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Ba-Shammakh SA, Alrayes BM, Abu-Obead HM, Ba-Shammakh MA, Al-Mohd FM, Ramzoun EH, Abu-Nowar L. Vacuum-Assisted Closure Therapy: A Lifesaver in a Case of Neck Necrotizing Fasciitis. Cureus 2023; 15:e44291. [PMID: 37779734 PMCID: PMC10535721 DOI: 10.7759/cureus.44291] [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] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Necrotizing fasciitis (NF) is a severe and rare soft tissue infection with a high potential for mortality, particularly in cases related to odontogenic infections in immunocompromised patients. The conventional treatment for NF includes broad-spectrum antibiotics and aggressive surgical debridement. This report presents a unique case of a 34-year-old healthy male who developed NF following a lower left wisdom tooth extraction. The infection extended into the superior mediastinum, requiring emergency surgical intervention. The therapeutic management included vacuum-assisted closure (VAC), a treatment modality showing promise in managing complex soft tissue infections, in combination with other adjunct treatments. The patient showed a satisfactory healing process and no signs of recurrence during the six-month follow-up period. This case underlines the importance of early diagnosis and the potential benefit of VAC therapy in managing advanced NF, emphasizing the need for further research and clinical application.
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Affiliation(s)
| | | | | | | | - Fahmi M Al-Mohd
- Department of General Surgery, The Islamic Hospital, Amman, JOR
| | - Ebrahim H Ramzoun
- Department of Oral and Maxillofacial Surgery, The Islamic Hospital, Amman, JOR
| | - Laith Abu-Nowar
- Department of General Surgery, The Islamic Hospital, Amman, JOR
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2
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The utility of metagenomic next-generation sequencing in the identification of pathogens causing cervicofacial necrotizing fasciitis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e660-e662. [PMID: 35472485 DOI: 10.1016/j.jormas.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022]
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3
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Odontogenic Cervicofacial Necrotizing Fasciitis: Microbiological Characterization and Management of Four Clinical Cases. Pathogens 2022; 11:pathogens11010078. [PMID: 35056026 PMCID: PMC8778522 DOI: 10.3390/pathogens11010078] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
Necrotizing fasciitis of the head and neck is a rare, very severe disease, which, in most cases, originates from odontogenic infections and frequently ends with the death of the patient. Rapid surgical intervention in combination with a preferably pathogen-specific antibiotic therapy can ensure patients’ survival. The question arises concerning which pathogens are causative for the necrotizing course of odontogenic inflammations. Experimental 16S-rRNA gene analysis with next-generation sequencing and bioinformatics was used to identify the microbiome of patients treated with an odontogenic necrotizing infection and compared to the result of the routine culture. Three of four patients survived the severe infection, and one patient died due to septic multiorgan failure. Microbiome determination revealed findings comparable to typical odontogenic abscesses. A specific pathogen which could be causative for the necrotizing course could not be identified. Early diagnosis and rapid surgical intervention and a preferably pathogen-specific antibiotic therapy, also covering the anaerobic spectrum of odontogenic infections, are the treatments of choice. The 16S-rRNA gene analysis detected significantly more bacteria than conventional methods; therefore, molecular methods should become a part of routine diagnostics in medical microbiology.
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4
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Nazir H, Ying Chieng C, Rogers SN, Nekrasisus R, Dodd M, Shah N. Outcomes of necrotizing fasciitis in the head and neck region in the United Kingdom-a case series and literature review. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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5
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Derruau S, Bogard F, Exartier-Menard G, Mauprivez C, Polidori G. Medical Infrared Thermography in Odontogenic Facial Cellulitis as a Clinical Decision Support Tool. A Technical Note. Diagnostics (Basel) 2021; 11:diagnostics11112045. [PMID: 34829390 PMCID: PMC8624025 DOI: 10.3390/diagnostics11112045] [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: 10/10/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Odontogenic cellulitis are frequent infections of the head and neck fascial spaces that can sometimes spread and be life-threatening, requiring urgent hospitalization. Early diagnosis of facial cellulitis with diffuse inflammatory process is crucial in patient management but not always obvious in the field. Medical infrared thermography (MIT) is a noninvasive tool increasingly used to evaluate skin temperature maps and delineate inflammatory lesions. Objective: The aim of this work was to evaluate the use of MIT to improve the clinical examination of patients with facial cellulitis. Methods: Image processing work was carried out to highlight the thermal gradient resulting from inflammation linked to infection, in 2 patients with facial cellulitis. Results: In real-time, MIT allowed to precisely locate the inflammatory focus linked to cellulitis with no propagation to danger areas such as infraorbital space or around pharyngeal axis. Conclusions: Here, we show the first cases using MIT as a powerful complementary tool in the clinical evaluation of patients with facial cellulitis. Significance: This technology could help optimize the hospitalization decision through a facilitated assessment of infection spread in head and neck tissues and helping to incision for drainage.
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Affiliation(s)
- Stéphane Derruau
- UFR Odontologie, Université de Reims Champagne-Ardenne, 51100 Reims, France; (G.E.-M.); (C.M.)
- Pôle de Médecine Bucco-Dentaire, Service de Chirurgie Orale, Centre Hospitalier Universitaire de Reims, 51092 Reims, France
- BioSpecT EA-7506, UFR Pharmacie, Université de Reims Champagne-Ardenne, 51096 Reims, France
- Correspondence:
| | - Fabien Bogard
- MATIM EA, UFR Sciences, Université de Reims Champagne-Ardenne, 51687 Reims, France; (F.B.); (G.P.)
| | - Guillaume Exartier-Menard
- UFR Odontologie, Université de Reims Champagne-Ardenne, 51100 Reims, France; (G.E.-M.); (C.M.)
- Pôle de Médecine Bucco-Dentaire, Service de Chirurgie Orale, Centre Hospitalier Universitaire de Reims, 51092 Reims, France
| | - Cédric Mauprivez
- UFR Odontologie, Université de Reims Champagne-Ardenne, 51100 Reims, France; (G.E.-M.); (C.M.)
- Pôle de Médecine Bucco-Dentaire, Service de Chirurgie Orale, Centre Hospitalier Universitaire de Reims, 51092 Reims, France
- BIOS EA-4691, UFR Pharmacie, Université de Reims Champagne-Ardenne, 51096 Reims, France
| | - Guillaume Polidori
- MATIM EA, UFR Sciences, Université de Reims Champagne-Ardenne, 51687 Reims, France; (F.B.); (G.P.)
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6
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Campana VL, Braun FM, Giuliani C. Cervical necrotizing fasciitis by dental abscess treated with negative pressure wound therapy: Case report. Int J Surg Case Rep 2020; 77:795-798. [PMID: 33395898 PMCID: PMC7718123 DOI: 10.1016/j.ijscr.2020.10.121] [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: 04/24/2020] [Revised: 10/25/2020] [Accepted: 10/25/2020] [Indexed: 12/03/2022] Open
Abstract
Necrotizing fasciitis is a very rare complication, especially in head and neck region. Diagnosis and treatment have to be quickly and aggressive because of its rapidly fatal complication. Negative wound pressure therapy is a new technic that has emerge in treating complicated wounds. This new therapy is rarely use in maxillofacial area.
Necrotizing fasciitis is a severe soft tissue infection very uncommon in head and neck. This infection could be very aggressive involving subcutaneous tissue and fascial planes and can be rapidly fatal. Negative pressure wound therapy (NPWT) has emerge recently and became very popular in treating complicated wounds. A case of necrotizing fasciitis in cervical region from an odontogenic infection is presented. After surgical debridement, a NPWT device was installed. NPWT provides advantages compared to conventional debridement and drainage. This method is recommended as an alternative in treating necrotizing fasciitis in head and neck, because it eradicates infection and provides comfort to the patient.
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Affiliation(s)
- Veronica L Campana
- Department of Maxillofacial Surgery Clinica de Imagenes, Neuquen City, Argentina.
| | - Federico M Braun
- Department of Maxillofacial Surgery of Pedro Moguillansky Hospital, Cipoletti, Rio Negro, Argentina
| | - Carina Giuliani
- Department of Head and Neck Surgery of Castro Rendon Hospital, Neuquen City, Argentina
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7
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Lee MH, Votto SS, Read-Fuller AM, Reddy LV. Necrotizing fasciitis of the scalp stemming from odontogenic infection. Proc (Bayl Univ Med Cent) 2020; 33:110-112. [PMID: 32063792 DOI: 10.1080/08998280.2019.1675419] [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: 08/22/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 01/24/2023] Open
Abstract
Necrotizing fasciitis is a severe, rapidly progressive infectious process characterized by rapid spread and extensive tissue destruction. This condition stems from a variety of sources, may affect any area of the body, and requires rapid diagnosis and aggressive intervention. We present a rare case of odontogenic infection progressing to acute cervicofacial necrotizing fasciitis of the scalp and neck.
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Affiliation(s)
- Michael H Lee
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas.,United States Navy
| | - Samuel S Votto
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas.,United States Navy
| | - Andrew M Read-Fuller
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas
| | - Likith V Reddy
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas
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Peetermans M, de Prost N, Eckmann C, Norrby-Teglund A, Skrede S, De Waele JJ. Necrotizing skin and soft-tissue infections in the intensive care unit. Clin Microbiol Infect 2019; 26:8-17. [PMID: 31284035 DOI: 10.1016/j.cmi.2019.06.031] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission. OBJECTIVES To review all aspects of care for a critically ill individual with NSTI. SOURCES Literature search using Medline and Cochrane library, multidisciplinary panel of experts. CONTENT The initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure sometimes less impressive skin findings. The infection can spread rapidly, and delayed surgery worsens prognosis, hence there is a limited role for additional imaging in the critically ill patient. Also, the utility of clinical scores is contested. Prompt surgery with aggressive debridement of necrotic tissue is required for source control and allows for microbiological sampling. Also, prompt administration of broad-spectrum antimicrobial therapy is warranted, with the addition of clindamycin for its effect on toxin production, both in empirical therapy, and in targeted therapy for monomicrobial group A streptococcal and clostridial NSTI. The role of immunoglobulins and hyperbaric oxygen therapy remains controversial. IMPLICATIONS Close collaboration between intensive care, surgery, microbiology and infectious diseases, and centralization of care is fundamental in the approach to the severely ill patient with NSTI. As many aspects of management of these rare infections are supported by low-quality data only, multicentre trials are urgently needed.
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Affiliation(s)
- M Peetermans
- Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - N de Prost
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, IMRB, Créteil, France
| | - C Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Academic Hospital of Medical University Hannover, Germany
| | - A Norrby-Teglund
- Centre for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Sweden
| | - S Skrede
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.
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9
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Bettoni J, Olivetto M, Racz C, Dakpé S. Non-febrile spontaneous neck pain in a patient with diabetes. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:80-81. [PMID: 29969681 DOI: 10.1016/j.jormas.2018.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
Affiliation(s)
- J Bettoni
- Maxillofacial surgery department, university hospital of Amiens, avenue Laennec, 80000 Amiens, France; Facing faces institute, avenue Laennec, 80000 Amiens, France; EA CHIMERE, avenue Laennec, 80000 Amiens, France.
| | - M Olivetto
- Maxillofacial surgery department, university hospital of Amiens, avenue Laennec, 80000 Amiens, France; Facing faces institute, avenue Laennec, 80000 Amiens, France; EA CHIMERE, avenue Laennec, 80000 Amiens, France
| | - C Racz
- Maxillofacial surgery department, university hospital of Amiens, avenue Laennec, 80000 Amiens, France; Facing faces institute, avenue Laennec, 80000 Amiens, France; EA CHIMERE, avenue Laennec, 80000 Amiens, France
| | - S Dakpé
- Maxillofacial surgery department, university hospital of Amiens, avenue Laennec, 80000 Amiens, France; Facing faces institute, avenue Laennec, 80000 Amiens, France; EA CHIMERE, avenue Laennec, 80000 Amiens, France
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10
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Gunaratne DA, Tseros EA, Hasan Z, Kudpaje AS, Suruliraj A, Smith MC, Riffat F, Palme CE. Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature. Head Neck 2018; 40:2094-2102. [PMID: 29934952 DOI: 10.1002/hed.25184] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/14/2018] [Accepted: 02/20/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. METHODS A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis." RESULTS There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. CONCLUSION Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.
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Affiliation(s)
- Dakshika A Gunaratne
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Evan A Tseros
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Zubair Hasan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Akshay S Kudpaje
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Anand Suruliraj
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Mark C Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten E Palme
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Crown Princess Mary Cancer Centre, Westmead Hospital, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
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11
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Abstract
Necrotizing fasciitis (NF) is a devastating disease that typically affects immunocompromised patients, chronically debilitated patients or drug users, but can also affect healthy patients. Necrotizing fasciitis can rapidly produce septic shock and requires immediate surgical management of the necrotic tissue. It is a bacterial infection that progresses rapidly and has a high mortality generally caused by aerobic and anaerobic bacteria. The patient was immunocompromised and drug user. During treatment, a combination of broad-spectrum antibiotic therapy with Ciprofloxacin and Metronidazole, besides the use of activated charcoal dressing composed of carbonized fabric and impregnated with 0.15% silver nitrate enveloped by layer of fabric without activated carbon, chemical-mechanical debridement with hydrogen peroxide, 0.9% saline, and povidone iodine. According to the patient presented, for the treatment of NF there is a need for broad-spectrum antibiotic therapy associated with surgical debridement, use of activated charcoal for antiseptic compression and general intensive care.
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12
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Bayetto K, Cheng A, Sambrook P. Necrotizing fasciitis as a complication of odontogenic infection: a review of management and case series. Aust Dent J 2017; 62:317-322. [PMID: 28241379 DOI: 10.1111/adj.12508] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aims of the present study were to establish the incidence of head and neck necrotizing fasciitis (NF) in the Adelaide Oral and Maxillofacial Surgery Unit; review the current literature regarding the management of head and neck NF; and determine the evidence for the role of hyperbaric oxygen therapy in the management of NF. METHODS A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006-2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. RESULTS A total of 672 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48/100 000 infections per year. CONCLUSIONS The first-line treatment of severe odontogenic infections remains conventional surgical and medical management; however, hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients.
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Affiliation(s)
- K Bayetto
- Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A Cheng
- Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - P Sambrook
- Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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13
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Mazzella A, Santagata M, Cecere A, La Mart E, Fiorelli A, Tartaro G, Tafuri D, Testa D, Grella E, Perrotta F, Bianco A, Mazzarella G, Santini M. Descending necrotizing mediastinitis in the elderly patients. Open Med (Wars) 2016; 11:449-460. [PMID: 28352835 PMCID: PMC5329867 DOI: 10.1515/med-2016-0080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 08/19/2016] [Indexed: 12/20/2022] Open
Abstract
Descending Necrotizing Mediastinitis (DNM) is a polymicrobic, dangerous and often fatal process, arising from head or neck infections and spreading along the deep fascial cervical planes, descending into the mediastinum. It can rapidly progress to sepsis and can frequently lead to death. It has a high mortality rate, up to 40% in the different series, as described in the literature. Surgical and therapeutic management has been discussed for long time especially in an elderly patient population. The literature has been reviewed in order to evaluate different pathogenesis and evolution and to recognise a correct therapeutic management.
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Affiliation(s)
| | - Mario Santagata
- Maxillo-Facial Surgery Unit, Second University of Naples, Italy
| | - Atirge Cecere
- Maxillo-Facial Surgery Unit, Second University of Naples, Italy
| | - Ettore La Mart
- Maxillo-Facial Surgery Unit, Second University of Naples, Italy
| | | | | | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - Domenico Testa
- Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Naples, Italy
| | - Edoardo Grella
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Italy
| | - Fabio Perrotta
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Italy
| | - Andrea Bianco
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Piazza Miraglia, 2, 80138 Naples, Italy
| | - Gennaro Mazzarella
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples/Hosp. Monaldi, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Italy
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14
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Frankel JK, Rezaee RP, Harvey DJ, McBeath ER, Zender CA, Lavertu P. Use of negative pressure wound therapy with instillation in the management of cervical necrotizing fasciitis. Head Neck 2015; 37:E157-60. [PMID: 25756193 DOI: 10.1002/hed.24028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 12/12/2014] [Accepted: 03/04/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cervical necrotizing fasciitis is an aggressive infection that can be rapidly fatal if aggressive therapies are not initiated early. Negative pressure wound therapy has been established as an effective tool in promoting wound healing, but its use in the acutely infected wound has been avoided because it limits frequent irrigations and standard dressing changes. METHODS We discuss a novel application of negative pressure wound therapy with instillation in an immunocompromised patient with extensive cervical necrotizing fasciitis. RESULTS The negative pressure wound therapy with instillation provided pain relief by minimizing the frequency of dressing changes, increased the speed of healing, helped to control infection, and facilitated the development of a healthy wound bed sufficient for reconstruction with a split thickness skin graft. CONCLUSION The role of negative pressure wound therapy with instillation continues to expand and can be used in the management of both acute and chronic wounds in the head and neck.
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Affiliation(s)
- Jonathan K Frankel
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
| | - Rod P Rezaee
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
| | - Donald J Harvey
- University Hospitals Case Medical Center, Plastic Surgery, Cleveland, Ohio
| | - Evan R McBeath
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
| | - Chad A Zender
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
| | - Pierre Lavertu
- University Hospitals Case Medical Center, Otolaryngology - Head and Neck Surgery, Cleveland, Ohio
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15
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Alblas J, Klicks RJ, Andrlessen A. A special case: treatment of a patient with necrotising fasciitis. ACTA ACUST UNITED AC 2013; 22:S22-4, S26. [PMID: 24180022 DOI: 10.12968/bjon.2013.22.sup10.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The case study in this article describes the rapid and accurate diagnosis of a critically ill patient with necrotising fasciitis (NF). Full-thickness patchy skin necrosis of the right thigh, buttock and flank was detected on admission. Prompt radical debridement together with aggressive fluid resuscitation and broad-spectrum antibiotic administration was initiated. Case ascertainment was used to evaluate the effectiveness of a debridement and wound treatment regime,using a monofilament debridement product, negative wound pressure treatment and, after the critical period had ended, a bio-cellulose+ polyhexamethylene biguanide (PHMB) dressing, followed by a collagen dressing. NF after open haemorrhoidectomy represents a life-threatening complication to otherwise healthy patients. Accurate diagnosis, prompt critical care and surgical treatment, together with debridement using the monofilament product and effective wound bed preparation, lead to a successful outcome.
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16
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Chunduri NS, Madasu K, Tammannavar PS, Pushpalatha C. Necrotising fasciitis of odontogenic origin. BMJ Case Rep 2013; 2013:bcr-2012-008506. [PMID: 23821623 DOI: 10.1136/bcr-2012-008506] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Necrotising fasciitis (NF) is a rare infection of the fascial planes, which is less common in head and neck, because of the rarity and higher vascularity in the region. We report a case of necrotising fasciitis in a 43-year-old man, arising from a dental infection treated successfully by early diagnosis, prompt surgical management, antibiotic therapy and adjunctive hyperbaric oxygen (HBO) therapy. The diagnosis of descending NF must always be considered in a patient who presents with a history of oropharyngeal infection with evidence of neck swelling, chest pain, and dyspnea or respiratory distress. Aggressive surgical debridement of all involved tissue along with intravenous antibiotic therapy should be initiated before aerobic and anaerobic cultures are obtained. HBO may also be of some benefit in the treatment of this potentially fatal infection.
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Affiliation(s)
- Nagendra Srinivas Chunduri
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeet Dental College, Sangli, Maharashtra, India
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17
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Oguz H, Yilmaz MS. Diagnosis and Management of Necrotizing Fasciitis of the Head and Neck. Curr Infect Dis Rep 2012; 14:161-5. [DOI: 10.1007/s11908-012-0240-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Sandner A, Börgermann J. Update on necrotizing mediastinitis: causes, approaches to management, and outcomes. Curr Infect Dis Rep 2011; 13:278-86. [PMID: 21369879 DOI: 10.1007/s11908-011-0174-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Descending necrotizing mediastinitis (DNM) is one of the most feared and fatal forms of mediastinitis, occurring as a complication after odontogenic or cervicofascial infections or after cervical trauma. Delayed recognition, underestimation of the extent of disease, and insufficient therapy promote spread of infection. Primary treatment of DNM includes surgical eradication of the pharyngeal or odontogenic infection focus, and a concomitant major drainage applied to the neck and the mediastinum. However, the mortality rate of DNM remains high, even with the routine use of CT scanning, antibiotics, advancements in anesthesia and intensive care, and immediate surgical drainage. The present state of the optimal management of DNM is discussed controversially, in particular the question of whether thoracotomy should be performed routinely or if minimally invasive procedures (eg, video-assisted thoracoscopy) may be introduced. This review reports on the incidence and course of this disease and discusses management approaches to DNM.
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Affiliation(s)
- Annett Sandner
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 12, 06097, Halle/Saale, Germany,
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Murray M, Dean J, Finn R. Cervicofacial necrotizing fasciitis and steroids: case report and literature review. J Oral Maxillofac Surg 2011; 70:340-4. [PMID: 21664745 DOI: 10.1016/j.joms.2011.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 02/03/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Matthew Murray
- Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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