1
|
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 2024; 125:101513. [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] [MESH Headings] [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.
Collapse
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
| |
Collapse
|
2
|
Koç RH, ABakay MA, Sayın İ. Determining the prognostic value of CRP and neutrophil lymphocyte ratio in patients hospitalized for deep neck infection. Braz J Otorhinolaryngol 2024; 90:101492. [PMID: 39205364 PMCID: PMC11399593 DOI: 10.1016/j.bjorl.2024.101492] [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: 03/26/2024] [Revised: 07/25/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES This study aims to assess the impact of the Neutrophil/Lymphocyte Ratio (NLR) and C-Reactive Protein (CRP), both markers of systemic inflammation, on the duration of hospitalization for Deep Neck Infections (DNIs). METHODS The research encompassed patients of all age groups admitted between January 2016 and January 2021 due to DNIs. Patient data, including demographic details, etiology, comorbidities, radiological findings, treatment specifics, laboratory results (CRP values, leukocyte counts, neutrophil counts, lymphocyte counts, NLR), culture outcomes, length of stay, complications, mortalities were retrospectively evaluated. Patients were categorized into two groups based on their hospitalization duration: less than 7-days and 7-days or more. Univariate and multivariate analyses were conducted to examine the association between age, NLR, CRP, and hospital stay length. RESULTS The study encompassed 275 patients, with a mean age of 36 ± 20.2 years. The mean hospital stay was 9.6 ± 6.6 days. Tonsillopharyngeal infections were the most common etiology (34%). Notably, in both univariate and multivariate analyses, age, NLR, and CRP values demonstrated significant (p < 0.05) predictive influence on hospitalization duration. CONCLUSION Age emerges as a determinant that affects hospital stay duration in DNIs. Moreover, NLR is proven to be comparable to CRP in predicting hospitalization length for these patients. NLR's feasibility as a cost-effective predictive marker, being conveniently derived from routine complete blood count assessments, adds to its clinical significance. This study underscores the potential value of NLR and CRP in informing patient management and care strategies for DNIs.
Collapse
Affiliation(s)
- Recep Haydar Koç
- Sultangazi Haseki Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey.
| | - Mehmet Akif ABakay
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey
| | - İbrahim Sayın
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey
| |
Collapse
|
3
|
Liao TI, Ho CY, Chin SC, Wang YC, Chan KC, Chen SL. Sequential Impact of Diabetes Mellitus on Deep Neck Infections: Comparison of the Clinical Characteristics of Patients with and without Diabetes Mellitus. Healthcare (Basel) 2024; 12:1383. [PMID: 39057526 PMCID: PMC11276557 DOI: 10.3390/healthcare12141383] [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: 06/01/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Deep neck infections (DNIs) can compromise the airway and are associated with high morbidity and mortality rates. Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia that is associated with several comorbidities. We compared the clinical characteristics of DNI patients with and without DM. METHODS This study recorded the relevant clinical variables of 383 patients with DNIs between November 2016 and September 2022; of those patients, 147 (38.38%) had DM. The clinical factors between DNI patients with and without DM were assessed. RESULTS Patients with DM were older (p < 0.001), had higher white blood cell counts (p = 0.029) and C-reactive protein levels (CRP, p < 0.001), had a greater number of deep neck spaces (p = 0.002) compared to patients without DM, and had longer hospital stays (p < 0.001). Klebsiella pneumoniae was cultured more frequently from patients with DM than those without DM (p = 0.002). A higher CRP level (OR = 1.0094, 95% CI: 1.0047-1.0142, p < 0.001) was a significant independent risk factor for DM patients with prolonged hospitalization. The lengths of hospital stays in patients with poorly controlled DM were longer than those with well-controlled DM (p = 0.027). CONCLUSIONS DNI disease severity and outcomes were worse in patients with DM than those without DM. Antibiotics effective against Klebsiella pneumoniae should be used for DNI patients with DM. DNI patients with DM and high CRP levels had more prolonged hospitalizations. Appropriate blood glucose control is essential for DNI patients with DM.
Collapse
Affiliation(s)
- Ting-I Liao
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Yu-Chien Wang
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan;
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Kai-Chieh Chan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Shih-Lung Chen
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| |
Collapse
|
4
|
Wong CH, Chew SC. Neck Space Infection: A Retrospective Study of 40 Cases at a Tertiary Care Center in Sibu, Malaysia. Indian J Otolaryngol Head Neck Surg 2024; 76:2391-2403. [PMID: 38883552 PMCID: PMC11169142 DOI: 10.1007/s12070-024-04475-4] [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: 11/18/2023] [Accepted: 01/01/2024] [Indexed: 06/18/2024] Open
Abstract
This study is intended to explore the relationship of etiologies of neck space infection (NSI) and its prevalent microorganisms of NSI and to compare the treatments and its clinical outcomes with other studies. A retrospective study of 1 year duration from April 2022-April 2023 at ENT department Hospital Sibu includes total 40 NSI patients. 30 male and 10 female patients, with a male-to-female ratio of 3 were studied, with a mean age of 35.07 (± 18.25) years. Diabetes mellitus still constituted a high risk factor (27.3%), while patients with biohazard status (Hepatitis B and C) contributes 15.1%. There were 18 cases (45%) which etiology remained unknown, followed by odontogenic infection (27.5%), then upper respiratory tract infection (7.5%). 9 out of 40 patients required intensive care unit (ICU) care, with a median of 2.5 days ICU admission. Among the complications developed, airway obstruction (9 patients; 42.9%) was the most common. The most common infected neck space in our study was the submandibular space 18.1%; then the parapharyngeal space 13.3% and peritonsillar space 10.8%. The most common microorganism isolated was Streptococci Viridans (6 cases, 15%), followed by streptococcus pyogenes Group A (5 cases, 12.5%), then Klebsiella pneumoniae (4 cases, 10%). Interestingly, 62.5% of the neck infection cases were caused by single bacteria, while only 7.5% cases were infected by polymicrobial cause. Augmentin (amoxicillin and clavulanic acid) constitutes the highest proportion (40.4%) of first line antibiotics, while unasyn (ampicillin-sulbactam) was be a second substitute (13.5%). The duration of hospitalization ranged from 1 to 8 weeks, with a mean stay of 1.54 ± 1.49 weeks days. We achieved a high recovery rate of 97.5% with 1 patient died due to extensive small bowel ischemia.
Collapse
Affiliation(s)
- Chyau Hong Wong
- Hospital Sibu, 5 1/2KM, Jalan Oya, 96000 Sibu, Sarawak Malaysia
| | | |
Collapse
|
5
|
Lemmet T, Mazzucotelli JP, Collange O, Fath L, Mutter D, Brigand C, Falcoz PE, Danion F, Lefebvre N, Bourne-Watrin M, Gerber V, Hoellinger B, Fabacher T, Hansmann Y, Ruch Y. Infectious Mediastinitis: A Retrospective Cohort Study. Open Forum Infect Dis 2024; 11:ofae225. [PMID: 38751899 PMCID: PMC11095524 DOI: 10.1093/ofid/ofae225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
Background This study aimed to characterize the demographics, microbiology, management and treatment outcomes of mediastinitis according to the origin of the infection. Methods This retrospective observational study enrolled patients who had mediastinitis diagnosed according to the criteria defined by the Centers for Disease Control and Prevention and were treated in Strasbourg University Hospital, France, between 1 January 2010 and 31 December 2020. Results We investigated 151 cases, including 63 cases of poststernotomy mediastinitis (PSM), 60 cases of mediastinitis due to esophageal perforation (MEP) and 17 cases of descending necrotizing mediastinitis (DNM). The mean patient age (standard deviation) was 63 (14.5) years, and 109 of 151 patients were male. Microbiological documentation varied according to the origin of the infection. When documented, PSM cases were mostly monomicrobial (36 of 53 cases [67.9%]) and involved staphylococci (36 of 53 [67.9%]), whereas MEP and DNM cases were mostly plurimicrobial (38 of 48 [79.2%] and 8 of 12 [66.7%], respectively) and involved digestive or oral flora microorganisms, respectively. The median duration of anti-infective treatment was 41 days (interquartile range, 21-56 days), and 122 of 151 patients (80.8%) benefited from early surgical management. The overall 1-year survival rate was estimated to be 64.8% (95% confidence interval, 56.6%-74.3%), but varied from 80.1% for DNM to 61.5% for MEP. Conclusions Mediastinitis represents a rare yet deadly infection. The present cohort study exhibited the different patterns observed according to the origin of the infection. Greater insight and knowledge on these differences may help guide the management of these complex infections, especially with respect to empirical anti-infective treatments.
Collapse
Affiliation(s)
- Thomas Lemmet
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | | | - Olivier Collange
- Department of Anesthesia and Intensive Care, Strasbourg University Hospital, Strasbourg, France
| | - Léa Fath
- Department of E.N.T. and Head and Neck Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Didier Mutter
- Department of Visceral and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | | | - François Danion
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Lefebvre
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Morgane Bourne-Watrin
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Victor Gerber
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Baptiste Hoellinger
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Thibaut Fabacher
- Department of biostatistics, Strasbourg University Hospital, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Yvon Ruch
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| |
Collapse
|
6
|
Ranjbar K, Shahriarirad R, Ebrahimi K, Amirian A, Karoobi M, Mardani P, Erfani A, Fallahi MJ, Ketabchi F, Ziaian B. Demographic, clinical, and paraclinical features of patients operated with the diagnosis of acute descending necrotizing mediastinitis: a retrospective study in Southern Iran. J Cardiothorac Surg 2023; 18:354. [PMID: 38066576 PMCID: PMC10704827 DOI: 10.1186/s13019-023-02416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Descending necrotizing mediastinitis (DNM) is a type of acute mediastinitis that is rarely reported but is regarded as a fatal disease despite improvements in technological methods and antibiotic therapies. We aimed to determine the demographic, clinical, and paraclinical features of patients diagnosed with acute DNM. METHODS In this retrospective study, patients' hospital records with a diagnosis of DNM admitted to the Namazi hospital in southern Iran during 18 years (2002-2019) were reviewed. Demographic and clinical features were recorded and subsequently analyzed via SPSS 22. RESULTS Out of 67 mediastinitis patients, 25 (37.3%) were diagnosed as DNM with an average age of 37.2 ± 16.7 years, and 68% were male. Regarding etiology, 52.0% were due to neck infection. Based on the technique of surgery, 52% of the patients underwent the combined method, which was mostly among type I and IIA DNM, while thoracotomy was mostly performed on type IIB DNM (P = 0.08). Based on the incision, type IIA and IIB had the highest frequency of thoracotomy and cervicothoracic incisions (P = 0.02 and 0.002). Puss discharge was significantly lower in type I DNM (P = 0.01). Based on the presenting symptoms of our patients, the majority (72.0%) had a chief complaint of neck pain, followed by chills and fever (48%). There were no reports of mortality during our short-term follow-up. CONCLUSION We report one of the largest retrospective studies of DNM patients in our referral center, with a high prevalence of the disease among younger populations, especially under 40 years. The method of treatment should be chosen based on the extent of infection and can be limited to neck exploration in upper mediastinal infections, though thoracic or combined approach in more broad infections.
Collapse
Affiliation(s)
- Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamyar Ebrahimi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Amirian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamadreza Karoobi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Erfani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Fallahi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Ketabchi
- Department of Physiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bizhan Ziaian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
7
|
Hidaka H, Tarasawa K, Fujimori K, Obara T, Fushimi K, Shimamura A, Iwai H. Identification of Risk Factors for Mortality and Prolonged Hospitalization in Patients Treated With Surgical Drainage for Otogenic Intracranial Complications: A Nationwide Study Using a Japanese Inpatient Database. Otol Neurotol 2023; 44:1027-1032. [PMID: 37853770 DOI: 10.1097/mao.0000000000004038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Data on risk factors for otogenic intracranial complications including cerebral abscess have been limited. Using a nationwide database, the aim was to identify the factors related to mortality and delayed discharge. STUDY DESIGN Retrospective. SETTING Nationwide database using the Diagnostic Procedure Combination database. MAIN OUTCOME MEASURES Data of 145 patients were extracted from a Japanese inpatient database between 2012 and 2020. The main outcome was survival at discharge. In a subgroup analysis of the 137 surviving patients, the second outcome was delayed discharge. RESULTS The mortality rate was 5.5% (8 of 145). Logistic regression analyses identified intracerebral complications (adjusted odds ratio [OR], 3.09) and more than 2-day delay of the first surgery after admission (adjusted OR, 4.68) as risk factors for mortality. Specifically, consciousness level evaluated by the Japan Coma Scale (JCS) was significantly related to prolonged hospitalization or mortality: JCS I (adjusted OR, 3.40) and JCS ≥II (adjusted OR, 25.1). CONCLUSIONS Although otogenic intracranial complications are rare, and their mortality is decreasing because of the progress in imaging and clinical strategies, they remain the most severe complications of suppurative otitis media and/or cholesteatoma. Consciousness level at admission, comorbid diabetes mellitus, and a greater than 2-day delay of surgical intervention were related to prolonged hospitalization or mortality.
Collapse
Affiliation(s)
- Hiroshi Hidaka
- Department of Otolaryngology-Head and Neck Surgery, Kansai Medical University, Hirakata
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University School of Medicine
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University School of Medicine
| | | | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Akihiro Shimamura
- Department of Otolaryngology-Head and Neck Surgery, Kansai Medical University, Hirakata
| | - Hiroshi Iwai
- Department of Otolaryngology-Head and Neck Surgery, Kansai Medical University, Hirakata
| |
Collapse
|
8
|
van der Merwe P, Rule R, Olorunju S, Jacobs F. The empirical use of aminoglycosides in Ludwig's angina based on bacterial analysis of 63 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101409. [PMID: 36738888 DOI: 10.1016/j.jormas.2023.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
PURPOSES To determine if the empirical use of aminoglycosides is justified in Ludwig's angina based on microscopy, culture and sensitivity results. METHODS A retrospective analysis was done on patients that presented with Ludwig's angina to the Maxillofacial and Oral surgery department at the University of Pretoria. Demographical data was extracted from patient files. Pus specimens that were submitted as part of the initial surgical intervention were analysed. RESULTS Sixty-three patients were included in the study with the majority, 76.19% (n=48/63), comprising males. The mean patient age was 38.6 years (range 6 months to 78 years). The majority of infections (87.3%) had an odontogenic aetiology (n=55/63). Forty-four percent of the patients had immunosuppressive co-morbidities (n=28/63). Streptococci contributed 71.26% (n=62/87) of the cultured bacteria. Similar bacteria were cultured in the immunocompromised and the immunocompetent patients (p=0.672). Ninety-two percent (n=57/62) of the streptococci cultured were sensitive to penicillin. The addition of aminoglycosides to the study sample would not have made a statistically significant difference (p=0.1556). CONCLUSION Based on the findings of this study, the empirical use of aminoglycosides is not warranted in either immunocompromised or immunocompetent patients with Ludwig's angina.
Collapse
Affiliation(s)
- Petrie van der Merwe
- Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, C/o Steve Biko and Dr Savage Roads, Gezina, Pretoria 0002, South Africa.
| | - Roxanne Rule
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Medical Microbiology, National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa
| | - Steve Olorunju
- Biostatistics Unit (Pretoria office), South African Medical Research Council (SAMRC), South Africa
| | - Fred Jacobs
- Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, C/o Steve Biko and Dr Savage Roads, Gezina, Pretoria 0002, South Africa
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Desa C, Tiwari M, Pednekar S, Basuroy S, Rajadhyaksha A, Savoiverekar S. Etiology and Complications of Deep Neck Space Infections: A Hospital Based Retrospective Study. Indian J Otolaryngol Head Neck Surg 2023; 75:697-706. [PMID: 37275082 PMCID: PMC10235246 DOI: 10.1007/s12070-022-03428-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
Infections of the deep spaces of the neck often present a true clinical challenge to a Head and Neck surgeon which may rapidly spread due to the various connections between the spaces resulting in morbidity and mortality. This study aims to obtain knowledge about various DNSI's and their predisposing factors.. It was a hospital based retrospective cross-sectional study done in Goa Medical College, India. A total of 300 patients who presented with DNSI's over the past 7 years were studied. Simple proportions and percentages were calculated and Chi-square test was used to study associations. A total of 300 patients were evaluated and male preponderance was seen. Most of the patients were seen belonging to the pediatric age group (26%). Infections of dental origin (45.67%) were the most common etiological factor associated with poor oral hygiene and tobacco chewing (12.67%). Major comorbidities were anemia (34%) and diabetes (19.3%) which were directly related to the complications. The most common complication was airway compromise (14.66%) which was treated by tracheostomy. DNSI should be treated like a medical as well as a surgical emergency which can be life-threatening especially in diabetics and elderly who are immunocompromised and need special attention. Odontogenic infections associated with poor oral hygiene and tobacco chewing could be prevented by educating the population about oral hygiene.
Collapse
Affiliation(s)
- Carnegie Desa
- Department of ENT, Goa Medical College, Bambolim, Goa India
| | | | | | | | | | | |
Collapse
|
11
|
Ho CY, Chan KC, Wang YC, Chin SC, Chen SL. Assessment of Factors Associated With Long-Term Hospitalization in Patients With a Deep Neck Infection. EAR, NOSE & THROAT JOURNAL 2023:1455613231168478. [PMID: 37010020 DOI: 10.1177/01455613231168478] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Deep neck infection (DNI) is a severe infectious disorder of deep neck spaces that can cause serious complications. Long-term hospitalization is when a patient spends more time in the hospital than originally expected for a disease. There are few studies assessing the risk factors associated with long-term hospitalization for a DNI. This study investigated the factors causing DNI patients to experience long-term hospitalization. METHODS Long-term hospitalization is defined as a length of hospital stay exceeding 28 days (> 4 weeks) in this research. A total of 362 subjects with a DNI between October 2017 and November 2022 were recruited. Among these patients, 20 required long-term hospitalization. The relevant clinical variables were assessed. RESULTS In a univariate analysis, C-reactive protein (odds ratio [OR] = 1.003, 95% CI: 1.000-1.007, P = .044), involvement of ≥3 deep neck spaces (OR = 2.836, 95% CI: 1.140-7.050, P = .024), and mediastinitis (OR = 8.102, 95% CI: 3.041-21.58, P < .001) were significant risk factors for long-term hospitalization in DNI patients. In a multivariate analysis, mediastinitis (OR = 6.018, 95% CI: 2.058-17.59, P = .001) was a significant independent risk factor for long-term hospitalization for a DNI. There were no significant differences in pathogens between the patients with and without long-term hospitalization (all P > .05). However, the rates of no growth of specific pathogens were significantly different between patients with and without long-term hospitalization, and those with long-term hospitalization had greater rates of growth of specific pathogens (P = .032). The rate of tracheostomy in patients with long-term hospitalization was higher than for those without (P < .001). Nevertheless, the rates of surgical incision and drainage between patients with and without long-term hospitalization did not achieve statistical significance (P = .069). CONCLUSIONS Deep neck infection (DNI) is a critical, life-threatening disease that could lead to long-term hospitalization. The higher CRP and involvement of ≥3 deep neck spaces were significant risk factors in univariate analysis, while concurrent mediastinitis was an independent risk factor associated with long-term hospitalization. We suggest intensive care and prompt airway protection for DNI patients with concurrent mediastinitis.
Collapse
Affiliation(s)
- Chia-Ying Ho
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 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
| |
Collapse
|
12
|
Descending necrotizing mediastinitis: etiopathogenesis, diagnosis, treatment and long-term consequences-a retrospective follow-up study. Eur Arch Otorhinolaryngol 2023; 280:1983-1990. [PMID: 36478116 PMCID: PMC9988808 DOI: 10.1007/s00405-022-07769-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The primary aim of this retrospective study was to analyze the progression of descending necrotizing mediastinitis (DNM), evaluate the impact of comorbidities on complications and mortality and to observe long-term consequences of DNM on dysphagia and measurements quality of life. DNM is a serious infectious disease that requires multimodal treatment. Current literature varies in conclusions of risk factors, management and outcome of DNM. In addition, little is known about persisting effects on quality of life. METHODS Retrospective data analysis of 88 patients with DNM representing the largest single-center study. Recording data of patients and diseases as well as clinical progression from 1997 to 2018. Two questionnaires were sent to the participants to measure quality of life and to detect dysphagia. RESULTS 88 patients were included. The most frequently found pathogen were Streptococcus spp. (52%). 75% of the patients underwent multiple surgeries, mean count of surgical procedures was 4.3 times. 84% received intensive care treatment. Median length of stay on the intensive care unit was 7 days. 51% had pre-existing comorbidities associated with reduced tissue oxygenation (e.g., diabetes). The most common complication was pleural effusion (45%). During the observation period, the mortality rate was 9%. 12 questionnaires could be evaluated. 67% of the participants were affected by dysphagia at the time of the survey. CONCLUSIONS Descending necrotizing mediastinitis (DNM) is a severe disease requiring an immediate initiation of multimodal treatment. Although quality of life usually isn´t impaired permanently, dysphagia may often persist in patients after DNM.
Collapse
|
13
|
Demian N, Pearl C, Woernley T, Dallaire-Giroux C. Retrospective Cohort Study on the Management of Diffuse Deep Neck Space Infections Using a Modified Submental Approach and Placement of Wound Vacuum. J Oral Maxillofac Surg 2023; 81:337-343. [PMID: 36581313 DOI: 10.1016/j.joms.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Diffuse deep neck space infection (DDNSI) is an emergent condition that requires efficient surgical and airway management. A novel surgical approach has been developed to enhance access and improve visualization of the involved deep neck spaces, which allows for better evaluation of the extent of tissue necrosis. This study will compare the treatment of DDNSI with traditional incision and drainage with drain placement (Conventional) versus the new incision and drainage design with the use of a wound vacuum (VAC). METHODS This retrospective cohort study was performed on DDNSI cases treated with the VAC versus Conventional techniques from July 2014 to September 2020 at Memorial Hermann Hospital by the oral and maxillofacial surgery service. To be categorized as a DDNSI, the patient had to demonstrate radiographic evidence of an infection bilaterally in a minimum of four spaces, such as bilateral submandibular, sublingual, and submental spaces. Primary predictor variable was treatment method for DDNSI, Conventional versus VAC. Primary outcome variables were hospital length of stay (LOS), number of washouts, and days of intubation. Covariates were age, sex, number of spaces involved, presence of necrotic tissues, comorbidities, and mortality. Appropriate uni- and bi-variate statistics were calculated. Statistical significance was set at P < .05. RESULTS Fifty-one patients (17 female and 34 male) aged 18 to 65 years were treated for DDNSI. Twenty-eight patients were treated using the VAC approach and 23 patients were treated with the conventional approach. The average LOS 8.3 ± 0.8 days (P-value = .0001), number of days intubated 3 ± 0.3 (P-value = .0001), and number of required washouts 2 ± 0.2 (P-value = .004) were statistically lower in the VAC group compared to the Conventional group. CONCLUSIONS There were significant improvements encountered with overall length of hospital stay, number of days intubated, and the number of required wash outs. There were significant differences in outcomes between patients with comorbidities when compared to those who had none.
Collapse
Affiliation(s)
- Nagi Demian
- Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Craig Pearl
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Timothy Woernley
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Cyndie Dallaire-Giroux
- Chief Resident, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX.
| |
Collapse
|
14
|
Fan D, Hou J, Yang J, Zhao Z, Fang Q, Wu X. Predictive value of serum interleukin-6 to determine surgical drainage of deep neck space infection in adults. Eur Arch Otorhinolaryngol 2023; 280:1403-1410. [PMID: 36208332 DOI: 10.1007/s00405-022-07683-2] [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: 08/09/2022] [Accepted: 09/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to determine whether interleukin-6 (IL-6) could be used as a predictor for surgical drainage in deep neck space infection (DNSI). METHODS A retrospective study was conducted to analyze 69 adult patients newly diagnosed as DNSI from January 2017 to December 2021 at a single center. The patients were treated with either surgical drainage or not. The following clinical data including age, gender, maximum diameter of abscess (MDA), laboratory data, therapeutic modalities, comorbidities, duration of hospitalization and complications were collected and evaluated. RESULTS Patients in drained group had significantly elevated MDA, IL-6, procalcitonin, C-reactive protein and neutrophil to lymphocyte ratio compared to patients in non-drained group (all P < 0.01). Significant predictors for surgical drainage were IL-6 and MDA as independent factors, with the optimum cutoff values of 52.5 pg/mL and 14.4 mm, respectively. Moreover, the IL-6 had a wider area under the curve than MDA for prediction of surgical drainage in DNSI. CONCLUSIONS IL-6 as a promising predictor of the need for surgical drainage can be effectively used for routine assessment in the early stage of DNSI to determine the optimal treatments.
Collapse
Affiliation(s)
- Dachuan Fan
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China.
| | - Jinxiao Hou
- Department of Hematology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Jianming Yang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China
| | - Zhentao Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China
| | - Qi Fang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China
| | - Xiaoman Wu
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui, China
| |
Collapse
|
15
|
Principles of Treatment and Clinical-Evolutionary Peculiarities of Deep Cervical Spaces Suppurations-Clinical Study. Life (Basel) 2023; 13:life13020535. [PMID: 36836892 PMCID: PMC9965330 DOI: 10.3390/life13020535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
As medical-surgical emergencies, regardless of the causal agent, deep cervical space suppurations are not only a diagnostic challenge, but also a therapeutic one. In some cases, in spite of proper therapeutic measures, extremely severe complications can develop. A 5-year retrospective study (2016-2020) was conducted on a group of 107 patients suffering from cervical suppurations, being hospitalized and treated in the ENT Clinic of the "Sf. Apostol Andrei" Emergency County Hospital of Galați. This research is a clinical-statistical study based on the experience of this ENT clinic and was carried out based on the analysis of the patients' medical records. Descriptive analysis' statistical methods of the data series collected from the clinical observation sheets were used, with the patients' informed consent for the processing of the aforementioned data, with the agreement of the Ethics Commission of the Emergency Clinical Hospital "Sf. Apostol Andrei" Galați and the College of Physicians Galați, România. The patients' clinical and multidisciplinary treatment features included in the study group are presented. The results highlight the clinical particularities of deep cervical space suppurations treatment, including under COVID-19 impact, or with other comorbidities, having consequences on the case mix index increase or directly on the costs, admittance duration and the clinical status of the patient at discharge. The conclusions of the clinical study are based on the fulfillment of the research objectives in terms of treatment and symptomatology of deep cervical space suppurations and under the impact of comorbidities (global health crisis and pandemic, triggering of comorbidities due to health care access difficulty in the context of anti-COVID-19 government-implemented measures and the infection-rate that overburdened the medical system in the early period of the pandemic). Individualized treatment of deep cervical space suppurations is recommended to be approached multidisciplinary. Of particular importance is early diagnosis combined with prompt and correctly instituted multidisciplinary treatment. In this context, an appropriate medical measure that we recommend is patient health education, as it was observed in the clinical study: most times, patients address medical services with advanced disease, hence the generally unfavorable prognosis and outcome (about 25% of patients develop unfavorable prognosis and 4% die).
Collapse
|
16
|
Tarle M, Zubović A, Kos B, Raguž M, Lukšić I. Retrospective Longitudinal Study on Changes in Atmospheric Pressure as a Predisposing Factor for Odontogenic Abscess Formation. Dent J (Basel) 2023; 11:42. [PMID: 36826187 PMCID: PMC9955754 DOI: 10.3390/dj11020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes.
Collapse
Affiliation(s)
- Marko Tarle
- Department of Maxillofacial Surgery, Dubrava University Hospital, Gojko Šušak Avenue 6, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10000 Zagreb, Croatia
| | - Arijan Zubović
- Department of Maxillofacial Surgery, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
- The Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Boris Kos
- Department of Maxillofacial Surgery, Dubrava University Hospital, Gojko Šušak Avenue 6, 10000 Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, Gojko Šušak Avenue 6, 10000 Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Ilica 242, 10000 Zagreb, Croatia
| | - Ivica Lukšić
- Department of Maxillofacial Surgery, Dubrava University Hospital, Gojko Šušak Avenue 6, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| |
Collapse
|
17
|
Tecle NE, Hackenberg S, Scheich M, Scherzad A, Hagen R, Gehrke T. Surgical management of lateral neck abscesses in children: a retrospective analysis of 100 cases. Eur J Pediatr 2023; 182:431-438. [PMID: 36378330 PMCID: PMC9829626 DOI: 10.1007/s00431-022-04676-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/09/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022]
Abstract
UNLABELLED Cervical abscesses are relatively common infections in pediatric patients. There is an ongoing debate about the necessity and time point of surgical drainage. The identification of a focus of infection might play an important role in facilitating a therapeutic decision. In a retrospective study, 100 pediatric patients aged 1-18 years who underwent incision and drainage of a lateral cervical abscess at our institution were analyzed. Patients were divided into two groups based on whether a focus of infection could be identified or not. Data collection included patient characteristics, microbiological results, antibiotic regimen, and clinical course. A focus of infection was found in 29% (29/100) of the patients, most frequently in the tonsils. A causative microorganism was found in 75% (75/100) of all patients, with Staphylococcus aureus and Streptococcus pyogenes being the most common pathogens. All patients received an empiric antibiotic therapy in addition to surgery. Antibiotic medication was changed in 31% in both groups (9/29 with a focus of infection and 22/71 without a focus of infection) during therapy. Children without an identified focus of infection generally were younger and had more comorbidities reducing immune response while also showing differences in the pathogens involved. There were no complications associated to surgery or antibiotic therapy in any of the patients involved. CONCLUSION Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding the microorganisms involved. But the focus of infection seems not to have an impact on patient's outcome. WHAT IS KNOWN • Neck abscesses are a relatively common disease in the pediatric population and may cause serious complications. • Therapy in general consists of intravenous antibiotics with or without surgery. WHAT IS NEW • The focus identification has no impact on patient's outcome. • Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding their medical history, age, and the microorganisms involved.
Collapse
Affiliation(s)
- Nyat-Eyob Tecle
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany.
| | - Stephan Hackenberg
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany ,Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Scheich
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Agmal Scherzad
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Thomas Gehrke
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany
| |
Collapse
|
18
|
Hematologic and inflammatory parameters for determining severity of odontogenic infections at admission: a retrospective study. BMC Infect Dis 2022; 22:931. [PMID: 36503406 PMCID: PMC9743669 DOI: 10.1186/s12879-022-07934-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Severe odontogenic infections in the head and neck region, especially necrotizing soft tissue infection (NSTI) and deep neck abscess, are potentially fatal due to their delayed diagnosis and treatment. Clinically, it is often difficult to distinguish NSTI and deep neck abscess in its early stage from cellulitis, and the decision to perform contrast-enhanced computed tomography imaging for detection is often a challenge. This retrospective case-control study aimed to examine the utility of routine blood tests as an adjunctive diagnostic tool for NSTI in the head and neck region and deep neck abscesses. METHODS Patients with severe odontogenic infections in the head and neck region that required hospitalization were classified into four groups. At admission, hematologic and inflammatory parameters were calculated according to the blood test results. In addition, a decision tree analysis was performed to detect NSTI and deep neck abscesses. RESULTS There were 271 patients, 45.4% in Group I (cellulitis), 22.5% in Group II (cellulitis with shallow abscess formation), 27.3% in Group III (deep neck abscess), and 4.8% in Group IV (NSTI). All hematologic and inflammatory parameters were higher in Groups III and IV. The Laboratory Risk Indicator for Necrotizing Fasciitis score, with a cut-off value of 6 and C-reactive protein (CRP) + the neutrophil-to-lymphocyte ratio (NLR), with a cut-off of 27, were remarkably useful for the exclusion diagnosis for Group IV. The decision tree analysis showed that the systemic immune-inflammation index (SII) of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 suggests Group III + IV and the classification accuracy was 89.3%. CONCLUSIONS Hematologic and inflammatory parameters calculated using routine blood tests can be helpful as an adjunctive diagnostic tool in the early diagnosis of potentially fatal odontogenic infections. An SII of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 can be useful in the decision-making for performing contrast-enhanced computed tomography imaging.
Collapse
|
19
|
Shah N, Patel S, Rupawala T, Makwana S, Mansuri S, Bhimani K. Evaluation of Efficacy of Ultrasonography as an Additional Diagnostic Tool for Deciding Management Protocol of Odontogenic Superficial Fascial Space Infections: A Prospective Clinical Study. J Maxillofac Oral Surg 2022; 21:1148-1154. [PMID: 36896083 PMCID: PMC9989102 DOI: 10.1007/s12663-021-01560-x] [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: 01/18/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022] Open
Abstract
Objective To explore the efficacy of ultrasonography as an additional diagnostic tool in superficial odontogenic fascial space infections of maxillofacial region and modifying the treatment plan when needed. Materials and Methods Forty patients with superficial fascial space infections underwent a detailed clinical, plain radiological and ultrasonographic examination. Based on the ultrasonographic findings, final diagnosis was made and compared with clinical findings. Patients diagnosed with cellulitis were given medical line of treatment, and those with abscess were subjected to incision and drainage along with standard general supportive care and removal of etiologic agent. Results In this study, out of 40 patients (male = 22, female = 18), clinical diagnosis of cellulitis was made in 26 cases (65%) and abscess in 14 (35.0%). On USG examination, cellulitis was present in 21 cases (52.5%), while abscess in 19 (47.5%). Final diagnosis of cellulitis was made in 13 (59.1%) males and 12(66.7%) females, while abscess was confirmed in 9 (40.9%) male and 6 (33.3%) female patients. The results showed that sensitivity of the clinical examination alone was 64% with 33% specificity, and for USG, sensitivity was 84% with specificity of 100%. Conclusion The adjuvant role of ultrasonography in the diagnosis and timely management of superficial fascial space infections is promising owing to its accessibility, relative safety, repeatability and cost-effectiveness.
Collapse
Affiliation(s)
- Naiya Shah
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Shital Patel
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Taher Rupawala
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Sanjay Makwana
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Saloni Mansuri
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Kruna Bhimani
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| |
Collapse
|
20
|
Risk Factors of Descending Necrotizing Mediastinitis in Deep Neck Abscesses. Medicina (B Aires) 2022; 58:medicina58121758. [PMID: 36556959 PMCID: PMC9788205 DOI: 10.3390/medicina58121758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives: Cervical space infection could also extend to the mediastinum due to the anatomical vicinity. The mortality rate of descending necrotizing mediastinitis is 85% if untreated. The aim of this study was to identify risk factors for the progression of deep neck abscesses to descending necrotizing mediastinitis. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing surgical treatment of deep neck abscesses from August 2017 to July 2022. Computed tomography (CT) was performed in all patients. Before surgery, lab data including hemoglobulin (Hb), white blood cell count, neutrophil percentage, C-reactive protein (CRP) level, and blood glucose were recorded. Patients' characteristics including gender, age, etiology, and presenting symptoms were collected. Hospitalization duration and bacterial cultures from the wound were also analyzed. Results: The C-reactive protein (CRP) level was higher in patients with a mediastinal abscess than in patients without a mediastinal abscess (340.9 ± 33.0 mg/L vs. 190.1 ± 72.7 mg/L) (p = 0.000). The submandibular space was more commonly affected in patients without a mediastinal abscess (p = 0.048). The retropharyngeal (p = 0.003) and anterior visceral (p = 0.006) spaces were more commonly affected in patients with a mediastinal abscess. Conclusions: Descending necrtotizing mediastinitis results in mortality and longer hospitalization times. Early detection of a mediastinal abscess on CT is crucial for treatment. Excluding abscesses of the anterior superior mediastinum for which transcervical drainage is sufficient, other mediastinal abscesses require multimodal treatment including ENT and thoracic surgery to achieve a good outcome.
Collapse
|
21
|
Tao X, Hua H, Liu Y. A novel model for predicting mortality in the management of deep neck infections. EAR, NOSE & THROAT JOURNAL 2022:1455613221133245. [PMID: 36318220 DOI: 10.1177/01455613221133245] [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: 06/16/2023] Open
Abstract
OBJECTIVES Deep neck infections (DNIs) are a common and intractable disease encountered in ENT clinics that impose a significant medical and financial burden on affected individuals and their families. However, insufficient data are currently available for predicting outcomes in cases of DNI. The present study thus sought to develop a novel model capable of predicting treatment outcomes of DNI patients just using indicators at the visit. METHODS Patients with DNIs treated from 2010 to 2022 were included in the present study. Patient data were retrospectively collected from medical records. Risk factors associated with mortality were identified using logistic regression models. A predictive model was constructed based on odds ratios for factors calculated using a multivariate regression model. RESULTS In total, 153 patients were enrolled in the present study. Risk factors associated with mortality included age >50 years, residence in a rural area, dyspnea at visit, the involvement of multiple infected sites, serum albumin<34 g/L, renal insufficiency, mediastinitis, pulmonary infection, and septic shock. A multivariate regression model revealed that mediastinitis (OR: 7.308, P < 0.001), serum creatinine>95 μmol/L (OR: 23.363, P < 0.05), and serum albumin<34 g/L (OR: 13.837, P < 0.05) were independent predictors of mortality in deep neck infection patients, with serum creatinine>95 μmol/L being particularly critical to the outcomes. Diabetes was not the predictor of mortality but was associated with long-term hospitalization (P < 0.001). CONCLUSIONS In summary, the model constructed in the present study was capable of estimating the potential for poor outcomes in DNI patients before the initiation of treatment. These findings may help improve doctor-patient communication, especially for those struggling financially.
Collapse
Affiliation(s)
- Xiaoyao Tao
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongting Hua
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yehai Liu
- Otorhinolaryngology Head and Neck Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
22
|
Degouy G, Nicot R, Poissy J, Mathieu D, Parmentier-Decrucq E. Risk factors for difficult ventilatory weaning in intensive care patients with cervical cellulitis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e396-e401. [PMID: 35227951 DOI: 10.1016/j.jormas.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/11/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Cervical cellulitis is an infrequent but serious infection. The management of the upper airways is difficult, at the actual time of intubation but also regarding the necessity of maintaining mechanical ventilation. The objective of this study is to identify risk factors on admission to the intensive care unit for difficult ventilatory weaning in patients with cervical cellulitis. METHODS Between January 2013 and December 2018, this retrospective observational study was performed in an intensive care unit with 10 beds in a university hospital recognized as a reference center for the management of cellulitis. All intensive care patients receiving mechanical ventilation after surgery for cervical cellulitis were eligible. Difficult ventilatory weaning was defined as mechanical ventilation lasting more than 7 days or failure of extubation as established by the WIND 2017 study. RESULTS We included 120 patients with severe cervical cellulitis. The median age was 43 years. Eighteen patients (16%) presented mediastinal extension. The risk factor for difficult ventilatory weaning (n = 49) in multivariate analysis was a high level of procalcitonin on admission (OR at 1.14[1.005-1.29]; p<0.042) and the protective factor was surgery in an expert center (OR at 0.11[0.026-0.47]; p<0.003). Eight patients required a tracheotomy in our study: 3 patients during surgery and at a later time for the other 5 of our 8 patients. CONCLUSION No intensive care studies have investigated ventilatory weaning risk factors in patients with cervical cellulitis. Yet simple criteria seem to predict this risk. It is now necessary to confirm them by a multicenter prospective study.
Collapse
Affiliation(s)
- Guillaume Degouy
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital.
| | - Romain Nicot
- Service de Chirurgie Maxillo-Faciale et Stomatologie, Lille University Hospital.
| | - Julien Poissy
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital.
| | - Daniel Mathieu
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital.
| | | |
Collapse
|
23
|
Singhal G, Jain S, Sen K. Clinical Presentation and Microbiological Profile of Deep Neck Space Infections in Different Age Groups. Indian J Otolaryngol Head Neck Surg 2022; 74:1870-1876. [PMID: 36452853 PMCID: PMC9702455 DOI: 10.1007/s12070-020-01869-y] [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: 02/10/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022] Open
Abstract
Deep neck space infection (DNI), is defined as infections in the deep fascia enclosing potential spaces of the neck. In the past the diagnosis and treatment of DNI have challenged. The health care personnel at all levels. The complex anatomy and the deep location of this region remains a big problem with significant risks of morbidity and mortality. The aim of this study is to analyse the difference in clinical presentation and microbiology of DNI in different age groups. Eighty two patients with DNI which were managed at the Department of Otorhinolaryngology, ABVIMS and Dr. Ram Manohar Lohia Hospital New Delhi, between November 2017 and March 2019 formed the basis of our prospective cross sectional observational study. We observed that DNI is a frequent and potentially life threatening condition in children and adults despite the use of antibiotics. For appropriate surgical management knowledge of complex spaces of the neck and their communication with the other spaces is necessary.
Collapse
Affiliation(s)
- Gaurang Singhal
- Department of ENT, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, Baba Kharag Singh MARG, New Delhi, 110001 India
| | - Shalini Jain
- Department of ENT, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, Baba Kharag Singh MARG, New Delhi, 110001 India
| | - Kanwer Sen
- Department of ENT, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, Baba Kharag Singh MARG, New Delhi, 110001 India
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Tailor BV, Devakumar H, Myuran T, Ioannidis D. Parapharyngeal and floor-of-mouth abscess secondary to tonsillar phlegmon: A rare and unusual cause of Ludwig's angina. Clin Case Rep 2022; 10:e6325. [PMID: 36172328 PMCID: PMC9468653 DOI: 10.1002/ccr3.6325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
We present an unusual case of Ludwig's angina secondary to a left tonsillar phlegmon in a previously fit and well 50-year-old woman. This tonsillar phlegmon spread along the peritonsillar/parapharyngeal plane to cause a diffuse cellulitis and collection in the submental, sublingual, and submandibular spaces despite empirical intravenous antibiotic therapy.
Collapse
Affiliation(s)
- Bhavesh V. Tailor
- Department of Otolaryngology, Colchester General HospitalEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | - Haran Devakumar
- Department of Otolaryngology, Colchester General HospitalEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | - Tharsika Myuran
- Department of Otolaryngology, Colchester General HospitalEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | - Dimitrios Ioannidis
- Department of Otolaryngology, Colchester General HospitalEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| |
Collapse
|
26
|
Cavernous Sinus Involvement and Near Miss Mediastinitis following Mandibular Tooth Infection Treated during the COVID-19 Pandemic: Clinical Diagnosis and Treatment. Case Rep Dent 2022; 2022:8650099. [PMID: 35865553 PMCID: PMC9296300 DOI: 10.1155/2022/8650099] [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: 11/02/2021] [Revised: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Odontogenic infections represent a frequent condition that in some cases, if not treated promptly, can spread quickly to the rest of the body and turn into life-threatening infections. In this work, the case is reported of a 59-year-old woman, diabetic and overweight, who presented to the Odontostomatology and Otolaryngology Section of the Policlinic of Bari with mandibular tooth infection that had developed into a deep neck space infection leading to the involvement of cavernous sinuses and near mediastinum. The diagnosis, the surgical drainage of the phlegmon and removal of infection foci, appropriate control of the airways, and a correct antibiotic therapy made it possible to avoid a potentially fatal condition. Prompt management and early diagnosis of deep space neck infections, such as phlegmon and/or necrotizing fasciitis, with the auxilium of CT scans and tools such as LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis), NLR (Neutrophil-to-Lymphocyte Ratio), and LRINECxNLR scores (Laboratory Risk Indicator for Necrotizing Fasciitis and Neutrophil to Lymphocyte Ratio), are advised to evade delays and complications that could potentially worsen the patient’s outcome.
Collapse
|
27
|
Arslan H, Bayır Ö, Aksoy Ş, Keseroğlu K, Saka C, Tatar EÇ, Saylam G, Korkmaz MH. Management of deep neck infections in adults and importance of clinical and laboratory findings. J Investig Med 2022; 70:1488-1493. [PMID: 35760449 DOI: 10.1136/jim-2021-002271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/04/2022]
Abstract
This study aimed to analyze laboratory and radiological imaging results in the prediction of treatment strategy in patients with deep neck infections. Eighty-three patients (55 (66.3%) men, mean age: 38.2±14.5 years) were included in the study. Patients were divided into three groups according to the treatment strategy: group 1 received only antibiotic treatment, group 2 underwent abscess drainage with needle puncture in addition to antibiotic treatment, and group 3 underwent surgical drainage with antibiotic treatment. Laboratory outcomes, imaging methods, duration of hospital stay, treatment strategy, and clinical outcomes were analyzed.According to the laboratory results, complete blood count values did not vary among the three groups, but C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were higher in group 3 (p<0.01). Based on receiver operating characteristic (ROC) analysis, the cut-off levels for CRP and ESR associated with the need for surgical drainage were 133 mg/L and 42.5, respectively. According to radiological imaging results, the number of involved neck spaces was significantly different among the three groups (p=0.03), and group 3 had more spaces involved when compared with groups 1 and 2 (p=0.04). Gas formation in the neck tissues was noted in 10 patients in group 3 and 5 patients in groups 1 and 2 (p=0.02). ESR and CRP levels were higher in patients who underwent surgical drainage. In patients with deep neck space infections, the involvement of two or more neck spaces and gas formation on radiological images might indicate surgical drainage as a treatment strategy.
Collapse
Affiliation(s)
- Hande Arslan
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Ömer Bayır
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Şevket Aksoy
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Kemal Keseroğlu
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Cem Saka
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | | |
Collapse
|
28
|
Chen SL, Ho CY, Chin SC, Wang YC. Factors affecting perforation of the esophagus in patients with deep neck infection. BMC Infect Dis 2022; 22:501. [PMID: 35624431 PMCID: PMC9137079 DOI: 10.1186/s12879-022-07480-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Deep neck infection (DNI) is a serious disease that can lead to severe morbidity, including esophageal perforation, and mortality. However, no previous study has explored the risk factors associated with esophageal perforation in patients with DNI. This study investigated these factors. Methods Between September 2015 and September 2021, 521 patients with DNI were studied. Relevant clinical variables and deep neck spaces were assessed. Results In a multivariate analysis, involvement of the retropharyngeal space (OR 5.449, 95% CI 1.603–18.51, p = 0.006) and the presence of mediastinitis (OR 218.8, 95% CI 55.98–855.3, p < 0.001) were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between 32 patients with and 489 patients without esophageal perforation (all p > 0.05). Conclusion Involvement of the retropharyngeal space and the presence of mediastinitis were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between the groups with and without esophageal perforation in DNI.
Collapse
Affiliation(s)
- Shih-Lung Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,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, Taoyuan, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chien Wang
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal TuCheng Hospital (Built and Operated By Chang Gung Medical Foundation), New Taipei, Taiwan
| |
Collapse
|
29
|
Recchia A, Cascella M, Altamura S, Borrelli F, De Nittis N, Dibenedetto E, Labonia M, Pavone G, Del Gaudio A. Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre's Syndrome. Antibiotics (Basel) 2021; 10:antibiotics10121526. [PMID: 34943737 PMCID: PMC8698451 DOI: 10.3390/antibiotics10121526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/14/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
A 20-year-old man was admitted to the intensive care unit for septic shock due to Lemierre’s syndrome. It is a rare syndrome that manifests as an upper respiratory infection, although systemic involvement, severe coagulopathy, and multi-organ failure can dangerously complicate the clinical picture. In this syndrome, sepsis-related neuroendocrine dysregulation and microcirculation impairment can have a rapid deleterious progression. Consequently, proper diagnosis, early source control, and appropriate antibiotics administration are mandatory to improve the prognosis. The intensive treatment is aimed at limiting organ damage through hemodynamic optimization. Remarkably, in septic shock due to Lemierre’s syndrome, hemodynamic optimization can be achieved through the synergic effect of norepinephrine, argipressin, and hydrocortisone.
Collapse
Affiliation(s)
- Andreaserena Recchia
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
- Correspondence: (A.R.); (M.C.); Tel.: +39-0882-4107-03 (A.R.)
| | - Marco Cascella
- Anesthesia and Pain Medicine Istituto Nazionale Tumori-IRCCS, Fondazione G. Pascale, 80100 Napoli, Italy
- Correspondence: (A.R.); (M.C.); Tel.: +39-0882-4107-03 (A.R.)
| | - Sabrina Altamura
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Felice Borrelli
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Nazario De Nittis
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Elisabetta Dibenedetto
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Maria Labonia
- Microbiology and Virology, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Giovanna Pavone
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Alfredo Del Gaudio
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| |
Collapse
|
30
|
Tsai MS, Yang YH, Huang TY, Tsai YT, Lu A, Wu CY, Hsu CM, Liu CY, Lee CP, Lin MH, Chang PJ, Chang GH. Pathogens and Prognosis of Deep Neck Infection in End-Stage Renal Disease Patients. Laryngoscope 2021; 132:1403-1409. [PMID: 34821388 DOI: 10.1002/lary.29955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/25/2021] [Accepted: 11/15/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To examine the pathogenic bacterial spectra and prognosis of deep neck infection (DNI) in end-stage renal disease (ESRD) patients. STUDY DESIGN Retrospective study. METHODS Patients diagnosed with DNI between 2004 and 2015 in Chang Gung Memorial Hospital were enrolled and divided into three groups, namely ESRD-DNI, chronic kidney disease (CKD)-DNI, and non-CKD-DNI. Differences in pathogenic bacteria, treatment, and prognosis were compared across the three groups. RESULTS The bacterial spectra differed among the three groups. The main three facultative anaerobic or aerobic bacteria causing ESRD-DNIs were methicillin-resistant Staphylococcus aureus (MRSA; 25.4%), methicillin-susceptible S. aureus (MSSA; 14.1%), and Klebsiella pneumoniae (KP; 12.7%). For CKD-DNIs, they were KP (23.5%), Viridans streptococci (VS; 23.5%), and MSSA (14.7%). For non-CKD-DNIs, they were VS (31.7%), KP (17.2%), and coagulase-negative staphylococci (8.0%). Compared with the other groups, the ESRD-DNI group had higher white blood cell and C-reactive protein levels, longer hospital stays, more frequent admissions to the intensive care unit, more mediastinal complications, and a significantly higher mortality rate. CONCLUSIONS The ESRD-DNI group exhibited more severe disease activity and higher mortality compared with those of the CKD-DNI and non-CKD-DNI groups. MRSA was the leading pathogen for patients with ESRD-DNI. Physicians must implement strategies for the early detection of MRSA to accurately prescribe antibiotics and prevent nosocomial transmission. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
Collapse
Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, 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
| | - Tsung-Yu Huang
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ang Lu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Yuan Wu
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pey-Jium Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
31
|
Tian C, Zhao R, Qiu Z, Liu Y. The Efficacy of Pyogenic Cavity Aerobic Therapy with Negative Pressure Drainage in the Treatment of Deep Neck Space Infections. Infect Drug Resist 2021; 14:4765-4771. [PMID: 34803386 PMCID: PMC8598126 DOI: 10.2147/idr.s337833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the effectiveness of pyogenic cavity aerobic therapy with negative pressure drainage in the treatment of deep neck space infections (DNSI). Methods The study was a prospective, observational analysis of 36 cases of DNSI at a tertiary care center. The patients were divided into two groups according to the treatment method. Group A was treated with pyogenic cavity aerobic therapy with negative pressure drainage and included 13 patients (6 males and 7 females), while group B was treated with traditional incision debridement drainage and included 23 patients (12 males and 11 females). The average hospitalization days and doctors’ workload (ie, average days of postoperative dressing changes) were analyzed and compared between the two groups. Results The mean hospitalization days in the traditional dressing group were 26.74 ± 3.39 days, while the average days of postoperative dressing change were 25.91 ± 3.43 days. In contrast, the averages for hospitalization days and days of postoperative dressing changes in the pyogenic cavity aerobic therapy plus negative pressure drainage were 11.08 ± 2.11 and 3.69 ± 0.21 days, respectively. All 36 patients were cured. Compared with the group B, group A had a shorter hospital stays and lower doctor workloads (P < 0.001). Conclusion Pyogenic cavity aerobic therapy is an effective and simple method for changing dressings after DNSI. This therapy, when combined with negative pressure drainage, shortens hospitalization days and days that require a dressing change. This has reduced the workload of clinical doctors and pain experienced by patients. This therapy also has a high degree of safety and a very satisfactory curative effect.
Collapse
Affiliation(s)
- Chunhui Tian
- Department of Otolaryngology-Head and Neck Surgery, Suzhou Hospital of Anhui Medical University, Suzhou, People's Republic of China.,Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Renwu Zhao
- Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Zengyu Qiu
- Department of Otolaryngology-Head and Neck Surgery, Suzhou Hospital of Anhui Medical University, Suzhou, People's Republic of China
| | - Yehai Liu
- Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| |
Collapse
|
32
|
Parotid Space, a Different Space from Other Deep Neck Infection Spaces. Microorganisms 2021; 9:microorganisms9112361. [PMID: 34835486 PMCID: PMC8623793 DOI: 10.3390/microorganisms9112361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Deep neck infections (DNIs) such as parotid abscesses are medical emergencies with a seemingly different etiology and treatment course from other DNIs. We sought to confirm this in the present retrospective population-based cohort study. Between August 2016 and January 2020, 412 patients with DNIs seen at a tertiary medical center were enrolled in this study. Infections of the parotid space were compared with those of other deep neck spaces, according to patient characteristics. All patients were divided into parotid space (PS; n = 91, 22.08%) and non-parotid space (NPS; n = 321, 77.92%) subgroups. We further divided the patients into single parotid space (PS-single; n = 50, 12.13%), single non-parotid space (NPS-single; n = 149, 36.16%), multiple parotid space (PS-multiple; n = 41, 9.95%), and multiple non-parotid space (NPS-multiple; n = 172, 41.76%) DNI subgroups. In the PS-single and PS-multiple subgroups, a longer duration of symptoms (p = 0.001), lower white blood cell count (p = 0.001), lower C-reactive protein level (p = 0.010), higher rate of ultrasonography-guided drainage (p < 0.001), and lower rates of surgical incision and drainage (p < 0.001) were observed compared with the NPS-single and NPS-multiple subgroups. The PS group had a higher positive Klebsiella pneumoniae culture rate (p < 0.001), and lower positive Streptococcus constellatus (p = 0.002), and Streptococcus anginosus (p = 0.025) culture rates than the NPS group. In a multivariate analysis, K. pneumoniae was independently associated with parotoid space involvement in comparisons of the PS and NPS groups, PS-single and NPS-single subgroups, and PS-multiple and NPS-multiple subgroups. The clinical presentation of a parotid space infection differs from that of other deep neck space infections.
Collapse
|
33
|
Matoušek P, Čábalová L, Formánková D, Staníková L, Čelakovský P, Mejzlík J, Chrobok V, Komínek P. Tonsillar origin of deep neck infection as a negative prognostic factor for developing complications. Otolaryngol Pol 2021; 76:42-45. [DOI: 10.5604/01.3001.0015.3431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Aim:</b> The aim of this study was to compare the odontogenic and tonsillar origins of deep neck infection (DNI) as a negative prognostic factor for developing complications. </br></br> <b>Methods:</b> This was a retrospective study of 544 patients with tonsillar and odontogenic origins of DNI treated between 2006 and 2015 at 6 ENT Departments and Departments of Oral and Maxillofacial Surgery. Complications from DNI (descending mediastinitis, sepsis, thrombosis of the internal jugular vein, pneumonia, and pleuritis) were evaluated in both groups and compared. Associated comorbidities (cardiovascular involvement, hepatopathy, diabetes mellitus respiratory involvement, gastroduodenal involvement) were reviewed. </br></br> <b>Results:</b> Five hundred and forty-four patients were analyzed; 350/544 males (64.3%) and 19/544 females (35.7%). There were 505/544 cases (92.8%) with an odontogenic origin and 39/544 cases (7.2%) with a tonsillar origin of DNI. Complications occurred more frequently in the group with tonsillar origin of DNI (P < 0.001). There was no difference in diabetes mellitus between the two groups. </br></br> <b>Conclusions:</b> Currently, the tonsillar origin of DNI occurs much less frequently; nevertheless, it carries a much higher risk of developing complications than cases with an odontogenic origin. We recommend that these potentially high-risk patients with a tonsillar origin of deep neck infections should be more closely monitored.
Collapse
Affiliation(s)
- Petr Matoušek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Czech Republic
| | - Lenka Čábalová
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Czech Republic
| | - Debora Formánková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Czech Republic
| | - Lucia Staníková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Czech Republic
| | - Petr Čelakovský
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Czech Republic
| | - Jan Mejzlík
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Czech Republic
| | - Viktor Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Czech Republic
| |
Collapse
|
34
|
Luan CW, Liu CY, Yang YH, Tsai MS, Tsai YT, Hsu CM, Wu CY, Chang PJ, Chang GH. The Pathogenic Bacteria of Deep Neck Infection in Patients with Type 1 Diabetes, Type 2 Diabetes, and Without Diabetes from Chang Gung Research Database. Microorganisms 2021; 9:microorganisms9102059. [PMID: 34683380 PMCID: PMC8537061 DOI: 10.3390/microorganisms9102059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022] Open
Abstract
Deep neck infection (DNI) is a lethal emergent condition. Patients with types 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) are predisposed to DNI and have poorer prognoses. The mainstay of the treatment is surgical drainage and antibiotics; however, the pathogenic bacteria of T1DM-DNI have not been studied before. We obtained the data of 8237 patients with DNI who were hospitalized from 2004 to 2015 from the Chang Gung Research Database, which contains multi-institutional medical records in Taiwan. Using diagnostic codes, we classified them into T1DM-DNI, T2DM-DNI, and non-DM-DNI and analyzed their pathogenic bacteria, disease severity, treatment, and prognosis. The top three facultative anaerobic or aerobic bacteria of T1DM-DNI were Klebsiella pneumoniae (KP, 40.0%), Viridans Streptococci (VS, 22.2%), and methicillin-sensitive Staphylococcus aureus (MSSA, 8.9%), similar for T2DM (KP, 32.2%; VS, 23.3%; MSSA, 9.5%). For non-DM-DNI, it was VS (34.6%), KP (9.8%), and coagulase-negative Staphylococci (8.7%). The order of anaerobes for the three groups was Peptostreptococcus micros, Prevotella intermedia, and Peptostreptococcus anaerobius. Patients with T1DM-DNI and T2DM-DNI had higher white blood cell (WBC) counts and C-reactive protein (CRP) levels, more cases of surgery, more cases of tracheostomy, longer hospital stays, more mediastinal complications, and higher mortality rates than those without DM-DNI. Patients in the death subgroup in T1DM-DNI had higher WBC counts, band forms, and CRP levels than those in the survival subgroup. Patients with DM-DNI had more severe disease and higher mortality rate than those without DM-DNI. KP and Peptostreptococcus micros are the leading pathogens for both patients with T1DM-DNI and those with T2DM-DNI. Clinicians should beware of high serum levels of infection markers, which indicate potential mortality.
Collapse
Affiliation(s)
- Chih-Wei Luan
- Department of Otorhinolaryngology-Head and Neck Surgery, Lo Sheng Sanatorium and Hospital Ministry of Health and Welfare, New Taipei City 24257, Taiwan
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Cheng-Ming Hsu
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ching-Yuan Wu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Pey-Jium Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Geng-He Chang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| |
Collapse
|
35
|
Ricciardiello F, Mazzone S, Viola P, Guggino G, Longo G, Napolitano A, Russo G, Sequino G, Oliva F, Salomone P, Perrella M, Romano GM, Cinaglia P, Abate T, Gargiulo M, Pisani D, Chiarella G. Deep Neck Infections: decisional algorithm for patients with multiple spaces involvement. Rev Recent Clin Trials 2021; 17:46-52. [PMID: 34514992 DOI: 10.2174/1574887116666210910153033] [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: 01/11/2021] [Revised: 05/20/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Deep Neck Infections (DNIs) spread along fascial planes and involve neck spaces. Recently, their incidence has decreased due to the introduction of antibiotics; nevertheless, complications related to DNIs are often life-threatening. OBJECTIVE The purpose of this article is focused on the identification of predisposing factors of these complications, as well as on the development of a reliable therapeutic algorithm. METHOD Sixty patients with DNIs were enrolled from 2006 to 2019 for a retrospective study. The exclusion criteria for the present study was cellulitis, small abscesses responding to empiric or specific antibiotic therapy or with involvement of only one deep neck space. During the analysis the following parameters of interest have been evaluated: gender, age, site of origin, pathways of spread, comorbidities, clinical features, bacteriology data, type of surgical approach required, complications, duration of hospitalization and mortality rate. On admission, microbial swab analysis was performed. RESULTS Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), iron deficiency anemia and the involvement of multiple spaces have been associated with a significantly higher risk of developing complications. Most of our patients had polymicrobial infections. All patients underwent surgical drainage. The complication rate had occurred in 56.6% of patients, while death in 18.3%. CONCLUSION DNIs represent a medical and surgical emergency with potential serious complications, thus avoiding diagnostic delay is mandatory. Our preliminary data suggest the importance of evaluating the extent of infections because the involvement of multiple spaces requires timely surgery due to the higher risk of complications and mortality.
Collapse
Affiliation(s)
| | | | - Pasquale Viola
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro. Italy
| | - Gianluca Guggino
- Thoracic Surgery Department, AORN Cardarelli Hospital, Napoli. Italy
| | - Giuseppe Longo
- Direzione Generale,"A. Cardarelli" Hospital, Naples. Italy
| | | | - Giuseppe Russo
- Direzione Sanitaria, AORN Cardarelli Hospital, Naples. Italy
| | - Giulio Sequino
- Ear Nose and Throat Unit, AORN Cardarelli Hospital, Napoli. Italy
| | - Flavia Oliva
- Ear Nose and Throat Unit, AORN Cardarelli Hospital, Napoli. Italy
| | | | - Marco Perrella
- Department of Anesthesia and Intensive Care, AORN Cardarelli Hospital, Naples. Italy
| | - Giovanni Marco Romano
- Department of Anesthesia and Intensive Care, AORN Cardarelli Hospital, Naples. Italy
| | - Pietro Cinaglia
- Department of Surgical and Clinical Science, Magna Graecia University, Catanzaro. Italy
| | - Teresa Abate
- Ear Nose and Throat Unit, AORN Cardarelli Hospital, Napoli. Italy
| | - Maurizio Gargiulo
- Thoracic Surgery Department, AORN Cardarelli Hospital, Napoli. Italy
| | - Davide Pisani
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro. Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro. Italy
| |
Collapse
|
36
|
Kim Y, Han S, Cho DG, Jung WS, Cho JH. Optimal Airway Management in the Treatment of Descending Necrotizing Mediastinitis Secondary to Deep Neck Infection. J Oral Maxillofac Surg 2021; 80:223-230. [PMID: 34582808 DOI: 10.1016/j.joms.2021.08.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To review our experiences of descending necrotizing mediastinitis (DNM) secondary to deep neck infection (DNI) and determine appropriate airway management for decreasing mortality and morbidity of patients with DNM. METHODS Medical records of 20 patients (8 women and 12 men) who had been managed for DNM secondary to DNI between March 2006 and December 2019 were analyzed. Diagnosis and extent of infection were confirmed by computed tomography of the neck and chest. The upper airway was closely monitored with a fiberoptic laryngoscope. Complications were evaluated according to various types of airway management in our serial cases. RESULTS Five (25%) out of 20 patients died as a result of septic shock and multiorgan failure. None of these patients died of accidental airway obstruction or airway management mishaps. Keeping short-term orotracheal intubation was safe and adequate after the initial surgery. Early tracheotomy was performed for 4 patients and it was significantly associated with mortality (P = .032). Three patients who underwent late tracheotomy had no mortality. Patients with tracheotomy had longer duration of overall hospital stay than those without tracheotomy. CONCLUSIONS Well-controlled airway management might decrease mortality, hospitalization, and airway complications in patients with DNM secondary to DNI. Keeping orotracheal intubation rather than upfront tracheotomy should be first considered when managing airway along with examination of the upper airway with a fiberoptic laryngoscope.
Collapse
Affiliation(s)
- Yoonho Kim
- Resident, Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungjun Han
- Clinical Assistant Professor, Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deog Gon Cho
- Professor, Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Sang Jung
- Clinical Associate Professor, Department of Radiology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung-Hae Cho
- Assistant Professor, Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
37
|
Factors Affecting the Necessity of Tracheostomy in Patients with Deep Neck Infection. Diagnostics (Basel) 2021; 11:diagnostics11091536. [PMID: 34573878 PMCID: PMC8468266 DOI: 10.3390/diagnostics11091536] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
Deep neck infection (DNI) is a serious disease that can lead to airway obstruction, and some patients require a tracheostomy to protect the airway instead of intubation. However, no previous study has explored risk factors associated with the need for a tracheostomy in patients with DNI. This article investigates the risk factors for the need for tracheostomy in patients with DNI. Between September 2016 and February 2020, 403 subjects with DNI were enrolled. Clinical findings and critical deep neck spaces associated with a need for tracheostomy in patients with DNI were assessed. In univariate and multivariate analysis, older age (≥65 years old) (OR = 2.450, 95% CI: 1.163–5.161, p = 0.018), multiple spaces involved (≥3 spaces) (OR = 4.490, 95% CI: 2.153–9.360, p = 0.001), and the presence of mediastinitis (OR = 14.800, 95% CI: 5.097–42.972, p < 0.001) were independent risk factors associated with tracheostomy in patients with DNI. Among the 44 patients with DNI that required tracheostomy, ≥50% of patients had involvement of the parapharyngeal or retropharyngeal space (72.72% and 50.00%, respectively). Streptococcus constellatus (25.00%) was the most common pathogen in patients with DNI who required tracheostomy. In conclusion, requiring a tracheostomy was associated with a severe clinical presentation of DNI. Older age (≥65 years old), multiple spaces (≥3 spaces), and presence of mediastinitis were significant risk factors associated with tracheostomy in patients with DNI. The parapharyngeal and retropharyngeal spaces were the most commonly involved, and Streptococcus constellatus was the most common pathogen in the patients with DNI that required tracheostomy.
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Treviño-Gonzalez JL, Maldonado-Chapa F, González-Larios A, Morales-Del Angel JA, Soto-Galindo GA, Zafiro García-Villanueva JM. Deep Neck Infections: Demographic and Clinical Factors Associated with Poor Outcomes. ORL J Otorhinolaryngol Relat Spec 2021; 84:130-138. [PMID: 34237752 DOI: 10.1159/000517026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deep neck infections (DNIs) are abscesses located in the profound spaces of the neck and constitute one of the most common otolaryngological life-threatening emergencies. The aim of this study is to review the clinical and demographic data of patients with DNI and identify factors associated with prolonged hospitalization, reoperation, and mortality. METHODS Retrospective review and analysis of 75 patients with DNI admitted from January 2015 to December 2019 in a tertiary referral hospital. RESULTS Of 75 patients, 50 (66.6%) were males and 25 (33.3%) females. Age ranged from 18 to 91 years with a mean of 41.79 (±15.48). DNIs were odontogenic in 49 patients (65.3%). History of diabetes mellitus (DM) was positive in 26 patients (34.6%). The submandibular space was involved in 57 patients (76%). Streptococcus spp. were isolated in 35 patients (46%). Intubation for airway preservation was needed in 21 patients (28%) and tracheostomy in 6 (8%). Mediastinitis presented in 8 patients (10.67%), with a mortality rate of 62.5% (n = 5). Mean hospital stay was 9.13 days (±7.2). DM (p = 0.016), age (p = 0.001), BMI classification 3, 4, and 6 (p = 0.041), and intensive care unit (ICU) admission (p = 0.009) were associated with a longer stay. Surgical drainage was performed after 1.71 days (±1.65). Surgical reintervention was needed in 6 cases (8%) and was associated with temporal (p = 0.001) and masticator (p = 0.002) space involvement and DM (p = 0.009). Overall mortality was 8% and decreased to 1.5% when mediastinitis was excluded. Mediastinitis (p = 0.001), ICU admission (p < 0.0001), Streptococcus spp. (p = 0.019), and low hemoglobin levels (p = 0.004) were associated with mortality. DISCUSSION/CONCLUSION DNIs are entities associated with high morbimortality. Mediastinitis and airway obstruction are life-threatening possible complications and should be promptly evaluated. Low HB could be used as a predicting factor for mortality.
Collapse
Affiliation(s)
- José Luis Treviño-Gonzalez
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico,
| | - Félix Maldonado-Chapa
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | - Amalia González-Larios
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | - Josefina Alejandra Morales-Del Angel
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | - Germán Armando Soto-Galindo
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | | |
Collapse
|
40
|
High Risk of Peritonsillar Abscess in End-Stage Renal Disease Patients: A Nationwide Real-World Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136775. [PMID: 34202480 PMCID: PMC8297125 DOI: 10.3390/ijerph18136775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/19/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023]
Abstract
Background: Peritonsillar abscess (PTA) is an infectious emergency in the head and neck, and patients with end-stage renal disease (ESRD) have an immunocompromised status. However, no relevant research has focused on the ESRD–PTA relationship. This study explored PTA in ESRD patients and their prognosis. Methods: We identified 157,026 patients diagnosed as having ESRD over January 1997 to December 2013 from Taiwan’s National Health Insurance Research Database (NHIRD). Each patient with ESRD (hereafter, patients) was matched with one control without chronic kidney disease (CKD; hereafter, controls) by sex, age, urbanization level, and income. Next, PTA incidence until death or the end of 2013 was compared between the two groups, and the relative risk of PTA was analyzed using a multiple logistic regression model. Results: The patients had a significantly higher PTA incidence than did the controls (incidence rate ratio: 2.02, 95% confidence interval [CI]: 1.40–2.91, p < 0.001). The Kaplan–Meier analysis revealed that the patients had a higher cumulative incidence of PTA than did the controls (p < 0.001). In Cox regression analysis, the patients had nearly twofold higher PTA risk (adjusted hazard ratio [HR]: 1.98, 95% CI: 1.37–2.86, p < 0.001). The between-group differences in the PTA-related hospital stay length (8.1 ± 10.3 days in patients and 5.7 ± 4.6 days in controls, p = 0.09), consequent deep-neck infection complication (4.2% in patients and 6.3% in controls, p = 0.682), and mortality (0.0% in both groups) were nonsignificant. Conclusions: Although ESRD does not predict a poor prognosis of PTA, it is an independent PTA risk factor.
Collapse
|
41
|
Gehrke T, Scherzad A, Hagen R, Hackenberg S. Deep neck infections with and without mediastinal involvement: treatment and outcome in 218 patients. Eur Arch Otorhinolaryngol 2021; 279:1585-1592. [PMID: 34160666 PMCID: PMC8897324 DOI: 10.1007/s00405-021-06945-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
Purpose Infections of the deep neck, although becoming scarcer due to the widespread use of antibiotics, still represent a dangerous and possibly deadly disease, especially when descending into the mediastinum. Due to the different specialities involved in the treatment and the heterogenous presentation of the disease, therapeutic standard is still controversial. This study analyzes treatment and outcome in these patients based on a large retrospective review and proposes a therapeutic algorithm. Methods The cases of 218 adult patients treated with deep neck abscesses over a 10-year period at a tertiary university hospital were analyzed retrospectively. Clinical, radiological, microbiological and laboratory findings were compared between patients with and without mediastinal involvement. Results Forty-five patients (20.64%) presented with abscess formation descending into the mediastinum. Those patients had significantly (all items p < 0.0001) higher rates of surgical interventions (4.27 vs. 1.11) and tracheotomies (82% vs. 3.4%), higher markers of inflammation (CRP 26.09 vs. 10.41 mg/dl), required more CT-scans (3.58 vs. 0.85), longer hospitalization (39.78 vs 9.79 days) and more frequently needed a change in antibiotic therapy (44.44% vs. 6.40%). Multi-resistant pathogens were found in 6.67% vs. 1.16%. Overall mortality rate was low with 1.83%. Conclusion Despite of the high percentage of mediastinal involvement in the present patient collective, the proposed therapeutic algorithm resulted in a low mortality rate. Frequent CT-scans, regular planned surgical revisions with local drainage and lavage, as well as an early tracheotomy seem to be most beneficial regarding the outcome.
Collapse
Affiliation(s)
- Thomas Gehrke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Agmal Scherzad
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Stephan Hackenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| |
Collapse
|
42
|
Lee SE, Mushtaq A, Gitman M, Paniz-Mondolfi A, Chung M, Obla A, Sordillo EM, Nowak MD, van Bakel H, Ramírez JD, Muñoz M, Lee M. Lemierre's syndrome associated with hypervirulent Klebsiella pneumoniae: A case report and genomic characterization of the isolate. IDCases 2021; 25:e01173. [PMID: 34141583 PMCID: PMC8188389 DOI: 10.1016/j.idcr.2021.e01173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
We describe a case of Lemierre’s syndrome (LS) caused by a hypervirulent strain of Klebsiella pneumoniae in a 63-year-old female with hypertension, hyperlipidemia, and diabetes mellitus, who presented with right neck pain and fevers. Computerized tomography of the neck and chest revealed an occluded right internal jugular vein secondary to thrombosis and septic emboli in lungs. Blood cultures grew K. pneumoniae. The patient was treated with ampicillin-sulbactam and then transitioned to amoxicillin-clavulanate to complete a 6-week course of antibiotics, and a 3-month course of rivaroxaban. String test of the K. pneumoniae isolate was positive at 2 cm. Whole genome sequencing identified several genes associated with the hypervirulent strain, notably the genes encoding for aerobactin (iucA and iucB) and salmochelin (iroB) iron acquisition systems. LS can rarely be caused by K. pneumoniae. Clinicians should monitor for known complications, such as septic emboli in patients with LS.
Collapse
Affiliation(s)
- Seung Eun Lee
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ammara Mushtaq
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa Gitman
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marilyn Chung
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ajay Obla
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emilia M Sordillo
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael D Nowak
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Harm van Bakel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología -UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Marina Muñoz
- Centro de Investigaciones en Microbiología y Biotecnología -UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Mikyung Lee
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
43
|
Rahimi-Nedjat RK, Sagheb K, Sagheb K, Hormes M, Walter C, Al-Nawas B. The role of diabetes mellitus on the formation of severe odontogenic abscesses-a retrospective study. Clin Oral Investig 2021; 25:6279-6285. [PMID: 33982168 PMCID: PMC8531061 DOI: 10.1007/s00784-021-03926-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
Objectives To analyze the correlation of diabetes mellitus and hyperglycemia with severe odontogenic abscesses. Materials and methods Records of all patients in the Department of Oral and Maxillofacial Surgery of the Medical Center of the Johannes Gutenberg-University who underwent inpatient treatment for severe odontogenic abscesses between 2010 and 2016 were evaluated retrospectively regarding diabetes anamnesis, maximum and fasting blood sugar count, and duration until discharge. In order to compare the numbers to a general maxillofacial group, all patients who received inpatient treatment in 2013 for any diagnosis other than an abscess of the head and neck region were analyzed as well, and the numbers were correlated. Results In total, 977 abscess patients were found in the analyzed period. 7.0% of the patients had a known diagnosis of diabetes mellitus type II and 0.6% of type I. Correlation with the general group showed that abscesses were significantly more likely in diabetics as well as patients with abnormal maximum and fasting blood sugar counts. These patients also needed significantly longer inpatient treatment. Conclusions Diabetics and patients with abnormal glucose tolerance show significantly higher numbers of severe odontogenic abscesses and might therefore benefit from earlier escalation of antibiotic medication. Clinical relevance Severe odontogenic abscesses are one of the most frequent diagnoses in maxillofacial practice. Adjusting the therapeutic approach for diabetics or patients with abnormal blood sugar counts might help to prevent the development of abscesses.
Collapse
Affiliation(s)
- Roman Kia Rahimi-Nedjat
- Department of Oral and Maxillofacial Surgery - Facial plastic Surgery, Medical Center of the Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery - Facial plastic Surgery, Medical Center of the Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Kawe Sagheb
- Department of Prosthodontics, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Maike Hormes
- Department of Oral and Maxillofacial Surgery - Facial plastic Surgery, Medical Center of the Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Christian Walter
- Department of Oral and Maxillofacial Surgery - Facial plastic Surgery, Medical Center of the Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery - Facial plastic Surgery, Medical Center of the Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131, Mainz, Germany
| |
Collapse
|
44
|
Yamaguchi R, Sakurada K, Saitoh H, Yoshida M, Makino Y, Torimitsu S, Mizuno S, Iwase H. Fatal airway obstruction due to Ludwig's angina from severe odontogenic infection during antipsychotic medication: A case report and a literature review. J Forensic Sci 2021; 66:1980-1985. [PMID: 33904596 DOI: 10.1111/1556-4029.14740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
Ludwig's angina is characterized by inflammation of the sublingual and submandibular spaces and is mainly caused by odontogenic infection, which leads to cellulitis of the soft tissues of the floor of the mouth and the neck. This causes asphyxia due to elevation and posterior deviation of the tissues of the floor of the mouth. We report a fatal case of airway obstruction due to Ludwig's angina. A woman in her forties who had no physical complications, but had a mental illness, was undergoing outpatient dental treatment for caries in the first premolar of the left mandible. She was admitted to a psychiatric hospital because of insomnia caused by pain, where she developed cardiopulmonary arrest while sleeping and died 14 days after onset of the dental infection. Postmortem computed tomography (PMCT) prior to autopsy showed swelling of the soft tissues-from the floor of the mouth to the oropharyngeal cavity, the supraglottic larynx, and the prevertebral tissue. Autopsy revealed a markedly swollen face and neck, an elevated tongue, and a highly edematous epiglottis and laryngopharyngeal mucosa. There was also cellulitis and abscess of the facial, suprahyoid, and neck musculature, which suggested that the cause of death was asphyxiation due to airway obstruction. This was an alarming case, with mental illness leading to risk of severe odontogenic infection, and in which obesity and use of antipsychotic medication might have acted synergistically leading to airway obstruction. This is also a case of Ludwig's angina captured by PMCT, which has rarely been reported.
Collapse
Affiliation(s)
- Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Koichi Sakurada
- Department of Forensic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hisako Saitoh
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Maiko Yoshida
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Satomi Mizuno
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| |
Collapse
|
45
|
Silva CM, Paixão J, Tavares PN, Baptista JP. Life-threatening complications of Ludwig's angina: a series of cases in a developed country. BMJ Case Rep 2021; 14:e240429. [PMID: 33906886 PMCID: PMC8076936 DOI: 10.1136/bcr-2020-240429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/03/2022] Open
Abstract
Ludwig's angina is a deep neck space infection defined as a rapidly progressive bilateral cellulitis of the submandibular space. In spite of being an uncommon entity in developed countries and the reduction of mortality and morbidity due to modern era of antibiotics, improved imaging and airway management, it is still an important and potentially life-threatening condition. The authors present 3 cases of Ludwig's angina that occurred in a developed country, and that required admission in intensive care unit and extensive surgical and medical treatment.
Collapse
Affiliation(s)
- Catarina Mendes Silva
- Serviço de Medicina Intensiva, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Joana Paixão
- Serviço de Medicina Interna, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - João Pedro Baptista
- Serviço de Medicina Intensiva, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| |
Collapse
|
46
|
Wu JH, Li X, Chen GP, Fu MY, Ye F. Changing trends of deep neck infections in southern China: A review of 127 cases. Sci Prog 2021; 104:368504211028367. [PMID: 34191640 PMCID: PMC10358622 DOI: 10.1177/00368504211028367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study aimed to review our experience with the clinical characteristics and management of deep neck infections (DNIs) and determine the changing trends of their characteristics over time in southern China. Patients diagnosed with a DNI between January 2009 and December 2018 were screened retrospectively for their demographic characteristics, etiology of infection, site of infection, microbiology, treatment, and complications. In total, 127 patients were included: 41 (32.3%) were treated between 2009 and 2013 (group A), and 86 (67.7%) were treated between 2014 and 2018 (group B). The most common site of infection in group A was the parapharyngeal space (15 patients, 36.6%), while that in group B involved multiple spaces (36 patients, 41.9%). The leucocyte count (×109 cells/L) was 13.23 ± 4.19 in group A and 16.04 ± 4.33 in group B (p < 0.001). Streptococcus viridans was the most common bacteria in both groups. The mean hospital stay was 21.46 ± 33.09 days in group A and 10.44 ± 6.19 days in group B. The rate of diabetes mellitus (DM) in group A was lower than that in group B (8/41 and 33/86, respectively; p = 0.034). Airway obstruction was the most common complication in both groups. DNIs are more likely to show multi-space involvement, affect more DM patients, and be associated with higher leucocyte counts over time. We infer that the duration from morbidity to admission and that from admission to operation play roles in the successful management of DNIs, possibly causing fewer complications, lower mortality rates, and shorter hospital stays. DM patients require increased attention.
Collapse
Affiliation(s)
- Jian-Hui Wu
- Min-Yi Fu, The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong 528400, P.R. China.
| | | | - Guo-Ping Chen
- The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, P.R. China
| | - Min-Yi Fu
- The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, P.R. China
| | - Fei Ye
- The Department of Otolaryngology in the Zhongshan City People’s Hospital, Zhongshan Affiliated Hospital of Sun Yat-sen University, Zhongshan, Guangdong, P.R. China
| |
Collapse
|
47
|
Ding MC, Hsu CM, Liu SYC, Lee YC, Yang YH, Liu CY, Chang GH, Tsai YT, Lee LA, Yang PR, Li HY, Tsai MS. Deep Neck Infection Risk in Patients with Sleep Apnea: Real-World Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063191. [PMID: 33808734 PMCID: PMC8003369 DOI: 10.3390/ijerph18063191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022]
Abstract
(1) Background: Sleep apnea may be a risk factor for deep neck infection (DNI). The objective of this study was to investigate the effects of sleep apnea on DNI. (2) Methods: In this first nationwide retrospective cohort study on the sleep apnea–DNI correlation, we obtained data from the Longitudinal Health Insurance Database 2005, a subset of the Taiwan National Health Insurance Research Database. Patients who were newly diagnosed with sleep apnea between 1997 and 2012 were identified, and patients without sleep apnea were matched at a 1:4 ratio in age, sex, socioeconomic status, and urbanization level. The primary outcome of this study was DNI occurrence. The treatment modalities for sleep apnea and the comorbidities that occurred during the study period were also analyzed. (3) Results: Our sleep apnea and comparison (non-sleep apnea) cohorts comprised 6114 and 24,456 patients, respectively. We compared the cumulative incidence of DNI between these cohorts and found a greater incidence of DNI in the sleep apnea cohort (p < 0.001). A strong sleep apnea–DNI association was found following analysis via the adjusted Cox proportional-hazards model (full model hazard ratio, 1.71; 95% confidence interval, 1.28–2.28; p < 0.001). In the subgroup analysis, sleep apnea increased DNI risk in men, in those aged < 50 years, and in those without diabetes mellitus, end-stage renal disease, liver cirrhosis, autoimmune disease, obesity, tonsillectomy, or adenotonsillectomy. (4) Conclusions: Our results confirmed sleep apnea to be an independent risk factor for DNI. Physicians should be aware of the potential occurrence of DNI in patients with sleep apnea.
Collapse
Affiliation(s)
- Meng-Chang Ding
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
| | - Cheng-Ming Hsu
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Yi-Chan Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Department of Otolaryngology–Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yao-Hsu Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- 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
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
| | - Geng-He Chang
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- 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 333, Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
| | - Li-Ang Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Department of Otolaryngology–Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Pei-Rung Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Hsueh-Yu Li
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- Department of Otolaryngology–Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Correspondence: (H.-Y.L.); (M.-S.T.); Tel.: +886-3-328-1200 (ext. 3968) (H.-Y.L.); +886-5-362-1000 (ext. 2076) (M.-S.T.); Fax: +886-3-397-9361 (H.-Y.L.); +886-5-3623002 (M.-S.T.)
| | - Ming-Shao Tsai
- Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (M.-C.D.); (C.-M.H.); (G.-H.C.); (Y.-T.T.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.L.); (Y.-H.Y.); (L.-A.L.); (P.-R.Y.)
- 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 333, Taiwan
- Correspondence: (H.-Y.L.); (M.-S.T.); Tel.: +886-3-328-1200 (ext. 3968) (H.-Y.L.); +886-5-362-1000 (ext. 2076) (M.-S.T.); Fax: +886-3-397-9361 (H.-Y.L.); +886-5-3623002 (M.-S.T.)
| |
Collapse
|
48
|
Hidaka H, Tarasawa K, Fujimori K, Obara T, Fushimi K, Sakagami T, Yagi M, Iwai H. Identification of risk factors for mortality and delayed oral dietary intake in patients with open drainage due to deep neck infections: Nationwide study using a Japanese inpatient database. Head Neck 2021; 43:2002-2012. [PMID: 33650237 DOI: 10.1002/hed.26660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUNDS Data on risk factors for deep neck infection including descending necrotizing mediastinitis (DNM) have been limited. Using a nationwide database, the aim was identifying the factors related to patient death and delay in recovering oral intake. METHODS Data of 4949 patients were extracted from a Japanese inpatient database between 2012 and 2017. The main outcome was survival at discharge. In a subgroup analysis of the 4949 patients with survival, the second outcome was delay in the interval between admission and full recovery of oral intake. RESULTS Only a few factors (advanced-age, ventilation) were associated with both mortality and delayed oral dietary intake by logistic regression analyses. Conversely, several factors including DNM (adjusted-odds ratio [OR] 1.41) and repeated surgery (adjusted-OR 1.70) were significantly related only to delayed oral dietary intake. CONCLUSIONS Although DNM was not necessarily related to mortality, patients with DNM should receive careful attention to avoid delayed oral dietary intake.
Collapse
Affiliation(s)
- Hiroshi Hidaka
- Department of Otolaryngology Head and Neck Surgery, Kansai Medical University, Hirakata, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University School of Medicine, Sendai, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University School of Medicine, Sendai, Japan
| | - Taku Obara
- Division of Molecular Epidemiology, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Tomofumi Sakagami
- Department of Otolaryngology Head and Neck Surgery, Kansai Medical University, Hirakata, Japan
| | - Masao Yagi
- Department of Otolaryngology Head and Neck Surgery, Kansai Medical University, Hirakata, Japan
| | - Hiroshi Iwai
- Department of Otolaryngology Head and Neck Surgery, Kansai Medical University, Hirakata, Japan
| |
Collapse
|
49
|
Borin M, Pignataro L, Ibba T, Di Cicco M, Folino F, Marchisio P, Capaccio P, Torretta S. Unrevealed foreign body in the deep neck space: A case report. Clin Case Rep 2021; 9:1478-1482. [PMID: 33768872 PMCID: PMC7981780 DOI: 10.1002/ccr3.3806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 12/04/2022] Open
Abstract
Clinical data provided by the patient are not always reliable or could be difficult to collect. In this case, a difficult history collection resulted in a diagnostic delay. Major complications were avoided performing an urgent surgical intervention.
Collapse
Affiliation(s)
- Marco Borin
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Tullio Ibba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | | | - Francesco Folino
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Pasquale Capaccio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Biomedical Surgical Dental ScienceUniversità degli Studi di MilanoMilanItaly
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| |
Collapse
|
50
|
Li WX, Dong Y, Zhang A, Tian J, Lu C, Quraishi MS, Liu L. Management of deep neck infections from cervical esophageal perforation caused by foreign body: A case series study. Am J Otolaryngol 2021; 42:102870. [PMID: 33418175 DOI: 10.1016/j.amjoto.2020.102870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Esophageal perforation caused by foreign body is common in Chinese medical institutions, and resultant deep neck infections (DNI) is quite different from typical DNI. The purpose of this article was to share our experience on management of this particular type of DNI. MATERIAL AND METHODS A retrospective review was conducted on a consecutive sample of such patients at Capital Medical University Beijing Friendship Hospital from 2015 to 2019. RESULTS In total, 24 cases were recorded. CT scan of the neck and upper thorax was the most useful tool for early diagnosis. Gas formation was not predictive of a worse clinical course. Eleven patients with minor DNI were treated with antibiotics and foreign body removal; while 13 patients with major DNI were treated with neck incision and drainage, ICU observation, and prolonged usage of antibiotics. Outcome was generally good, but major complications, including sepsis and lingual artery rupture, could occur. CONCLUSIONS Conservative management, focusing on prompt extraction of esophageal foreign body and adequate antibiotic coverage, can lead to good outcome for mild cases; while in addition to these measures, neck incision, cervical and superior mediastinal exploration, and high negative pressure drainage, should be performed for severe cases.
Collapse
Affiliation(s)
- Wan-Xin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yanbo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Aobo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jun Tian
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Mohammad Shahed Quraishi
- Department of Otolaryngology Head and Neck Surgery, Surgical Oncology, University of Sheffield Doncaster Royal Infirmary, South Yorkshire, UK
| | - Liangfa Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| |
Collapse
|