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Trott S, Burruss CP, Weltzer M, Iverson K, Azbell C, Bush ML. Perioperative factors influencing hospitalization duration for pediatric neck abscesses. Am J Otolaryngol 2023; 44:103967. [PMID: 37454430 DOI: 10.1016/j.amjoto.2023.103967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Pediatric neck abscesses are a common pathology seen in an ambulatory setting. Although some pediatric neck abscesses are managed medically with antibiotics, surgical intervention is often required. Given the often non-emergent presentation of many abscesses, a variety of logistical and perioperative factors may delay time to care and subsequently prolong hospital stay. The objective of this study was to examine factors that influence the overall time to surgery (TTS) and hospital length of stay (LOS) in a pediatric population with neck abscesses who ultimately require surgical drainage. MATERIALS AND METHODS 161 pediatric patients who underwent incision and drainage of a neck abscess over a ten-year period at a tertiary referral children's center were reviewed. Demographic information, radiographic studies, and surgical information were extracted from patient charts. Descriptive statistics, Mann-Whitney U tests, and multivariate analyses were performed. RESULTS The most common subcategory location was deep neck abscesses (33.1 %). Computed tomography (CT) was the most common pre-operative imaging modality (54.1 %) followed by ultrasound (US) (49.1 %) and magnetic resonance imaging (2.6 %). US and a combination of multiple preoperative imaging modalities were associated with increased LOS and TTS. Repeat surgery was associated with increased LOS. Pre-admission antibiotic use was associated with increased LOS and TTS. Younger patients were more likely to have a longer LOS. CONCLUSIONS A variety of factors can influence TTS, LOS, and time from surgery to discharge including patient age, abscess location, a non-optimized utilization of imaging modalities, the utilization of pre-admission antibiotics, and the need for repeat operations.
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Affiliation(s)
- Skylar Trott
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | | | | | - Kenneth Iverson
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Chris Azbell
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Matthew L Bush
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA.
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Adelson RT, Murray AD. Minimally Invasive Transoral Catheter-Assisted Drainage of a Danger-Space Infection. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130508401215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robert T. Adelson
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Miami (Fla.) School of Medicine
| | - Alan D. Murray
- Division of Pediatric Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas
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Roberts S, Chan L, Eisenberg R. Idiopathic pretracheal deep neck space infection with mediastinal extension: A series of 3 cases and review of the literature. EAR, NOSE & THROAT JOURNAL 2018. [PMID: 28636733 DOI: 10.1177/014556131709600622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Idiopathic pretracheal deep neck space infection is an extremely rare condition with potentially devastating complications. We present a series of 3 cases of pretracheal deep neck space infection that arose in the absence of trauma or a congenital lesion and that exhibited mediastinal spread. To the best of our knowledge, these cases represent the first reported series of this rare condition to be published in the English-language literature. All cultures grew Streptococcus milleri, and all patients had a favorable outcome. A high index of suspicion for a deep neck space infection is warranted in view of the devastating complications of this condition. Computed tomography is the investigation of choice. Treatment with intravenous antibiotics and surgical drainage, particularly when mediastinitis is present, is recommended. This rare presentation warrants a thorough investigation to identify the source of infection.
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Affiliation(s)
- Samuel Roberts
- ENT Department, John Hunter Hospital, Lookout Rd., New Lambton Hts., NSW 2305, Australia.
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Katori Y, Kawase T, Ho Cho K, Abe H, Rodríguez-Vázquez JF, Murakami G, Fujimiya M. Suprahyoid neck fascial configuration, especially in the posterior compartment of the parapharyngeal space: a histological study using late-stage human fetuses. Clin Anat 2012; 26:204-12. [PMID: 22576755 DOI: 10.1002/ca.22088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 01/27/2012] [Accepted: 03/27/2012] [Indexed: 01/09/2023]
Abstract
The fascial configuration in the suprahyoid parapharyngeal space was evaluated using semiserial sagittal sections of 15 late-stage human fetal heads. The prevertebral fascia covered the longus colli, longus capitis, and rectus capitis lateralis muscles, but was most evident along the longus colli muscle. The carotid sheath and its extension were located around the internal and external carotid arteries and the lower cranial nerves. The superior cervical ganglion was also inside the sheath. Even near full term, the fetal suprahyoid neck was short, with the jugular foramen and hypoglossal canal located at the posterolateral side of the oropharynx. Thus, the glossopharyngeal and accessory nerves ran across the upper part of the carotid sheath. Fasciae of the stylopharyngeus, styloglossus, and stylohyoideus muscles were attached to and joined the anterosuperior aspect of the carotid sheath. All these neurovascular and muscle sheaths are communicated with the visceral fascia covering the pharynx at multiple sites, and, together, they formed a mesentery-like bundle. This communication bundle was made narrow by the anteriorly protruding longus capitis muscle. The mesentery-like bundle was covered by the posterior marginal fascia of the prestyloid compartment of the parapharyngeal space. The external carotid artery ran on the lateral and posterior sides of the posterior marginal fascia. Consequently, the typical carotid sheath configuration was modified by muscle sheaths from the styloid process, communicated with the visceral fascia and, anteriorly, constituted the posterior margin of the prestyloid space.
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Affiliation(s)
- Yukio Katori
- Division of Otorhinolaryngology, Sendai Municipal Hospital, Sendai, Japan
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Miyake N, Takeuchi H, Cho BH, Murakami G, Fujimiya M, Kitano H. Fetal anatomy of the lower cervical and upper thoracic fasciae with special reference to the prevertebral fascial structures including the suprapleural membrane. Clin Anat 2011; 24:607-18. [PMID: 21647961 DOI: 10.1002/ca.21125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 11/22/2010] [Accepted: 12/02/2010] [Indexed: 11/09/2022]
Abstract
The aim of this study was to find basic rules governing the fetal anatomy of the deep cervical fasciae and their connections to the mediastinal fasciae. We examined the histology of paraffin-embedded preparations of 18 mid-term fetuses (5 between 9 and 12 weeks of gestation, 3 between 15 and 18 weeks, and 10 between 20 and 25 weeks). The prevertebral lamina of the deep cervical fasciae (PLDCF) developed as an intermediate aponeurosis for the bilateral bellies of the longus colli muscles. In contrast, the alar fascia developed as a connecting band between the bilateral adventitiae of the common carotid artery. The retropharyngeal fascia became evident much later than the latter two fasciae. The fascia covering the thymus was thicker than the fascia for the strap muscles (the pretracheal lamina of the cervical fascia). The primitive suprapleural membrane, or Sibson's fascia, contained veins and fatty tissues, and was composed of the alar fascia rather than the PLDCF, tranversalis fascia, or endothoracic fascia. The prevertebral two-laminar configuration was rather evident in the early stages of development because, in the later stages, the fasciae together provided a multilaminar structure, especially in the lateral area in front of the longus colli, which suspended the cupula pleurae. To consider a continuation from the base of the neck to the upper mediastinum, the alar fascia seems to be a key structure for connecting the vascular sheath to the parietal pleura.
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Affiliation(s)
- Naritomo Miyake
- Department of Otorhinolaryngology, Tottori University School of Medicine, Yonago, Japan
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Clark MT, Lobo M. Streptococcal pretracheal cellulitis and mediastinitis. J Paediatr Child Health 2008; 44:676-7. [PMID: 19012645 DOI: 10.1111/j.1440-1754.2008.01400.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Suehara AB, Gonçalves AJ, Claret Alcadipani FAM, Kavabata NK, Menezes MB. Deep neck infection - analysis of 80 cases. Braz J Otorhinolaryngol 2008; 74:253-9. [PMID: 18568205 PMCID: PMC9442126 DOI: 10.1016/s1808-8694(15)31097-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Accepted: 03/24/2007] [Indexed: 11/24/2022] Open
Abstract
Deep neck infections are serious diseases that involve several spaces in the neck. The most dreadful complication is descending necrotizing fasciitis, which needs early diagnosis and aggressive treatment. Aim To analyze 80 treated cases of deep neck infection and propose a schematic guideline for managing this disease. Method The authors present a retrospective analysis of 80 treated cases of deep neck infection, from June 1997 to June 2003. Results Odontogenic and tonsilar causes were the more frequent ones. Submandibular and parapharyngeal spaces were the most frequent location of deep neck infection. Staphylococcus aureus and Streptococcus sp were the microorganisms more commonly isolated. Conclusions Airway control should be priority in managing deep neck infections and if the patient has to be submitted to surgery special care should be taken at the moment of intubation - when curare must never be used. CT scan is the gold-standard imaging evaluation for the diagnosis of deep neck infection. Morbi-mortality is high when associated with septic shock and mediastinitis. Our mortality rate was 11.2% and only one, in five patients with mediastinitis, survived.
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Abstract
Using semiserial sections, we histologically observed the carotid sheath and adjacent structures in 8 sides of 5 cadavers. For description, we classified the carotid sheath into 2 parts or laminae: 1) a laminar "adventitia" enclosing each of the cervical great vessels; and 2) a "common sheath" outside the adventitia. Arterial and venous adventitial structures sometimes fused and provided a definite septum between the artery and vein. Contrasting with previous descriptions, the common sheath did not fuse with superficial or prethracheal lamina of the cervical fasciae, but often fused with visceral fascia to provide a thick plate. The common sheath as well as the prevertebral lamina of the cervical fasciae sometimes became interrupted or unclear, but the adventitia was consistently complete circular. The alar fascia was usually considered as one layer of the multilaminar structure behind the cervical viscera, but it was difficult to identify as a single proper lamina. The carotid sheath was thus not a dissection artifact, but a definite histological structure. However, interindividual and/or site-dependent variations were evident in thicknesses of the adventitia and common sheath. Consequently, the author proposed a model of the fascial arrangement around cervical great vessels that unexpectedly differs from most descriptions in textbooks.
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Affiliation(s)
- Shogo Hayashi
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan.
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Larawin V, Naipao J, Dubey SP. Head and neck space infections. Otolaryngol Head Neck Surg 2007; 135:889-93. [PMID: 17141079 DOI: 10.1016/j.otohns.2006.07.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 07/06/2006] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the incidence, causes, management, and complications of the different head and neck space infections in a Melanesian population. STUDY DESIGN AND SETTING We conducted a retrospective study in a tertiary referral and teaching hospital. RESULTS Of the total 103 patients with deep neck space infections (DNSI), odontogenic causes and suppurative lymphadenitis were responsible in 62 (60%) patients. A wide range of DNSI was encountered in our series. Ludwig's angina was the most commonly encountered infection seen in 38 (37%) patients, whereas prevertebral abscess was only seen in 1 (1%) patient. A combination of surgical drainage and medical treatment was the main mode of treatment. Nine (8.7%) patients with DNSI with upper airway obstruction underwent tracheostomy; 9 (8.7%) patients with DNSI succumbed to their infection. CONCLUSION DNSI needs early detection and aggressive management in order to evade dreaded complications.
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Affiliation(s)
- Varqa Larawin
- Department of Ear, Nose, and Throat, Port Moresby General Hospital, School of Medicine and Health Sciences, University of Papua, New Guinea
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Rusconi R, Bergamaschi S, Cazzavillan A, Carnelli V. Clivus osteomyelitis secondary to Enterococcus faecium infection in a 6-year-old girl. Int J Pediatr Otorhinolaryngol 2005; 69:1265-8. [PMID: 15894386 DOI: 10.1016/j.ijporl.2005.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 03/21/2005] [Indexed: 11/16/2022]
Abstract
A 6-year-old girl was diagnosed to suffer from clivus osteomyelitis secondary to Enterococcus faecium infection. On the basis of the magnetic resonance image, the abscess was drained via the posterior wall of the pharyngeal tract immediately. Subsequent antibiotic therapy allowed rapid improvement and long-term healing of the osteomyelitic process without any side effect. Osteomyelitis or abscess of the clivus is very rare in adult patients and extremely rare in children. Some etiopathogenetic hypotheses are discussed in this case.
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Affiliation(s)
- R Rusconi
- Department of Pediatrics, University of Milan, Clinica Pediatrica De Marchi, via Commenda 9, 20122 Milano, MI, Italy.
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Shenoy RD, Nair S, Kamath N. SIADH complicating deep neck abscess in infancy. Int J Pediatr Otorhinolaryngol 2005; 69:1113-6. [PMID: 16005353 DOI: 10.1016/j.ijporl.2005.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Revised: 02/09/2005] [Accepted: 02/09/2005] [Indexed: 11/22/2022]
Abstract
Symptomatic hyponatremia due to syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) in infancy is seen usually with pneumonia and meningitis and its association with deep neck abscess is not documented. Recognition and appropriate management of this complication is important to prevent mortality and long-term neurological morbidity. We report a 3-month-old infant with parapharyngeal abscess presenting with altered sensorium and recurrent seizures as a result of hyponatremia due to SIADH. The clinical course and outcome is described. Limitation of imaging modalities in an infant with airway compromise is discussed.
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Affiliation(s)
- Rathika D Shenoy
- Department of Pediatrics, Kasturba Medical College (KMC) Hospital Attavar, Attavar, Mangalore 575001, Karnataka, India.
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Ishimine P. A young boy with stridor. PEDIATRIC CASE REVIEWS (PRINT) 2003; 3:141-9. [PMID: 12865707 DOI: 10.1097/01.pca.0000074024.71816.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Paul Ishimine
- Children's Hospital and Health Center, San Diego, CA, USA
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Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol 2003; 24:111-7. [PMID: 12649826 DOI: 10.1053/ajot.2003.31] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The incidence of deep cervical space infections has decreased after the introduction of antibiotics and improvement of oral hygiene, but they still may be lethal especially when life-threatening complications occur. In this article, we try to find out whether there are predisposing factors related to complicated deep cervical space infections and prolonged hospitalization. MATERIALS AND METHODS We conducted a retrospective analysis of medical records of 196 patients with deep neck infections during the period from March 1996 to February 2002. Among the 196 patients, 15 patients developed lethal complications. As for data analysis, multiple regression and logistic regression with dummy variable were used. RESULTS In multiple regressions, patients with older age or with neck swelling, trismus, underlying diseases, complications, and C-reactive protein more than 100 microg/mL stayed longer in the hospital, and the P value reached statistical significance (P <.05). In logistic regression, male patients and patients with neck pain had negative correlation, and the P value reached statistical significance (P <.05). Patients with neck swelling and patients with respiratory difficulty had positive correlation, and the P value reached statistical significance (P <.05). That means female patients, patients with neck swelling, and patients with respiratory difficulty were more likely to have complicated deep neck infections. CONCLUSION Complicated deep neck infections remain potentially fatal, but the morbidity and mortality can be reduced. Doctors should pay more attention to those high-risk patients; they are female patients, patients with neck swelling, and patients with respiratory difficulty.
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Affiliation(s)
- Ling-Feng Wang
- Department of Otolaryngology, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung City 807, Taiwan
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Kelly CP, Isaacman DJ. Group B streptococcal retropharyngeal cellulitis in a young infant: a case report and review of the literature. J Emerg Med 2002; 23:179-82. [PMID: 12359288 DOI: 10.1016/s0736-4679(02)00489-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The diagnosis of retropharyngeal cellulitis and abscess, although most common in children under 6 years of age, is often misdiagnosed in the newborn or early infancy period. The clinical signs of drooling, neck swelling, dysphagia, and torticollis may be absent or not easily identifiable. The following case report details a 2 1/2-month-old infant who presented with fever and irritability, and was subsequently diagnosed with group B streptococcal retropharyngeal cellulitis. Retropharyngeal cellulitis and abscess should be considered in the differential diagnosis of infants and young children who present with fever and irritability, particularly when lumbar puncture results are normal. This case also serves to highlight a rare manifestation of late-onset group B steptococcal disease.
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Affiliation(s)
- Christopher P Kelly
- Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughter's, Norfolk, Virginia 23505, USA
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Sennes LU, Imamura R, Angélico Júnior FV, Simoceli L, Frizzarini R, Tsuji DH. Infecções dos espaços cervicais: estudo prospectivo de 57 casos. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0034-72992002000300014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objetivo: apesar da antibioticoterapia, as infecções dos espaços cervicais profundos continuam a ter grande importância, tanto por sua alta incidência, como pelo risco de complicações. Forma de estudo: clínico, prospectivo. Material e método: descrevem-se neste estudo 57 casos de pacientes com diagnóstico de infecção cervical (celulite, abscesso e fasceíte necrotizante) internados na Enfermaria de Otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da USP entre janeiro de 1999 e janeiro de 2001. Cinqüenta pacientes (87,7%) apresentavam abscesso cervical, cinco (8,8%), celulite e dois pacientes (3,5%), fasceíte necrotizante. A infecção odontogênica foi o foco de origem mais prevalente, responsável por 24 casos (42%), seguida das amigdalites (17,5%) e linfadenites (15,8%). Os espaços cervicais mais acometidos foram o submandibular (57,9%), o sublingual (26,3%) e o parafaríngeo (24,6%). Em 53 pacientes realizaram-se culturas das quais 71,7% foram positivas, sendo que 20,8% destas apresentaram flora mista. Os microorganismos mais prevalentes dentre os aeróbicos foi o Streptococcus viridans (41,5%) e, dentre os anaeróbios, Peptostreptococcus micros e Peptostreptococcus sp (5,7% e 3,8%, respectivamente). A associação entre penicilina cristalina e metronidazol foi o tratamento preconizado em 31 pacientes (54,3%). Nos demais, diversos antibióticos como clindamicina, cefalosporinas de terceira geração, cloranfenicol e oxacilina foram utilizados. Cinqüenta e quatro pacientes (94,7%) evoluíram satisfatoriamente, dois (3,5%) apresentaram deiscência da ferida cirúrgica e um (1,7%) foi a óbito por mediastinite. Conclusão: os abscessos cervicais ainda configuram uma importante causa de morbidade em nossa população e suas complicações requerem vigilância para a prevenção e abordagem oportunas, especialmente pelo tratamento mais adequado.
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Potter JK, Herford AS, Ellis E. Tracheotomy versus endotracheal intubation for airway management in deep neck space infections. J Oral Maxillofac Surg 2002; 60:349-54; discussion 354-5. [PMID: 11928085 DOI: 10.1053/joms.2002.31218] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of the present study was to compare costs and outcomes for patients with deep neck infections who were treated with either tracheotomy or endotracheal intubation. MATERIALS AND METHODS The charts of 85 patients with deep neck space infections were retrospectively studied. Requirements for inclusion in the study were incision and drainage in the operating room, involvement of more than 1 deep anatomic space, impending airway compromise, and maintenance of a postoperative artificial airway. The 85 patients were divided into 2 groups based on the type of airway used for treatment. Group 1 (n = 34) included patients who received a tracheotomy, and group 2 (n = 51) included patients whose airways were maintained with endotracheal intubation until the swelling had resolved sufficiently for extubation. RESULTS Patients in group 1 had a shorter overall hospital stay (4.8 vs 5.9 days, NS) and spent less time in the intensive care unit (1.1 vs 3.1 days, P <.05). The overall incidence of complications was 6% for group 1 and 10% for group 2. The rate of complications secondary to loss of airway was 3% for group 1 and 6% for group 2. Average costs associated with intensive care resources were 5 times greater and overall hospital stay costs were 60% greater for group 2. CONCLUSIONS Although both methods of airway control are useful and have a unique set of complications, the use of tracheotomy allowed earlier movement to a noncritical care unit and was associated with fewer intensive care costs and less overall cost of hospitalization. Tracheotomy may therefore provide better utilization of critical care resources in this group of patients.
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Affiliation(s)
- Jason K Potter
- Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9109, USA
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Spread of Injectate During C6 Stellate Ganglion Block and Fascial Arrangement in the Prevertebral Region. Reg Anesth Pain Med 2000. [DOI: 10.1097/00115550-200011000-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miller WD, Furst IM, Sàndor GK, Keller MA. A prospective, blinded comparison of clinical examination and computed tomography in deep neck infections. Laryngoscope 1999; 109:1873-9. [PMID: 10569425 DOI: 10.1097/00005537-199911000-00029] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine whether there is a scientific basis for the routine use of contrast-enhanced computed tomography (CECT) in the evaluation of suspected deep neck infection (DNI). STUDY DESIGN We conducted a prospective, blinded comparison of clinical examination and CECT in DNI. METHODS Thirty-five consecutive patients with suspected DNI were prospectively assessed by clinical examination and CECT for the presence and extent of surgically drainable purulent collections. Before CECT a surgeon recorded clinical data and predicted the extent of infection. A head and neck neuroradiologist, blinded to the clinical evaluation, predicted the extent of infection based on CECT. Final outcome (the presence of a purulent collection) was determined at surgery or in long-term follow-up. The clinical and CECT findings were compared with the final outcome to determine the sensitivity, specificity, and accuracy of each modality. RESULTS Twenty patients had purulent drainable collections. The accuracy of clinical examination alone in identifying a drainable collection was 63%, the sensitivity was 55%, and the specificity was 73%. The accuracy of CECT alone was 77%, the sensitivity was 95%, and the specificity 53%. When CECT and clinical examination were combined, the accuracy in identifying a drainable collection was 89%, the sensitivity was 95%, and the specificity 80%. If fluid collections with volumes of 2 mL or greater on CECT were considered, the accuracy of CECT would have been 85%, the sensitivity 89%, and the specificity 80%. CONCLUSION CECT and clinical examination are both critical components in the evaluation of suspected DNI.
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Affiliation(s)
- W D Miller
- Department of Medical Imaging, The University of Toronto, Ontario, Canada
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Abstract
Deep neck infections are less common in the antibiotic era, but when they do occur they remain serious infections. Historically, these infections carried significant morbidity and mortality due to the proximity of the airway, mediastinum, and other vital structures. Deep neck infections were once routinely treated with penicillin, and if infection progressed to abscess, surgical drainage was performed. In recent years the standard medical, surgical, and diagnostic approaches to deep neck infection have changed, and they continue to evolve. Physicians must be aware of these changes to optimally manage patients with deep neck infections.
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Affiliation(s)
- PJ Nicklaus
- Department of Otolaryngology, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160-7380, USA
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