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Escandón L, Matsui C, Tanaka T, Nishimura T, Imai T, Mizuno H. Case Report of Gas Gangrene after Reconstructive Surgery with Anterolateral Thigh Flap for Resection of Oral Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5381. [PMID: 37964920 PMCID: PMC10642894 DOI: 10.1097/gox.0000000000005381] [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: 04/10/2023] [Accepted: 09/20/2023] [Indexed: 11/16/2023]
Abstract
Necrotizing fasciitis (NF) type I is an acute subcutaneous tissue infection that can promptly disseminate generating crepitus. If not accurately diagnosed and expeditiously treated, it becomes a life-threatening infection. In this report, we present a 65-year-old man who developed a case of NF after a hemiglossectomy resecting a tumor in the dorsal surface of the tongue. A biopsy was performed, and he was pathologically diagnosed with squamous cell carcinoma (T2N1M0). The patient underwent preoperative oral cleaning. Right hemiglossectomy was performed by cervical dissection, pull-through style, with tooth removal on the right mandible and a left anterolateral femoral flap reconstruction. Routine intraoperative lavage was performed with 2000 mL of saline solution. Cefazolin 1gr was administered two times per day postoperatively. Four days after primary surgery, the flap circulation was inadequate; therefore, a computed tomography scan was taken, which indicated gas in the ventral neck area. Tooth extraction was the suspected etiology. Debridement was performed; the abscess was drained and cultured, indicating the presence of Staphylococcus haemolyticus and Escherichia coli. It seems that the abscess was not formed by NF, but rather by leachate reservoir associated with the head and neck tumor. After debridement, re-reconstruction was performed with a deltopectoral flap and pectoralis major myocutaneous flap. When NF is present after a neck dissection, there is a risk of disruption due to the direct invasion and inflammation into the carotid artery. Therefore, it is important to provide adequate oral cleaning care before the surgery and early suspicion of the diagnosis.
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Affiliation(s)
| | - Chihiro Matsui
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takakuni Tanaka
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Takayoshi Nishimura
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Takumi Imai
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Hiroshi Mizuno
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
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EKİCİ Ö. Epidemiological Analysis and Management of Patients with Facial Space Infections of Odontogenic Origin: A Retrospective Evaluation of Two Years. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.994256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Abstract
Objective: Odontogenic infections are one of the most common pathologies in the oral and maxillofacial regions. The spread of odontogenic infections after unsuccessful or late treatment can lead to serious complications. The aim of this study is to examine the epidemiological features and treatment management of patients with odontogenic facial abscesses.
Methods: This retrospective study included 88 patients with odontogenic facial area abscesses treated at Afyonkarahisar health sciences university, faculty of dentistry’s maxillofacial surgery clinic between 2019-2021. The socio-demographic, socio-economic characteristics and clinical examination findings of the patients and treatment methods for odontogenic abscess were analyzed comprehensively. Data were
evaluated using SPSS-20 and the level of significance was set at p < .05.
Results: In the two-year period between 2019 and 2021, 88 patients (44 male and 44 female, mean age was 39.72±16.42) were treated for diffuse facial infections of odontogenic origin. The most commonly involved area was the submandibular area (38.6%), the most affected tooth was mandibular 1st molar and mandibular 3rd molars (18.2%), and the most common cause was dental caries (65.90%). Incision and drainage were performed in half of the patients (36.4% intraoral, 13.6% extraoral). The most commonly used drugs were clindamycin (36.4%), amoxicillin-clavulanate, and ornidazole combination (27.3%).
Conclusion: The results of this study confirm that odontogenic abscesses can heal without complications with timely and effective basic interventions such as incision and drainage. In this study, successful results were obtained with the parenteral clindamycin, and a combination of oral amoxicillin-clavulanate and ornidazole in the treatment of odontogenic abscesses.
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Affiliation(s)
- Ömer EKİCİ
- AFYONKARAHİSAR SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ, KLİNİK BİLİMLER BÖLÜMÜ, AĞIZ, DİŞ VE ÇENE CERRAHİSİ ANABİLİM DALI
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Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience. Antibiotics (Basel) 2022; 11:antibiotics11050664. [PMID: 35625308 PMCID: PMC9137525 DOI: 10.3390/antibiotics11050664] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/03/2022] Open
Abstract
Descending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years. Fifteen male patients, mean age 49.07 ± 14.92 years, were treated: 9 with cervico-pharyngeal etiopathogenesis, 3 peri-tonsillar/tonsillar, 2 odontogenic, 1 post-surgical; 6 with DNM type I, 6 with type IIA, and 3 with type IIB (Endo’s classification). Mean time between diagnosis and treatment was 2.24 ± 1.61 days. In all cases, mediastinum drainage via thoracotomy was performed after neck drainage via cervicotomy, associated with tooth treatment in two; one required re-operation; tracheostomy was necessary in 9, temporary intensive care unit stay in 4; 6 developed complications, without post-operative mortality. Main isolated germs were Staphylococci and Candida; 7 had polymicrobial infection. The most used antibiotics were meropenem, metronidazole, teicoplanin, third-generation cephalosporins and clyndamicin; anti-fungal drugs were fluconazole, caspofungin and anidulafungin. On multivariate analysis, presence of cardiovascular disease was statistically significantly associated with longer chest tube duration and hospital stay. DNM requires early diagnosis and treatment to reduce mortality and morbidity. The most effective treatment should provide a multidisciplinary approach, combining cervicotomy and thoracotomy to drain all infectious collections with administration and monitoring of the proper antimicrobial therapy.
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Vodička J, Geiger J, Židková A, Andrle P, Mírka H, Svatonˇ M, Kostlivý T. Acute Mediastinitis - Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience). Ann Thorac Cardiovasc Surg 2022; 28:171-179. [PMID: 35264480 PMCID: PMC9209895 DOI: 10.5761/atcs.oa.21-00147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors’ worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy. Methods: During the period 2006–2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment. Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times. Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.
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Affiliation(s)
- Josef Vodička
- Department of Surgery, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Jan Geiger
- Department of Surgery, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Alexandra Židková
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Pavel Andrle
- Department of Stomatology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Hynek Mírka
- Department of Imaging Methods, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Svatonˇ
- Department of Pneumology and Phthisiology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Tomáš Kostlivý
- Department of Otorhinolaryngology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
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Pinkston J, Khoury C, Raper J. Necrotizing Mediastinitis Following Dental Extraction: A Case Report. Clin Pract Cases Emerg Med 2022; 6:45-48. [PMID: 35226847 PMCID: PMC8885237 DOI: 10.5811/cpcem.2021.11.54567] [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: 08/30/2021] [Accepted: 11/10/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Necrotizing mediastinitis is a rare complication following a dental
procedure. It is frequently lethal and requires prompt diagnosis with
advanced imaging, administration of broad-spectrum antimicrobials, and early
surgical consultation. Case Report A 19-year-old, otherwise healthy male presented to the emergency department
with chest pain, muffled voice, and facial and neck swelling six days
following dental extraction. He was found to have a retropharyngeal abscess
causing necrotizing mediastinitis and septic shock. The patient was started
on broad-spectrum antimicrobials, required 10 surgical procedures, and
experienced a prolonged hospitalization. Conclusion Consider necrotizing mediastinitis in patients presenting with chest pain and
signs of retropharyngeal infection after dental procedures. Prompt imaging,
antimicrobial therapy, and surgical consultation is critical in treating
this frequently fatal disease.
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Affiliation(s)
- Justin Pinkston
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Charles Khoury
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Jaron Raper
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
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Ayvaci B, Gökdağ E. A rare case: Descending necrotizing mediastinitis. Turk J Emerg Med 2022; 22:230-232. [DOI: 10.4103/2452-2473.357345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022] Open
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Iwata E, Kusumoto J, Takata N, Furudoi S, Tachibana A, Akashi M. The characteristics of oro-cervical necrotizing fasciitis-Comparison with severe cellulitis of oro-cervical region and necrotizing fasciitis of other body regions. PLoS One 2021; 16:e0260740. [PMID: 34851994 PMCID: PMC8635337 DOI: 10.1371/journal.pone.0260740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/16/2021] [Indexed: 01/02/2023] Open
Abstract
Background Necrotizing fasciitis (NF) is an acute and life-threatening soft-tissue infection however rarely seen in oro-cervical region. Therefore, the details of oro-cervical NF (OCNF) are not well known. The purpose of this study was to investigate the characteristics of OCNF by comparing it with severe cellulitis of oro-cervical region (OCSC) or NF of other body regions (e.g., limb, perineum, and trunk) (BNF), respectively. Materials and methods At first, various risk factors for OCNF in oro-cervical severe infection (OCSI; composed of OCNF and OCSC), including neutrophil-to-lymphocyte ratio (NLR) and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, were investigated by univariate and multivariate analyses. Next, the differences between OCNF and BNF, including inflammatory markers and mortality, were investigated. Results In the present study, 14 out of 231 OCSI patients had OCNF. Multivariate analyses of OCSI patients showed that NLR ≥15.3 and LRINEC score ≥6 points were significantly related to OCNF. During the same period, 17 patients had BNF. The OCNF group had significantly higher inflammatory markers than the BNF group when diagnosis, but significantly lower clinical stages at the time and mortality as outcomes. Conclusion We found that compared to BNF, OCNF can be detected at lower clinical stage by using indexes, such as NLR and LRINEC score, besides clinical findings, which may help contributing to patient’s relief.
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Affiliation(s)
- Eiji Iwata
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- * E-mail:
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Takata
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Konan Medical Center, Kobe, Japan
| | - Akira Tachibana
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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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.
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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
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Escobedo MF, Junquera LM, Megias J, García-San Narciso L, Fernández MJ, Junquera S. Mediastinitis of odontogenic origin. A serious complication with 80 years of history. Br J Oral Maxillofac Surg 2020; 59:683-689. [PMID: 34001379 DOI: 10.1016/j.bjoms.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022]
Abstract
We performed a systematic review of the literature about descending necrotising mediastinitis (DNM) of odontogenic origin. In parallel, a retrospective review of this pathology was carried out in an Oral and Maxillofacial Surgery Service of a reference hospital for a population of 1,100,000 inhabitants. The main objectives were to determine changes in mortality and prevalence of this serious complication. The systematic review included 51 articles with 89 patients and our study comprised seven patients. The period of time with the highest number of cases was between 2000-2009 (38 patients). The percentage of mortality observed was 20.2% in diffuse DNM and 4.9% in localised DNM. Thirty-one patients with DNM in our review were admitted for more than 41 days. Despite evidence of a decrease in DNM cases, publications have increased over the years, but it does not appear to be due to an increase in those of odontogenic origin. The survival of DNM has improved since 1998 and remained stable since then. Despite the low prevalence of this disease, multicentre control studies are needed to achieve better evidence about this entity.
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Affiliation(s)
- M F Escobedo
- School of Dentistry, University of Oviedo, Oviedo, Spain.
| | - L M Junquera
- Department of Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Megias
- Department of Maxillofacial Surgery, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - S Junquera
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Heim N, Jürgensen B, Kramer FJ, Wiedemeyer V. Mapping the microbiological diversity of odontogenic abscess: are we using the right drugs? Clin Oral Investig 2020; 25:187-193. [PMID: 32472254 DOI: 10.1007/s00784-020-03350-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was categorizing the microbial flora and susceptibility to antibiotics and to clarify to which degree the empiric administered antibiotics are suitable for therapy. MATERIALS AND METHODS A 3.5-year retrospective study evaluated hospital records of 206 patients who suffered from head and neck infections of odontogenic origin. All patients underwent surgical incision and drainage and received intravenous antibiotics and inpatient treatment. The specimens were obtained by performing a swab. RESULTS Two hundred six patients were included with 251 strains isolated (1.22 per patient). One hundred eight strains showed antibiotic resistance. Eighty-seven patients showed at least one bacterial strain that showed antibiotic resistance (42.2%). The most frequent isolated bacteria were Streptococcus spp. (n = 116), with a high rate of antibiotic resistance (50.8%). We investigated 205 cases of antibiotic resistance in 87 subjects. Nine bacterial strains showed no susceptibility to unacid (4.3%) and 36 strains to clindamycin (17.5%). CONCLUSION Antibiotic resistance against clindamycin was rather high. The distribution of the afflicted spaces and isolated bacteria was alike recent findings. It is mandatory to understand that immediate surgical treatment in terms of incision and drainage is the basis in abscess treatment. Antibiotic treatment is adjunct therapy. CLINICAL RELEVANCE Streptococcus species were the most frequently identified bacteria presenting antibiotic resistance in more than 50%. Increased resistant rates for clindamycin require reconsiderations regarding an empiric antibiotic treatment.
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Affiliation(s)
- Nils Heim
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Bonn, Venusberg Campus 1, Haus 11, 2. OG, D-53127, Bonn, Germany.
| | - Benedict Jürgensen
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Bonn, Venusberg Campus 1, Haus 11, 2. OG, D-53127, Bonn, Germany
| | - Franz-Josef Kramer
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Bonn, Venusberg Campus 1, Haus 11, 2. OG, D-53127, Bonn, Germany
| | - Valentin Wiedemeyer
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Bonn, Venusberg Campus 1, Haus 11, 2. OG, D-53127, Bonn, Germany
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Weise H, Naros A, Weise C, Reinert S, Hoefert S. Severe odontogenic infections with septic progress - a constant and increasing challenge: a retrospective analysis. BMC Oral Health 2019; 19:173. [PMID: 31375095 PMCID: PMC6679486 DOI: 10.1186/s12903-019-0866-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/26/2019] [Indexed: 12/01/2022] Open
Abstract
Background More than 90% of all infections in the head and neck region can be traced back to an odontogenic origin. In rare cases they can lead to sepsis, which may pose a vital threat to the patient. The purpose of this study was to analyse characteristics concerning etiology and progress of severe odontogenic infections with a fulminant development. Methods All patients with odontogenic infections requiring hospital admission were included in a retrospective analysis conducted from 02/2012 to 09/2017. Of 483 patients 16 patients (13 male, 3 female) showed severe exacerbation with septic progress. The average age was 52.8 years. All patients underwent at least one surgical procedure that involved an extraoral incision and drainage as well as high volume irrigation intraoperatively. At least one revision was required for four of the patients. Three patients showed an exceedingly severe disease progression with multiorgan dysfunction syndrome (MODS) and circulatory arrest. Antibiotic treatment was adjusted according to the results of an antibiogram and resistogram. Irrigation with saline was done several times a day. Results Sixteen patients showed odontogenic infections that spread over multiple maxillo-facial and cervical regions accompanied by septic laboratory signs. All these patients needed intensive care and a tracheostomy. The hospitalization period was 27.8 days on average. In 16 cases risk factors for the development of odontogenic abscesses like diabetes mellitus, obesity, chronic alcohol and nicotine abuse, rheumatism and poor oral hygiene were present. Intraoperative swabs showed a typical polymicrobial aerobic and anaerobic spectrum of oral bacteria, especially anaerobes and streptococci, mainly Streptocococcus viridans. Conclusion Odontogenic infections with fulminant progression should be treated based on clinical and imaging data with immediate surgical incision and drainage including elimination of odontogenic foci as well as intensified intra- and postoperative irrigation. If needed, repeat imaging followed by further incisions should be performed. Immediate antibiotic treatment adapted to the antibiogram is of utmost importance. A combination of tazobactam and piperacillin has proven to be a good first choice and can be recommended for abscesses that spread over multiple levels with initial signs of severe infections.
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Affiliation(s)
- H Weise
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tübingen, Germany.
| | - A Naros
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tübingen, Germany
| | - C Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tübingen, Germany
| | - S Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tübingen, Germany
| | - S Hoefert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tübingen, Germany
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Tent PA, Juncar RI, Onisor F, Bran S, Harangus A, Juncar M. The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections. Drug Metab Rev 2019; 51:340-355. [PMID: 30999773 DOI: 10.1080/03602532.2019.1602630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.
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Affiliation(s)
- Paul Andrei Tent
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Raluca Iulia Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Florin Onisor
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Simion Bran
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Antonia Harangus
- Spitalul Clinic de Pneumoftiziologie Leon Daniello Cluj-Napoca , Cluj-Napoca , Romania
| | - Mihai Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
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Sysolyatin PG, Shmakov AN, Ivantsov ME, Kohno VN, Elisar'eva NL, Streltsova EI, Loktin EM, Kolosov AN, Il'in VI. [General anesthesia and intensive care for patients surgically treated for deep neck odontogenic infections]. STOMATOLOGII︠A︡ 2019; 97:37-40. [PMID: 29795104 DOI: 10.17116/stomat201897237-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The study objectives were to determine the significance of deep neck odontogenic infections severity to predict the postoperative morbidity. Observational study was conducted in 2014-2015. A continuous sample of 38 patients who were urgently hospitalized in the Novosibirsk Regional Clinical Hospital with deep neck odontogenic infections and operated on the day of hospitalization was analyzed. SAPS scale rates correlated positively with the duration of the artificial lungs ventilation (ALV). The positive balance of the introduced and withdrawn liquid in the first day of the postoperative period is associated with the ALV duration, which requires accurate dosing of the infusion volumes. The described protocol of perioperative care significantly decreases morbidity in patients with deep neck odontogenic infections.
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Affiliation(s)
- P G Sysolyatin
- Novosibirsk State Medical University, Novosibirsk, Russia, 630091
| | - A N Shmakov
- Novosibirsk State Medical University, Novosibirsk, Russia, 630091; Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia, 630087
| | - M E Ivantsov
- Novosibirsk State Medical University, Novosibirsk, Russia, 630091; Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia, 630087
| | - V N Kohno
- Novosibirsk State Medical University, Novosibirsk, Russia, 630091
| | - N L Elisar'eva
- Novosibirsk State Medical University, Novosibirsk, Russia, 630091; Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia, 630087
| | - E I Streltsova
- Novosibirsk State Medical University, Novosibirsk, Russia, 630091; Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia, 630087
| | - E M Loktin
- Novosibirsk State Medical University, Novosibirsk, Russia, 630091
| | - A N Kolosov
- Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia, 630087
| | - V I Il'in
- Novosibirsk Regional Clinical Hospital, Novosibirsk, Russia, 630087
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The role of immediate versus secondary removal of the odontogenic focus in treatment of deep head and neck space infections. A retrospective analysis of 248 patients. Clin Oral Investig 2019; 23:2921-2927. [PMID: 30623306 DOI: 10.1007/s00784-018-02796-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/20/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Aim of this study was to investigate conditions and predisposing factors for head and neck infection progress regarding the length of stay (LOS) in hospital, with special emphasis on the time of removal of the odontogenic infection focus. MATERIAL AND METHODS A 3-year retrospective study reviewed hospital records of 248 subjects who were treated under inpatient conditions with severe odontogenic infections who received surgical incisions, drainage, and intravenous (IV) antibiotics. Outcomes measured included age, gender, involved fascial spaces, LOS, number of infected spaces, antibiotics administered, and comorbidities. We precisely recorded the time between abscess incision and focus extraction. RESULTS Removal of infection focus (tooth) in the same stay (1 stay, n = 106; group 1; mean 6.5 days ± 3) showed significantly higher (p = 0.042) LOS than extraction in a second stay (2 stays, n = 46; group 2; 5.3 ± 3.1). Group 3 patients showed infection after removal of teeth in outpatient management (1 stay ex-op, n = 96) and presented significantly lower LOS (5.6 ± 2.5) compared to group 1 (p = 0.0216). LOS of group 3 to group 2 patients showed no significance (p = 0.668). Infection expansion and diabetes showed a significant increase of LOS. CONCLUSION Simultaneous removal of infection focus and abscess incision leads to the lowest LOS. If tooth extraction is performed after incision, subsequent focus extraction performed in a second stay shows lower overall-LOS than extraction at the same stay at later stage. CLINICAL RELEVANCE Multiple factors tend to increase the LOS of patients with severe head and neck infections of odontogenic origin. Our data reveals the role of removal of odontogenic focus and additionally ranks further parameters that influence the LOS. Based on our findings, decisions regarding the surgical treatment can be recommended.
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Pota V, Passavanti MB, Sansone P, Pace MC, Peluso F, Fiorelli A, Aurilio C. Septic shock from descending necrotizing mediastinitis - combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report. J Med Case Rep 2018; 12:55. [PMID: 29499757 PMCID: PMC5834850 DOI: 10.1186/s13256-018-1611-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 02/08/2018] [Indexed: 11/14/2022] Open
Abstract
Background Descending necrotizing mediastinitis is a common and progressive polymicrobial infection involving the neck and chest with a high death rate (10 to 40%). From a microbiological point of view, descending necrotizing mediastinitis is sustained by Gram-positive bacteria (43–62%), anaerobes (46–78%), and, rarely, Gram-negative bacteria. Data collected during the Antibiotic Resistance-Istituto Superiore di Sanità project confirmed that Italy is positioned among the countries with the highest levels of resistance in most pathogenic species under surveillance. In particular, 32.9% of Klebsiella pneumoniae isolates were resistant to carbapenem, 33.6% of Staphylococcus aureus to methicillin, and 28.7% and 43.9% of Escherichia coli isolates to third-generation cephalosporins and fluoroquinolones, respectively. Case presentation We describe the case of a 38-year-old white man with septic shock due to descending necrotizing mediastinitis sustained by multidrug-resistant Gram-negative and Gram-positive bacteria treated after surgery with an IgM-enriched immunoglobulin preparation and polymyxin B hemoperfusion therapy. Conclusion Despite the contrasting data on the use of immunoglobulins and polymyxin B hemoperfusion in septic shock and the lack of literature in cases of acute mediastinitis caused by both Gram-negative and Gram-positive multidrug-resistant bacteria, we obtained an improvement in clinical conditions and the survival of our patient, against all odds.
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Affiliation(s)
- Vincenzo Pota
- Department of Women, Infant and Surgical and Specialist Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.
| | - Maria Beatrice Passavanti
- Department of Women, Infant and Surgical and Specialist Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Pasquale Sansone
- Department of Women, Infant and Surgical and Specialist Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Maria Caterina Pace
- Department of Women, Infant and Surgical and Specialist Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Filomena Peluso
- Department of Women, Infant and Surgical and Specialist Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania "L. Vanvitelli", Naples, Italy
| | - Caterina Aurilio
- Department of Women, Infant and Surgical and Specialist Surgery, University of Campania "L. Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
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Abstract
BACKGROUND Descending necrotizing mediastinitis (DNM) originates from odontogenic or oropharyngeal infections which spread along preformed cervicothoracic spaces into the mediastinum and requires emergency multidisciplinary treatment. MATERIAL AND METHODS A total of seven patients were diagnosed with DNM based on typical radiological features in a cervicothoracic computed tomography (CT) scan and subsequently underwent standardized transcervical and open transthoracic radical debridement. RESULTS The initially detected polymicrobial spectrum of pathogens was dominated by streptococci followed by enterobacteriae. After calculated antibiotic treatment a shift in the spectrum of pathogens was noted and in particular a mycotic superinfection occurred in 43 % of the cases. Anterolateral thoracotomy was performed for radical removal of tissue necrosis and mediastinothoracic drainage extending to the posterior mediastinum was placed. In selected cases, cervico-mediastino-thoracic tubes were transmediastinally placed by the rendevouz technique either in the previsceral or retrovisceral mediastinal space. Despite predominantly advanced mediastinitis (Endo classification type II B) in this patient cohort, the mortality only reached 14 %. CONCLUSION Rapid diagnosis, anatomical knowledge, understanding of the progression of infections as well as critical care, antimicrobial treatment and multidisciplinary radical surgical therapy are paramount for successful treatment of DNM. We favor anterolateral thoracotomy as the standard open transthoracic approach to the mediastinum. Placement of cervico-mediastino-thoracic irrigation drains can help to limit DNM.
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Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982–2016). REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Risk factors for delayed oral dietary intake in patients with deep neck infections including descending necrotizing mediastinitis. Eur Arch Otorhinolaryngol 2017; 274:3951-3958. [DOI: 10.1007/s00405-017-4716-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/12/2017] [Indexed: 10/19/2022]
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Abu-Omar Y, Kocher GJ, Bosco P, Barbero C, Waller D, Gudbjartsson T, Sousa-Uva M, Licht PB, Dunning J, Schmid RA, Cardillo G. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg 2017; 51:10-29. [PMID: 28077503 DOI: 10.1093/ejcts/ezw326] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/24/2022] Open
Abstract
Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lungs, or as descending necrotizing infection from the head and neck. In addition, there is a chronic form of 'chronic fibrosing mediastinitis' usually caused by granulomatous infections. In this expert consensus, the evidence for strategies for treatment and prevention of mediatinitis is reviewed in detail aiming at reducing the incidence and optimizing the management of this serious condition.
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Affiliation(s)
- Yasir Abu-Omar
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Gregor J Kocher
- Division of General Thoracic Surgery, Bern University Hospital / Inselspital, Switzerland
| | - Paolo Bosco
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Cristina Barbero
- Department of Cardiovascular and Thoracic Surgery, University of Turin-Italy, Città della Salute e della Scienza-San Giovanni Battista Hospital, Torino, Italy
| | - David Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Miguel Sousa-Uva
- Unit of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon, Portugal
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Ralph A Schmid
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera S. Camillo Forlanini, Lazzaro Spallanzani Hospital, Rome, Italy
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Wei D, Bi L, Zhu H, He J, Wang H. Less invasive management of deep neck infection and descending necrotizing mediastinitis: A single-center retrospective study. Medicine (Baltimore) 2017; 96:e6590. [PMID: 28403094 PMCID: PMC5403091 DOI: 10.1097/md.0000000000006590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
By a 7-year retrospective review, we reported our experience in management of descending necrotizing mediastinitis (DNM) and deep neck infection (DNI). A retrospective design was used to reveal the clinical characteristics of DNI and DNM. The clinical outcome was analyzed to validate less invasive management. We reviewed 82 patients between 2009 and 2016, 12 of which were diagnosed as DNM by clinical and computed tomography findings. A total of 35 patients had relevant systemic conditions, mainly diabetes mellitus (19 patients). Most cases were secondary to oropharyngeal or dental infections. All patients underwent transcervical drainage, and 10 DNM patients were treated with additional closed thoracic drainage simultaneously. Twenty patients accepted more than 1 operation. Seven patients died as a result of sepsis and/or multiple organ failure. The mortality rate in our study was similar to that in other studies. In our opinion, less invasive therapies are useful to most patients. Transcervical drainage alone is optimal management for all DNI cases and some DNM cases. Additional closed thoracic drainage is enough for type I and IIA DNM with pleural effusion or empyema.
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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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Zirk M, Buller J, Goeddertz P, Rothamel D, Dreiseidler T, Zöller JE, Kreppel M. Empiric systemic antibiotics for hospitalized patients with severe odontogenic infections. J Craniomaxillofac Surg 2016; 44:1081-8. [PMID: 27369813 DOI: 10.1016/j.jcms.2016.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/16/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Odontogenic infections may lead to severe head and neck infections with potentially great health risk. Age, location of purulent affected sites and beta-lactam allergy are some mentionable factors regarding patients' in-hospital stay and course of disease. Are there new challenges regarding bacteria' antibiotic resistance for empiric treatment and what influences do they have on patients' clinical course? METHODS We analyzed in a 4-year retrospective study the medical records of 294 in-hospital patients with severe odontogenic infections. On a routine base bacteria were identified and susceptibility testing was performed. Length of stay in-hospital was evaluated regarding patients' age, beta-lactam allergy profile, affected sites and bacteria susceptibility to empiric antibiotics. RESULTS Length of stay in-hospital was detected to be associated with affected space and penicillin allergy as well (p < 0.05). Isolates presented large amounts of aerobic gram-positive bacteria (64.2%), followed by facultative anaerobic bacteria (gram+/15.8%, gram-/12.7%). Tested ampicillin in combination with sulbactam (or without) and cephalosporins displayed high susceptibility rates, revealing distinguished results regarding clindamycin (p < 0.05). Co-trimoxazol and moxifloxacin showed high overall susceptibility rates (MOX: 94.7%, COTRIM: 92.6%). DISCUSSION This study demonstrates ampicillin/sulbactam in addition to surgical intervention is a good standard in treatment of severe odontogenic neck infections. Cephalosporins seem to be a considerable option as well. If beta-lactam allergy is diagnosed co-trimoxazol and moxifloxacin represent relevant alternatives. CONCLUSION Age, allergic profile and bacteria' resistance patterns for empiric antibiotics have an influence on patients in-hospital stay. Ampicillin/sulbactam proves itself to be good for empiric antibiosis in severe odontogenic infections. Furthermore cephalosporins could be considered as another option in treatment. However moxifloxacin and co-trimoxazol deserves further investigation as empiric antibiosis in odontogenic infections if beta-lactam allergy is diagnosed.
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Affiliation(s)
- Matthias Zirk
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany.
| | - Johannes Buller
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Peter Goeddertz
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Daniel Rothamel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Timo Dreiseidler
- Dreifaltigkeits-Krankenhaus Wesseling, University Teaching Hospital, Germany
| | - Joachim E Zöller
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
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Chevalier AT, Khaja MS, Yang B. Surgical Management of Necrotizing Mediastinitis With Large Aortic Pseudoaneurysm. Ann Thorac Surg 2016; 101:e143-5. [DOI: 10.1016/j.athoracsur.2015.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/18/2015] [Accepted: 10/09/2015] [Indexed: 11/27/2022]
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Prado-Calleros HM, Jiménez-Fuentes E, Jiménez-Escobar I. Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description. Head Neck 2016; 38 Suppl 1:E2275-83. [DOI: 10.1002/hed.24183] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 12/12/2022] Open
Affiliation(s)
- Héctor M. Prado-Calleros
- Division of Otolaryngology and Head and Neck Surgery; General Hospital “Dr. Manuel Gea González,”; México City México
| | | | - Irma Jiménez-Escobar
- Medical Director; General Hospital “Dr. Manuel Gea González,”; México City México
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Guan X, Zhang WJ, Liang X, Liang X, Wang F, Guo X, Zhou Y. Optimal surgical options for descending necrotizing mediastinitis of the anterior mediastinum. Cell Biochem Biophys 2015; 70:109-14. [PMID: 24696071 DOI: 10.1007/s12013-014-9865-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The mortality rates from descending necrotizing mediastinitis (DNM) are between 25 and 40 % mainly because of delayed diagnosis and inappropriate surgical treatment. This study was undertaken to examine two surgical options for DNM and determine the optimal surgical option for DNM of the anterior mediastinum. Fifteen cases of DNM of the anterior mediastinum, January 2001 and October 2010, were retrospectively reviewed. Eleven were anterosuperior mediastinitis, with infection located above the tracheal bifurcation and four had infections involving the entire anterior mediastinum. Depending on the location of mediastinitis, open drainage of the submandibular and neck abscesses, in addition to other surgical treatments, was performed. If the infection was anterosuperior, transcervical mediastinal drainage or thoracotomy was performed. If the entire anterior mediastinum was involved, necrotic tissue was removed with thoracoscopic via subxiphoid incision, the bilateral pleurae were opened for drainage, and a tunnel connecting the neck incision and the subxiphoid incision through the whole anterior mediastinum was made for drainage. The anterosuperior mediastinitis cases were treated with either transcervical mediastinal drainage (n = 8) or thoracotomy (n = 3). Patients healed after an average of 24.5 and 20.0 days in the hospital, respectively. For the four other cases, one patient died of septic shock, while the other three patients were healed after and an average of 43.3 days in the hospital. Mortality rate was 6.7 %. The surgical procedure used to treat DNM should be selected according to the location of the infection. DNM involving the anterosuperior mediastinum can be treated by transcervical mediastinal drainage. If anterosuperior mediastinitis spreads to the side of the trachea, open thoracotomy is a suitable therapy. If the entire anterior mediastinum is involved, debridement and drainage of the anterior mediastinum should be performed with a thoracoscope via the subxiphoid incision.
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Affiliation(s)
- Xin Guan
- Department of Thoracic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 5th Building 4 Flour, 639 Zhi Zao Ju Road, Shanghai, 200011, People's Republic of China,
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Cervical Necrotizing Fasciitis--The Value of the Laboratory Risk Indicator for Necrotizing Fasciitis Score as an Indicative Parameter. J Oral Maxillofac Surg 2015; 73:2319-33. [PMID: 26079692 DOI: 10.1016/j.joms.2015.05.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Cervical necrotizing fasciitis (CNF) is uncommon, difficult to diagnose, and rapidly progressive. The objective of the present study was to determine the predictive value of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for CNF. MATERIALS AND METHODS The LRINEC score for 16 consecutive cases of CNF and 595 cases of severe non-necrotizing neck infections was determined over a 6.5-year period in a single-center retrospective cohort study and case report. CNF was confirmed by histologic examination and operative report documentation. RESULTS Using a cutoff score of 6, the LRINEC score had a sensitivity of 0.94 (95% confidence interval [CI] 0.92 to 0.96) and specificity of 0.94 (95% CI 0.70 to 1.00). The positive predictive value was 0.29 (95% CI 0.17 to 0.44), and the negative predictive value was 0.99 (95% CI 0.99 to 1.00). CONCLUSIONS The LRINEC score can detect early cases of CNF. Patients with a LRINEC score of ≥6 must be carefully evaluated for the presence of CNF.
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Opitz D, Camerer C, Camerer DM, Raguse JD, Menneking H, Hoffmeister B, Adolphs N. Incidence and management of severe odontogenic infections-a retrospective analysis from 2004 to 2011. J Craniomaxillofac Surg 2014; 43:285-9. [PMID: 25555896 DOI: 10.1016/j.jcms.2014.12.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022] Open
Abstract
The management of odontogenic infections is a typical part of the spectrum of maxillofacial surgery. Normally these infections can be managed in a straight forward way however under certain conditions severe and complicated courses can arise which require interdisciplinary treatment including intensive care. A retrospective analysis of all patients affected by an odontogenic infection that received surgical therapy from 2004 to 2011 under stationary conditions was performed. Surgical treatment consisted in incision and drainage of the abscess supported by additional i.v. antibiotic medication in all patients. Detailed analysis of all patients that required postoperative intensive medical care was additionally performed with respect to special risk factors. During 8 years 814 patients affected by odontogenic infections received surgical treatment under stationary conditions representing 4% of all patients that have been treated during that period (n = 18981). In 14 patients (1.7%) intensive medical therapy after surgery was required, one lethal outcome was documented (0.12%). In all of these 14 patients a history of typical risk factors was present. According to these results two patients per week affected by an odontogenic infection required stationary surgical treatment, about two patients per year were likely to require additional intensive medical care. If well-known risk factors are present in patients affected by odontogenic infection appropriate interdisciplinary management should be considered as early as possible.
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Affiliation(s)
- Daniel Opitz
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany.
| | - Christian Camerer
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Doris-Maria Camerer
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Jan-Dirk Raguse
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Horst Menneking
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Bodo Hoffmeister
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Nicolai Adolphs
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
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D'Cunha J, James M, Antonoff MB, Green CA, Andrade RS, Maddaus MA, Beilman GJ. Descending necrotizing mediastinitis: a modified algorithmic approach to define a new standard of care. Surg Infect (Larchmt) 2013; 14:525-31. [PMID: 24351133 DOI: 10.1089/sur.2012.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Descending necrotizing mediastinitis (DNM) is a highly morbid infectious process. This uncommon disease process has carried historically a substantial burden of morbidity and mortality. In this study we hypothesized that application of a prospective modified management algorithm would decrease the morbidity and mortality from this highly destructive process. METHODS We developed a systematic approach for managing DNM, focusing on serial debridement guided by imaging, in conjunction with the use of broad-spectrum antibiotics and modern principles of critical care. We reviewed all patients admitted with this disease process from 2007-2012. Data collected included demographic information, co-morbidities, laboratory data including culture results, operative details, imaging frequency and findings, complications, and survival. Continuous variables were reported as median values and ranges. RESULTS From 2007-2010, we treated eight patients with DNM. The median age of the patients was 33 y (range 28-63 y), and 63% were male. In accordance with our algorithm, the patients underwent serial imaging at regular intervals following operative debridement. The median number of imaging studies was 11 (range 4-19). The patients required a median of five operative debridements (range 1-15). In five patients, drainage was necessary through a cervical exploration. A thoracic approach was required in six patients (two thoracoscopic, four via thoracotomy). Additional procedures included thymectomy (n=2), anterior mediastinotomy, carotid sheath exploration and resections of the clavicle, first rib, manubrium, pectoralis major muscle, and sternocleidomastoid muscle. The most common etiologic agents were Peptostreptococcus spp. and Streptococcus anginosus. Study patients received a median of six different antibiotics (range 2-10) for a total of 42 d (range 34-55 d). These patients were hospitalized for a median of 29 days (range 16-56 d), with 15 d (range 7-48 d) spent in the intensive care unit. Remarkably, the rate of survival was 100% (median follow-up of 33 mo). The patients developed no major complications, required no re-admissions, and had no re-infections. CONCLUSIONS We applied an algorithmic approach to the treatment of DNM, consisting of aggressive operative debridement and enhanced by equally aggressive imaging. Our patients had excellent outcomes despite the widely known lethality of DNM. An aggressive approach may decrease complications and improve survival in this devastating disease process. Furthermore, our prospective experience with DNM suggests that this algorithm used in the present study should be the standard for managing patients with this challenging condition.
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Affiliation(s)
- Jonathan D'Cunha
- 1 Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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Zheng L, Yang C, Zhang W, Cai X, Jiang B, Wang B, Pu Y, Jin J, Kim E, Wang J, Zhang Z, Zhou L, Zhou J, Guan X. Comparison of multi-space infections of the head and neck in the elderly and non-elderly: Part I the descriptive data. J Craniomaxillofac Surg 2013; 41:e208-12. [DOI: 10.1016/j.jcms.2013.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 10/29/2012] [Accepted: 01/09/2013] [Indexed: 11/26/2022] Open
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