheal Tube Cuff Pressure in an Unconscious Patient with Brain Trauma. Korean J Neurotrauma 2018; 14:155-158. [PMID: 30402437 PMCID: PMC6218336 DOI: 10.13004/kjnt.2018.14.2.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/17/2018] [Accepted: 09/27/2018] [Indexed: 11/18/2022] Open
Abstract
Deep neck infections (DNIs) are mainly caused by dental caries, tonsillitis, and pharyngitis; however, DNIs can also occur after head and neck trauma. A 79-year-old male patient underwent a craniectomy due to an acute subdural hematoma. The patient was unconscious and continued to have a fever, but no clear cause was found. On postoperative day 9, he suddenly showed redness and swelling on the anterior neck. Enhanced computed tomography of the pharynx revealed tracheal necrosis and an abscess in the surrounding area. An incision and drainage were performed and Enterobacter aerogenes and E. faecalis were identified. The infection was controlled after antibiotic treatment. High endotracheal tube cuff pressure was suspected as the cause of the tracheal infection. Although DNIs are difficult to predict in patients who cannot report their symptoms due to unconsciousness, prevention and rapid diagnosis are important, as DNIs have serious side effects.
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Affiliation(s)
- Ja Myoung Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - In Sung Park
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chul-Hee Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kwang-Ho Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Dong Hyun Chun
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji-yoon Kim
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Seok Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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Chang GH, Tsai MS, Liu CY, Lin MH, Tsai YT, Hsu CM, Yang YH. End-stage renal disease: a risk factor of deep neck infection - a nationwide follow-up study in Taiwan. BMC Infect Dis 2017; 17:424. [PMID: 28610562 PMCID: PMC5470218 DOI: 10.1186/s12879-017-2531-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uremia is likely a risk factor for deep neck infection (DNI). However, only a few relevant cases have been reported, and evidence sufficient to support this hypothesis is lacking. The aim of the study is to investigate the effects of end-stage renal disease (ESRD) on DNI. METHODS We used the database of the Registry for Catastrophic Illness Patients (RFCIP), a subset of the National Health Insurance Research Database (NHIRD) in Taiwan, to conduct a retrospective follow-up study. Between 1997 and 2013, a total of 157,340 patients in Taiwan with ESRD who received dialysis were registered in the RFCIP, whom were matched with a database consisting of 1,000,000 randomly selected patients who represented the national population, to conduct the follow-up study for investigating the incidence of DNI in the ESRD and control cohorts. RESULTS In the ESRD group, 280 DNIs were identified with an incidence rate of 43 per 100,000 person-years. In the comparison group, 194 DNIs were identified with an incidence rate of 20 per 100,000 person-years. The incidence rate ratio was 2.16 (p < 0.001). Kaplan-Meier analysis indicated that the ESRD group had a significantly higher cumulative incidence of DNI (p < 0.001). According to Cox regression analysis, the hazard ratio of ESRD for DNI was 2.23 (p < 0.001). The therapeutic methods (non-surgery and surgery), performance of tracheostomy, duration of hospitalization did not differ significantly between the two groups, except more ESRD-DNI patients were admitted to intensive care units. The mortality rate of patients with DNI in the ESRD group was significantly higher than that in the control group (8.6% for ESRD vs 3.6% for control, p = 0.032). Furthermore, the Kaplan-Meier analysis demonstrated a poorer survival outcome in the ESRD group (p = 0.029). However, the individual survival outcomes following non-surgical and surgical therapies in the ESRD group did not differ significantly (p = 0.31). CONCLUSIONS ESRD is a predisposing factor for DNI, increasing its risk by twofold. In the patients with ESRD, DNI was not associated with higher rates of surgical debridement, tracheostomy, and mediastinal complications or longer hospital stays; however, it was associated with poorer survival outcomes, regardless of the therapeutic method.
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Affiliation(s)
- Geng-He Chang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Yen Liu
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-Hung Lin
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan. .,Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,, No.6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan.
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Brito TP, Hazboun IM, Fernandes FL, Bento LR, Zappelini CEM, Chone CT, Crespo AN. Deep neck abscesses: study of 101 cases. Braz J Otorhinolaryngol 2017; 83:341-348. [PMID: 27236632 PMCID: PMC9444774 DOI: 10.1016/j.bjorl.2016.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/28/2016] [Accepted: 04/12/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Thiago Pires Brito
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, Campinas, SP, Brazil.
| | - Igor Moreira Hazboun
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, Campinas, SP, Brazil
| | - Fernando Laffitte Fernandes
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, Campinas, SP, Brazil
| | - Lucas Ricci Bento
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, Campinas, SP, Brazil
| | - Carlos Eduardo Monteiro Zappelini
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, Campinas, SP, Brazil
| | - Agrício Nubiato Crespo
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, Campinas, SP, Brazil
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Is ultrasonography-guided drainage a safe and effective alternative to incision and drainage for deep neck space abscesses? J Laryngol Otol 2017; 131:259-263. [DOI: 10.1017/s002221511700007x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Deep neck space abscesses are common head and neck surgery emergencies. Traditionally, surgical incision and drainage has been the main treatment for deep neck abscesses. Recently, it has been suggested that ultrasound-guided drainage of neck abscesses can be an effective and less invasive alternative to incision and drainage.Methods:Patients with deep neck space abscesses referred to the emergency department of Amiralam Hospital were assessed and enrolled to the study if they met the inclusion criteria. Patients were randomly assigned to incision and drainage or ultrasound-guided drainage groups using sealed envelopes.Results:Sixty patients were evaluated, with 30 patients in each group. There was a significant difference (p < 0.001) in mean length of hospital stay between patients who underwent ultrasound-guided drainage (5.47 days) and those who underwent incision and drainage (9.70 days).Conclusion:Ultrasound-guided drainage is an effective and safe procedure, leading to shorter hospital stay, and thus may be a suitable alternative to incision and drainage of deep neck abscesses.
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Gujrathi AB, Ambulgekar V, Kathait P. Deep neck space infection - A retrospective study of 270 cases at tertiary care center. World J Otorhinolaryngol Head Neck Surg 2016; 2:208-213. [PMID: 29204568 PMCID: PMC5698542 DOI: 10.1016/j.wjorl.2016.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/28/2016] [Accepted: 11/01/2016] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To review the clinical findings in deep neck infections and identification predisposing factors of these complications. METHODS In this study, 270 patients with deep neck infections were studied retrospectively, study conducted in the Department of Ear, Nose and Throat, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India, from March 2013 to March 2016. RESULTS Analysis showed that males are most likely to have deep neck space infections (DNSI). Odontogenic and tonsillar causes were the more frequent ones. Staphylococcus aureus and Streptococcus species were the microorganisms more commonly isolated. CONCLUSION DNSI remains a common and challenging disease for otorhinolaryngologists, and should be treated on emergency basis. In developing countries, lack of adequate nutrition, poor oral hygiene, tobacco chewing, smoking and beetle nut chewing has led to an increased prevalence of dental and periodontal diseases. In present study, Odontogenic infections were the most common etiological factor for DNSI.
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Affiliation(s)
- Atishkumar B. Gujrathi
- Department of Ear, Nose and Throat, Dr. S. C. Government Medical College, Nanded, Maharashtra 431601, India
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Cable BB, Brenner P, Bauman NM, Mair EA. Image-Guided Surgical Drainage of Medial Parapharyngeal Abscesses in Children: A Novel Adjuvant to a Difficult Approach. Ann Otol Rhinol Laryngol 2016; 113:115-20. [PMID: 14994765 DOI: 10.1177/000348940411300206] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical drainage of localized infections in deep neck spaces in children is often completed without a high degree of technical difficulty. However, abscess drainage within the superior parapharyngeal space medial to the great vessels is particularly challenging for otolaryngologists. Drawbacks to both the intraoral and external approaches to this area have led us to develop a new adjunctive technique that utilizes intraoperative image-guided technology to augment the intraoral approach. Here we present a case series of 12 children in whom this technique was successfully used.
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Affiliation(s)
- Benjamin B Cable
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Biller JA, Murr AH. The Importance of Etiology on the Clinical Course of Neck Abscesses. Otolaryngol Head Neck Surg 2016; 131:388-91. [PMID: 15467605 DOI: 10.1016/j.otohns.2004.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE: Formation of neck abscesses from injecting illicit drugs continues to be a common problem in the United States. We sought to determine whether neck abscesses resulting from direct inoculation differ in their clinical course and severity from those that arise from direct spread through inflamed tissue, as in pharyngitis or odontogenic infections. STUDY DESIGN AND SETTING: Patients were separated based on the cause of their neck abscess into either an injection drug use group or a noninjection drug use group. We retrospectively compared both groups of patients by examining multiple clinical endpoints, including the number of operations, length of hospital stay, and requirement for emergent airway intervention. RESULTS: Injection drug use was the most common cause of neck abscess. Only 1 of these patients needed more than 1 drainage procedure, and no patients required emergent airway intervention or an intensive care unit (ICU) stay. The majority of the patients in the noninjection drug group had a neck abscess as a result of unknown causes; nearly one half required an emergent operation for airway management and the mean ICU stay was 2.5 days. CONCLUSION: Neck abscesses formed by direct inoculation have a relatively more benign clinical course than those resulting from spread through inflamed tissue. The latter require a longer hospital stay, more days in the ICU, and more emergent intervention.
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Affiliation(s)
- Jason A Biller
- Department of Otolarygology-Head and Neck Surgery, University of California, San Francisco, USA
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Cabrera CE, Deutsch ES, Eppes S, Lawless S, Cook S, O'Reilly RC, Reilly JS. Increased incidence of head and neck abscesses in children. Otolaryngol Head Neck Surg 2016; 136:176-81. [PMID: 17275535 DOI: 10.1016/j.otohns.2006.09.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 09/07/2006] [Indexed: 11/21/2022]
Abstract
Objective To describe increasing incidence and changing microbiology of head and neck abscesses in children admitted to the hospital during the first quarters of 2000 through 2003. Study Design and Setting Retrospective data warehouse review identified 89 children less than 19 years of age admitted to a tertiary care pediatric hospital during the first quarters of 2000 through 2003 for suspicion of head and neck abscess involving the neck, face, and peritonsillar, retropharyngeal, and parapharyngeal spaces; and for orbital and intracranial complications of acute sinusitis. Outcome Measures Outcome measures included the incidence of infection admissions and description of infection location and microbiology, calculated by χ2 technique. Results The incidence of infections increased in 2003. The greatest increase was in neck abscesses and complications of acute sinusitis. Conclusions The increase in group A strep infections may be related to its biologic properties. Significance Group A strep remains a significant cause of head and neck infections in children.
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Affiliation(s)
- Cristina E Cabrera
- Department of Surgery, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE 19899, USA
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Farmahan S, Tuopar D, Ameerally PJ. A study to investigate changes in the microbiology and antibiotic sensitivity of head and neck space infections. Surgeon 2015; 13:316-20. [DOI: 10.1016/j.surge.2014.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/20/2013] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
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Alotaibi N, Cloutier L, Khaldoun E, Bois E, Chirat M, Salvan D. Criteria for admission of odontogenic infections at high risk of deep neck space infection. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:261-4. [PMID: 26347337 DOI: 10.1016/j.anorl.2015.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Many patients with odontogenic infections are hospitalised because of the risk of deep neck space infection. The objective of this study was to identify risk factors allowing more reliable selection of patients requiring hospitalisation for both specialists and emergency physicians. MATERIAL AND METHODS This retrospective study was based on a cohort of 97 patients hospitalised for odontogenic infection in the Department of Otorhinolaryngology and Head and Neck Surgery of Centre hospitalier Sud Francilien, Île-de-France, from January 2008 to June 2012. RESULTS The majority of patients presented with dental abscess (66 patients; 68%). Nineteen patients (20%) presented with deep neck space infection. The frequency of deep neck space infection was significantly higher in patients with mandibular odontogenic infection (16/55 patients (29%) than in those with maxillary odontogenic infection (3/42 (7%); P ≤ 0.009). The incidence of deep neck space infection was significantly higher in patients with dental abscess (17/66, (26%) than in those without dental abscess (2/31 (6%); P ≤ 0.03). CONCLUSION In addition to the well-known classical criteria (fever, neck swelling, dyspnoea, dysphagia, trismus, leukocytosis, elevated C reactive protein (CRP)), the criteria for admission for odontogenic infection should include mandibular odontogenic infection and/or the presence of dental abscess.
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Affiliation(s)
- N Alotaibi
- Service d'ORL et de chirurgie cervico-maxillo-faciale, centre hospitalier Sud Francilien, 116, boulevard Jean-Jaurès, 91100 Corbeil-Essonnes, France.
| | - L Cloutier
- Service d'ORL et de chirurgie cervico-maxillo-faciale, centre hospitalier Sud Francilien, 116, boulevard Jean-Jaurès, 91100 Corbeil-Essonnes, France
| | - E Khaldoun
- Service d'ORL et de chirurgie cervico-maxillo-faciale, centre hospitalier Sud Francilien, 116, boulevard Jean-Jaurès, 91100 Corbeil-Essonnes, France
| | - E Bois
- Service d'ORL et de chirurgie cervico-maxillo-faciale, centre hospitalier Sud Francilien, 116, boulevard Jean-Jaurès, 91100 Corbeil-Essonnes, France
| | - M Chirat
- Service d'ORL et de chirurgie cervico-maxillo-faciale, centre hospitalier Sud Francilien, 116, boulevard Jean-Jaurès, 91100 Corbeil-Essonnes, France
| | - D Salvan
- Service d'ORL et de chirurgie cervico-maxillo-faciale, centre hospitalier Sud Francilien, 116, boulevard Jean-Jaurès, 91100 Corbeil-Essonnes, France
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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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Ouattassi N, Chmiel M, El Kerouiti Z, Ridal M, Alami MN. Acute febrile torticollis in youth: clinical investigation and current management. Pan Afr Med J 2015; 21:163. [PMID: 26328000 PMCID: PMC4546785 DOI: 10.11604/pamj.2015.21.163.5843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/02/2015] [Indexed: 11/17/2022] Open
Abstract
Acute febrile torticollis in children is a rare and a special clinical picture of variable causes. It may indicate an inflammatory or an infectious pathology affecting any of the anatomical structures of the neck. Treatment is quite clearly defined, and it may be a therapeutic emergency. It is a condition that all ENT specialists must be familiar with since they are most likely to be the first physician to whom such a child is brought
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Affiliation(s)
- Naouar Ouattassi
- ENT Head and Neck Surgery Department, Hassan II University Hospital, Fez, Morocco
| | - Mohammed Chmiel
- ENT Head and Neck Surgery Department, Hassan II University Hospital, Fez, Morocco
| | - Zakaria El Kerouiti
- ENT Head and Neck Surgery Department, Hassan II University Hospital, Fez, Morocco
| | - Mohammed Ridal
- ENT Head and Neck Surgery Department, Hassan II University Hospital, Fez, Morocco
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Management and maintenance of the airway in cervical necrotising fasciitis: a retrospective analysis of 15 cases. Br J Oral Maxillofac Surg 2015; 53:642-6. [PMID: 25981627 DOI: 10.1016/j.bjoms.2015.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 04/18/2015] [Indexed: 11/23/2022]
Abstract
Cervical necrotising fasciitis is a progressive deep infection of the neck associated with high mortality, and skillful management of the airway is critical for operations under general anaesthesia. Tracheostomy under local anaesthesia has been considered the gold standard of airway management in patients with deep neck infections, but it may be difficult or impossible in advanced cases. We report here our experience over 6 years (January 2008 and December 2013) during which a total of 15 patients was diagnosed with cervical necrotising fasciitis. Of 6 patients, admitted between January 2008 and March 2010, 5 had routine tracheostomy under local anaesthesia, 1 had direct laryngoscopy intubation, and 9 who were admitted between Spring 2010 and December 2013 were treated with nasotracheal intubation. Postoperatively all patients were given moderate sedation and analgesia. Nasotracheal intubation was continued until the infection had been controlled. During intubation patency of the endotracheal tube was maintained by humidification with a continuous pump of 0.45% sodium chloride and suction. All 15 patients (10 men and 5 women, mean age 62 years, range 36-93) required an emergency drainage procedure under general anaesthesia. Fourteen of the 15 had evidence of compromise of the airway, but emergency intervention was not required. Since Spring 2010, 9 consecutive patients had required nasotracheal intubation, including 7 video laryngoscopies and 2 fibreoptic bronchoscopies. No other interventions were required. Patients were intubated postoperatively from 3 to 14 days, and there were no problems with the airway. Advanced techniques for control of the airway have a high rate of success in patients with necrotising fasciitis and could be an appropriate alternative to a traditional airway. Postoperative sedation and analgesia should be considered as routine management of pain and anxiety.
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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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Bali R, Sharma P, Gaba S. Use of metronidazole as part of an empirical antibiotic regimen after incision and drainage of infections of the odontogenic spaces. Br J Oral Maxillofac Surg 2014; 53:18-22. [PMID: 25277645 DOI: 10.1016/j.bjoms.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
The combination of amoxicillin/clavulanate and metronidazole is a widely-accepted empirical regimen for infections of the odontogenic spaces. Once adequate drainage has been established micro-organisms are less likely to grow and multiply, particularly anaerobes. This may obviate the need for anaerobic coverage after drainage in healthy hosts. We studied 60 patients in this randomised prospective study, the objective of which was to evaluate metronidazole as part of an empirical antibiotic regimen after drainage of infections of the odontogenic spaces. Samples of pus were sent for culture and testing for sensitivity. Amoxicillin/clavulanate and metronidazole were given to all patients. After incision and drainage the patients were randomly allocated to two groups. In the first group both antibiotics were continued, and in the second metronidazole was withdrawn. The groups were compared both clinically and microbiologically. There were no significant differences between the groups in the resolution of infection. Thirteen patients (n=6 in the 2-antimicrobial group, and n=7 in the amoxicillin/clavulanate group) showed no improvement during the 48 h postoperatively. Overall there was need to substitute another antibiotic for amoxicillin/clavulanate in only 6 cases. Six patients in the amoxicillin/clavulanate group required the addition of metronidazole after drainage. We conclude that in healthy subjects metronidazole is not necessary in the period after drainage, but its prescription should be based on assessment of clinical and laboratory markers of infection.
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Affiliation(s)
- Rishi Bali
- Department of OMFS, D.A.V. Dental College and M.M. General Hospital, Yamunanagar, Haryana 135001, India
| | - Parveen Sharma
- Department of OMFS, D.A.V. Dental College and M.M. General Hospital, Yamunanagar, Haryana 135001, India
| | - Shivani Gaba
- Department of OMFS, D.A.V. Dental College and M.M. General Hospital, Yamunanagar, Haryana 135001, India.
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Microbiological examination and antibiotic sensitivity of infections in the head and neck. Has anything changed? Br J Oral Maxillofac Surg 2014; 52:632-5. [DOI: 10.1016/j.bjoms.2014.02.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/04/2014] [Indexed: 11/19/2022]
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Saini S, Kshetrapal KK, Ahlawat G, Kamal H, Singh T. Anaesthetic challenges in a patient with Ludwig angina:A case report. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2008.10872562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Characteristics of deep neck infection in children according to weight percentile. Clin Exp Otorhinolaryngol 2014; 7:133-7. [PMID: 24917911 PMCID: PMC4050086 DOI: 10.3342/ceo.2014.7.2.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 12/19/2012] [Accepted: 01/07/2013] [Indexed: 12/03/2022] Open
Abstract
Objectives To evaluate the effect of weight percentile on deep neck infections in children. Methods A retrospective evaluation of 79 patients who were treated for deep neck infections. The patients were divided into six groups according to weight percentile. Patients who had systemic and/or congenital disease were excluded. Their demographics, etiology, localization, laboratory, and treatment results were reviewed. Results In total, 79 pediatric patients were recorded: 48.1% were females and 51.9% were males, with a mean age of 7.3 years. In total, 60 patients were under the 50th percentile according to their weight versus all children. The anteroposterior triangle (29.1%) and submandibular (26.5%) spaces were most commonly involved with deep neck infection. However, the anteroposterior triangle space was the highest in the group below the 3rd percentile (44.4%). In the blood analysis, white blood cell levels in patients with at percentile values of 75-50 were higher than other groups (P<0.05). Significant differences were found between C-reactive protein and hemoglobin levels and diameter of abscesses. The need for surgical drainage in patients in lower percentiles was higher. The patients who needed surgical drainage consisted of 56 patients (93.3%) below the 50th percentile and 9 patients (100%) below the 3rd percentile. Conclusion Deep neck infection is more insidious and dangerous in low-weight-percentile children, especially those having low white blood cell counts, low hemoglobin levels, and high C-reactive protein in laboratory results.
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Transoral negative-pressure catheter drainage of a retropharyngeal and mediastinal abscess. Am J Otolaryngol 2014; 35:313-7. [PMID: 24629587 DOI: 10.1016/j.amjoto.2014.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/20/2014] [Accepted: 02/06/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE A retropharyngeal abscess (RPA) is an extremely rare entity in adults that has a tendency to spread vertically and cause a mediastinal abscess. Traditionally, immediate aggressive drainage is recommended via a transcervical or transthoracic approach for the treatment of a retropharyngeal abscess with mediastinal extension. Here, we present a case of a retropharyngeal and mediastinal abscess using a transoral negative-pressure catheter drainage approach. PATIENTS AND METHODS A 24-year-old woman was admitted with a 4-day history of severe sore throat and painful swallowing. Computed tomography identified a retropharyngeal abscess extending to the upper posterior mediastinum. We performed transoral negative-pressure catheter drainage. RESULTS The postoperative course was uneventful. The patient reported a rapid improvement in symptoms and had a good tolerance of the catheters in the nasal cavity. At 2 years postoperatively, physical examinations revealed no recurrence or surgical complications. CONCLUSIONS Transoral negative-pressure catheter drainage is a minimally invasive operation for the treatment of RPA in adults with or without a mediastinal abscess. This method could be recommended as an alternative approach in such cases.
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Cho JB, Sung KY. Incidentally Discovered Deep Neck Infection in a Septic Patient. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jin Beom Cho
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Ki Young Sung
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Hyun SY, Oh HK, Ryu JY, Kim JJ, Cho JY, Kim HM. Closed suction drainage for deep neck infections. J Craniomaxillofac Surg 2013; 42:751-6. [PMID: 24360753 DOI: 10.1016/j.jcms.2013.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 08/30/2013] [Accepted: 11/04/2013] [Indexed: 01/29/2023] Open
Abstract
PURPOSE There have been various incision and drainage methods for deep neck infection (DNI). Closed-suction drainage (CSD) has been used to decrease hematoma or to drain pus in other forms of medical surgery. The purpose of this investigation was to evaluate the usefulness of CSD for DNI. PATIENTS AND METHODS This study consisted of 30 patients who underwent CSD after incision and drainage for DNI between January 2006 and December 2011. The patients' demographics, systemic diseases, methods of airway control, involved spaces, incision, CSD results, duration of hospitalization, and complications were investigated. RESULTS CSD was used to treat 30 DNI patients. Eleven patients (37%) had underlying systemic diseases like diabetes mellitus, hypertension, hepatitis, asthma, etc. Twenty four patients (80%) had odontogenic infections in the mandibular molar region. Tracheostomy was performed in 5 patients (17%). The involved spaces were various from parapharyngeal space to mediastinum (mean: 4.8 spaces), and CSD was applied with drainage lines (mean: 3; 2-7 drains) over the course of 4-37 days (mean 14.6 days). The total amount of drained pus was 8-1344 cc (mean: 406 cc) and the daily amount was 1-61 cc (mean: 28 cc) from each patient. The mean length of hospital stay was 26 days, with a range of 9-83 days. Wound rupture happened in 7% of 56 total incision sites and spontaneous removal of the drain tube occurred in 3% of 91 total tubes. Four patients died because of cardiac arrest, pulmonary edema, and hypoxia. A statistical significance was accepted about total and daily amount of drainage at Pearson's correlation test (p < 0.001). CONCLUSION Accurate diagnosis, safe airway management, and early surgical drainage were important in DNI treatment. Compared to other drainage systems, CSD is clinically useful for treating DNI due to minimal incision, convenience of post-operative management, and less postoperative complications.
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Affiliation(s)
- Sung Youl Hyun
- Department of Thoracic Cardiovascular Surgery, Gachon University Gil Medical Center, South Korea.
| | - Hee Kyun Oh
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Chonnam National University, South Korea.
| | - Jae Young Ryu
- Department of Oral & Maxillofacial Surgery (Head: Prof. Hyeon Min Kim), Gachon University Gil Medical Center, South Korea.
| | - Jin Joo Kim
- Department of Emergency Medicine, Gachon University Gil Medical Center, South Korea.
| | - Jin Yong Cho
- Department of Oral & Maxillofacial Surgery (Head: Prof. Hyeon Min Kim), Gachon University Gil Medical Center, South Korea.
| | - Hyeon Min Kim
- Department of Oral & Maxillofacial Surgery (Head: Prof. Hyeon Min Kim), Gachon University Gil Medical Center, South Korea.
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Wahab D, Bichard J, Shah A, Mann B. Just a sore throat? Uncommon causes of significant respiratory disease. BMJ Case Rep 2013; 2013:bcr-2013-008739. [PMID: 23632177 DOI: 10.1136/bcr-2013-008739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present two uncommon underlying causes of a sore throat which, if missed or delayed in diagnosis, can lead to disastrous consequences. Our first case is of Lemierre's syndrome diagnosed in a 21-year-old man presenting with a 5-day history of sore throat, fever, right-sided pleuritic chest pain and bilateral pulmonary nodules on CT imaging. Fusobacterium necrophorum cultured from peripheral blood and an occluded left internal jugular vein on ultrasound lead to an eventual diagnosis. Our second case presents a 29-year-old woman with a 5-day history of sore throat, fever and right-sided pleuritic chest pain. A left-sided quinsy was diagnosed and aspirated and the patient was discharged home. She represented shortly with worsening pleuritic pain and was found to have a right-sided pleural effusion with descending mediastinitis originating from the tonsillar abscess. Delayed diagnosis resulted in open thoracotomy, decortication and prolonged intravenous antibiotics.
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Affiliation(s)
- Dalia Wahab
- Department of Respiratory, Royal Brompton Hospital, London, UK.
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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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Panda NK, Mann SB, Sharma SC. Mediastinitis following deep neck infections : A therapeutic challenge. Indian J Otolaryngol Head Neck Surg 2012; 52:391-5. [PMID: 23119735 DOI: 10.1007/bf02991489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To emphasize the salient features of surgical management of Mediastinitis occurring secondary to deep neck infections. STUDY DESIGN Case series. Retrospective analysis SETTING Institutional teaching department Patients Four consecutive cases of mediastinal abscess treated between 1990 to 1996. Selection criteria were presence of deep neck infection radiological evidence of widening of mediastinum and confirmation of mediastinal infection at surgery. Computerized tomography of neck and thorax was done in one case to document the extent of abscess. SARGICAL MANAGEMENT: All the patients underwent transcervical drainage of neck abscess and superior mediastintomy. The involved spaces in the neck and mediastinum were irrigated with betadine antimicrobial solution and negative suction drains put in the superior mediastinum ta facilitate contituous drainage of the mediastinum. One patient required intercostal chest drainage for associated empyema. Tracheotomy was done in all the patients. RESULTS All the patients survived and discharged after a hospital stay of around three weeks. CONCLUSIONS Mediastinal complication of deep neck infections can he alarmingly rapid and can be effectively managed by early recognition and aggressive surgical drainage combined with antibiotic therapy after appropriate aerobic and anaerobic cultures.
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Affiliation(s)
- N K Panda
- Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, (India)
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Panduranga Kamath M, Shetty AB, Hegde MC, Sreedharan S, Bhojwani K, Padmanabhan K, Agarwal S, Mathew M, Rajeev Kumar M. Presentation and management of deep neck space abscess. Indian J Otolaryngol Head Neck Surg 2012; 55:270-5. [PMID: 23119999 DOI: 10.1007/bf02992436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To study the presentation, etiology, microbiology and morbidity of deep neck space infections. STUDY DESIGN Retrospective study Methods: 29 patients admitted in Kasturba Medical College Hospital, Mangulore, India between January 1997 and December 2002 with deep neck space infections.,were included in the study. REMITS The most common space involved was the parapharyngeul space. No specific etiology was determined in .38%; an odontogenic cause was discovered in 28% of the patients; tonsillar/pharyngeal infections in 24% of patients and foreign body impaction in 7% of cases. The main morbidity was due to mediastinitis (5 patients). I patient succumbed to the disease. Mixed flora with aerobic and anaerobic infections was identified in most of the cases.
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Affiliation(s)
- M Panduranga Kamath
- Department of ENT, Kasturba Medical College Hospital, Attavar, 575001 Mangalore, Karnataka India
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Sarna T, Sengupta T, Miloro M, Kolokythas A. Cervical Necrotizing Fasciitis With Descending Mediastinitis: Literature Review and Case Report. J Oral Maxillofac Surg 2012; 70:1342-50. [DOI: 10.1016/j.joms.2011.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 10/17/2022]
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Blaivas M, Adhikari S. Bedside transoral ultrasonographically guided drainage of a retropharyngeal abscess in the emergency department. Ann Emerg Med 2011; 58:497-8. [PMID: 22018109 DOI: 10.1016/j.annemergmed.2011.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 10/16/2022]
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