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Vrinceanu D, Dumitru M, Banica B, Patrascu OM, Pertea M, Radulescu M, Marinescu A. Suppurative Cervicomediastinitis From the Perspective of the Head and Neck Surgeon in a Tertiary Treatment Unit. Cureus 2024; 16:e67912. [PMID: 39193062 PMCID: PMC11348871 DOI: 10.7759/cureus.67912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 08/29/2024] Open
Abstract
Introduction Cervical suppurations represent an emergency pathology, with a dramatic evolution in the absence of adequate treatment. It frequently affects young people, hence the medico-legal implications of these cases. The anatomical substrate for the development of these deep cervical suppurations is represented by the cervical fascia and spaces. A distinct and extremely serious sub-chapter within diffuse cervical suppurations is necrotic cervical fasciitis, a polymicrobial infection with the most common oropharyngeal or odontogenic starting point, with rapidly progressive, destructive evolution in the deep fascial planes of the neck. Materials and method We will present a retrospective clinical study carried out on 26 cases diagnosed and treated between September 2013 and September 2018 in the ENT Clinic Department of the Bucharest University Emergency Hospital. Results Our retrospective analysis of a cohort of 26 patients in a tertiary referral center showed that deep cervical suppurations are slightly more common in men than in women. The most affected age groups were 50-59 years, followed by 20-29 years, representing a percentage of 53.84% of all cases. Also, 53.84% of the studied patients with deep cervical suppurations had a precarious and modest status. The most common clinical signs at presentation were malaise, cervical swelling, neck pain, dysphagia, fever, dysphonia, dyspnea, and cervical erythema. More than 60% of suppurations were odontogenic and 23% were caused by a traumatic element. Diabetes mellitus represents a comorbidity in 30.8% of patients, while 42.3% of patients had no personal pathological history, and thus this pathology has a lethal potential also in a patient in full health. In the study group, 46 (15%) had cervicomediastinitis, and 61.53% developed necrotizing fasciitis. One-third (34.61%) of our patients had undergone previous drainage surgery. Bacteriological examinations of the wound were with group C, D, G betahemolytic streptococcus, while 61.53% of the cultures were negative. Most patients required at least two cervicotomies. The average duration of hospitalization was 28.26 days, and the mortality rate was 23.07%; therefore, practically, one out of four cases resulted in death. In the studied group, no direct relationship can be established between the length of hospitalization and the favorable and unfavorable evolution of the patient. We propose a 10-step management protocol for the management of a cervical suppuration. Conclusion The multidisciplinary approach to these suppurations by the head and neck surgeon, the thoracic surgeon, the oromaxillofacial surgeon, anesthetist, imagist, specialist in infectious diseases, pathologist, psychologist, and so on, is the key to success in a patient who presents not only a suppuration in the throat but also a disease with systemic resonance and significant lethal potential.
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Affiliation(s)
- Daniela Vrinceanu
- ENT Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Mihai Dumitru
- ENT Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Bogdan Banica
- Oral and Maxillofacial Surgery Department, Bucharest University Emergency Hospital, Bucharest, ROU
| | - Oana Maria Patrascu
- Pathology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Mihaela Pertea
- Department of Surgery 1, Grigore T Popa University of Medicine and Pharmacy, Iasi, ROU
| | - Mihai Radulescu
- Thoracic Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Andreea Marinescu
- Radiology and Imaging Department, University Emergency Hospital of Bucharest, Bucharest, ROU
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López-Martínez C, Pampín-Martínez MM, García-López-Chicharro A, Aragón-Niño Í, Cebrián-Carretero JL. Application of 3D technology for the design of a guidewire for deep cervicofacial collections percutaneous management. J Clin Exp Dent 2024; 16:e383-e386. [PMID: 38600933 PMCID: PMC11003277 DOI: 10.4317/jced.61354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 04/12/2024] Open
Abstract
Background This study aims to present a case of deep cervicofacial abscesses and demonstrate the efficacy of CT-guided drainage with a custom-designed puncture guide in a challenging anatomical location. The use of this type of guide is an innovative technique since CAD-CAM technology has not been used for this type of application until now. Material and Methods A 76-year-old man with persistent facial swelling and trismus underwent surgical drainage initially, but symptoms persisted. A CT-guided transcutaneous approach was planned using a custom-designed positioning guide created with "in-house" 3D technology. The guide was fabricated using Surgical Guide resin, and the patient underwent successful CT-guided drainage. Results The intervention facilitated precise drainage without damaging critical anatomical structures. The patient exhibited prompt clinical improvement, shortened hospitalization, and favorable aesthetic outcomes. Conclusions CT-guided drainage, particularly when combined with a custom puncture guide, offers a less invasive alternative for challenging cervicofacial abscesses. This approach proves valuable in reducing procedure duration, minimizing soft tissue trauma, and enhancing preoperative planning, making it especially beneficial for patients with high anesthetic risk or complex anatomical considerations. Key words:Cervical abscess, 3D technology, drainage guide, percutaneous puncture.
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Affiliation(s)
- Clara López-Martínez
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Madrid, Spain
| | | | | | - Íñigo Aragón-Niño
- Oral and Maxillofacial Surgery Department, University Hospital La Paz, Madrid, Spain
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Nie W, Du L, Chen G, Zheng Y, Yang X, Li B, Zhang W, Zheng J. Ultrasound-guided puncture drainage versus surgical incision drainage for deep neck space abscesses: a protocol for a systematic review with meta-analysis and trial sequential analysis. BMJ Open 2024; 14:e077631. [PMID: 38176871 PMCID: PMC10773404 DOI: 10.1136/bmjopen-2023-077631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Deep neck space abscesses (DNAs) are serious surgical emergencies, associated with life-threatening complications. Surgical incision and drainage combined with antibiotics is the main treatment for DNAs, but drawbacks still exist. Ultrasound-guided puncture drainage is an alternative treatment for some DNAs with limited clinical evidence. Hence, the optimal drainage technique for the treatment of DNAs remains unclear. Therefore, we will perform a protocol for a systematic review and meta-analysis to identify the efficacy of ultrasound-guided puncture drainage for DNAs. METHODS AND ANALYSIS PubMed, Ovid Medline, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang database, VIP database and trial registry databases will be searched from inception to September 2023 to identify randomised controlled trials of patients diagnosed with DNAs accepting ultrasound-guided puncture drainage. The primary outcome will be the length of hospital stay. The secondary outcomes will be the cure rate, incidence of retreatment, complications and overall cost to the healthcare system. Fixed-effects or random-effects model will be used according to the statistical heterogeneity. Mean differences or standardised mean differences with 95% CIs for continuous data and risk ratio (RR) with 95% CIs for dichotomous data. The Cochrane risk-of-bias tool 2, Grading of Recommendations Assessment, Development and Evaluation (GRADE) and trial sequential analysis will be conducted to evaluate the evidence quality and control the random errors. Funnel plots and Egger's regression test will be performed to evaluate publication bias. ETHICS AND DISSEMINATION Ethical approval was not required for this systematic review protocol. The results will be disseminated through peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42023441031.
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Affiliation(s)
- Wei Nie
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Du
- Department of Anesthesiology, Sichuan Cancer Hospital and Research Institute, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yongbo Zheng
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xibiao Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Li
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weiyi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianqiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Garola F, Cores B, Santalla Claros E, Botta M, Pigazzini P, Piemonte E, Garzón JC. Management of cervicofacial infection: a 7-year retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:19-29. [PMID: 37880047 DOI: 10.1016/j.oooo.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE We aimed to describe and analyze the epidemiologic and clinical variables associated with, treatment for, and development of cervicofacial infection (CFI). STUDY DESIGN We retrospectively examined 201 patients older than 14 years who had met the CFI diagnostic criteria and whose treatment required hospitalization and intervention under general anesthesia at our hospital. We performed chi-square tests to compare proportions in categorical variables and either the Student t test or the Wilcoxon signed-rank test to compare quantitative variables. We performed an analysis of variance to compare 3 or more categories and either Pearson or Spearman correlation coefficient analysis to examine the correlations between quantitative variables. RESULTS The majority (85.07%) of the CFIs were of odontogenic origin. The mean hospitalization length was 4.58 days. Patients with diabetes who used tobacco and/or alcohol had a significantly longer length of hospitalization and several postoperative complications.The most common symptoms were pain, trismus and toothache. Symptoms of fever and nausea were associated with longer hospitalization. The most affected anatomic spaces were submandibular and pterygomandibular. Buccal and infraorbital, temporal, and parotid spaces were associated with longer hospitalization. CONCLUSIONS Most CFIs are of odontogenic origin. Diabetes and tobacco and alcohol use are important risk factors. Treatment should be surgical and target the cause of infection. Timely referrals are important when patients present symptoms compatible with CFI for immediate treatment.
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Affiliation(s)
- Federico Garola
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Bárbara Cores
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ezequiel Santalla Claros
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariano Botta
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
| | - Paola Pigazzini
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
| | - Eduardo Piemonte
- Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba, Argentina
| | - Julio César Garzón
- Oral and Maxillofacial Surgery Department, Hospital General de Agudos Parmenio Piñero, Ciudad Autónoma de Buenos Aires, Argentina
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Sakkas A, Weiß C, Zink W, Rodriguez CA, Scheurer M, Pietzka S, Wilde F, Thiele OC, Mischkowski RA, Ebeling M. Airway Management of Orofacial Infections Originating in the Mandible. J Pers Med 2023; 13:950. [PMID: 37373939 DOI: 10.3390/jpm13060950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
The primary aim of this study was to assess the incidence of a difficult airway and emergency tracheostomy in patients with orofacial infections originating in the mandible, and a secondary aim was to determine the potential predictors of difficult intubation. This retrospective single-center study included all patients who were referred between 2015 and 2022 with an orofacial infection originating in the mandible and who were surgically drained under intubation anesthesia. The incidence of a difficult airway regarding ventilation, laryngoscopy, and intubation was analyzed descriptively. Associations between potential influencing factors and difficult intubation were examined via multivariable analysis. A total of 361 patients (mean age: 47.7 years) were included in the analysis. A difficult airway was present in 121/361 (33.5%) patients. Difficult intubation was most common in patients with infections of the massetericomandibular space (42.6%), followed by infections of the mouth floor (40%) and pterygomandibular space (23.5%). Dyspnea and stridor were not associated with the localization of infection (p = 0.6486/p = 0.4418). Multivariable analysis revealed increased age, restricted mouth opening, higher Mallampati scores, and higher Cormack-Lehane classification grades as significant predictors of difficult intubation. Higher BMI, dysphagia, dyspnea, stridor and a non-palpable mandibular rim did not influence the airway management. Patients with a difficult airway were more likely to be admitted to the ICU after surgery than patients with regular airway were (p = 0.0001). To conclude, the incidence of a difficult airway was high in patients with orofacial infections originating in the mandible. Older age, limited mouth opening, a higher Mallampati score, and a higher Cormack-Lehane grade were reliable predictors of difficult intubation.
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Affiliation(s)
- Andreas Sakkas
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Christel Weiß
- Medical Statistics and Biomathematics, Mannheim Medical Faculty of the Heidelberg University, 68167 Mannheim, Germany
| | - Wolfgang Zink
- Department of Anesthesiology and Intensive Care Medicine, Ludwigshafen Hospital, 67063 Ludwigshafen, Germany
| | | | - Mario Scheurer
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Sebastian Pietzka
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Frank Wilde
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Oliver Christian Thiele
- Department of Cranio-Maxillo-Facial-Surgery, Ludwigshafen Hospital, 67063 Ludwigshafen, Germany
| | | | - Marcel Ebeling
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
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Saputri RAH, Massie GC, Gatera VA, Boesoirie SF. The application of honey in wound care of raw surface at spontaneous rupture submandibular abscess that extends to submental and right neck: A case report. Int J Surg Case Rep 2022; 90:106672. [PMID: 34968982 PMCID: PMC8717243 DOI: 10.1016/j.ijscr.2021.106672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Honey has been reported to accelerate wound healing. The use of honey in wound care mostly uses medicated (Manuka) honey. There are still few who report using Nusantara honey, local honey from Indonesia, as a wound dressing. We report wound care using Nusantara honey in patients with a remarkably open wound due to a ruptured submandibular abscess extending to the submental and right neck. PRESENTATION OF CASE A 67 years old male patient came with a ruptured submandibular abscess that extends to the submental and right neck. On the right submandibular region, an ulcer extends to submental with a size of 10 × 4 × 3 cm, hyperemic, edema around the wound, fluctuating, with pus and tenderness. The isolated bacteria were Staphylococcus aureus. The patient received combination antibiotic therapy, blood sugar management, necrotomy debridement, tooth extraction, and wound care using Nusantara honey on the sixth day after surgery. An improvement was seen on the 10th day after necrotomy. DISCUSSION The use of honey for wound care is based on thousands of years of history. Honey can accelerate wound healing and show different effects depending on the phase of wound healing. In addition, honey also has antibacterial properties. CONCLUSION Applying Nusantara honey to treat raw surfaces can help speed up wound healing and provide cost-efficiency. There were no allergic reactions or secondary bacterial infections after using honey in this patient.
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Affiliation(s)
- R Ayu Hardianti Saputri
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Padjadjaran Universitas/Dr. Hasan Sadikin General Hospital, Bandung, Jl. Pasteur No. 38, Kec. Sukajadi, Bandung City, West Java 40161, Indonesia
| | - Gracia Cintia Massie
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Padjadjaran Universitas/Dr. Hasan Sadikin General Hospital, Bandung, Jl. Pasteur No. 38, Kec. Sukajadi, Bandung City, West Java 40161, Indonesia.
| | - Vesara Ardhe Gatera
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Jl. Raya Bandung Sumedang KM.21, Hegarmanah, Jatinangor, Kabupaten Sumedang, West Java 45363, Indonesia
| | - Shinta Fitri Boesoirie
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Padjadjaran Universitas/Dr. Hasan Sadikin General Hospital, Bandung, Jl. Pasteur No. 38, Kec. Sukajadi, Bandung City, West Java 40161, Indonesia.
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