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Gupta C, Bhola N, Sonpal P, Bodiwala N. Rare Insights: Temporoparietal Necrotizing Fasciitis Stemming From a Dental Source. Cureus 2024; 16:e60278. [PMID: 38872676 PMCID: PMC11172393 DOI: 10.7759/cureus.60278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Necrotizing fasciitis (NF) of the face is a rare yet serious condition requiring prompt and comprehensive management. This approach typically involves input from various medical specialties such as infectious disease specialists, critical care physicians, and surgeons. The primary goals are early recognition, aggressive surgical debridement, appropriate antibiotic therapy, and supportive care. Prompt diagnosis is crucial, based on symptoms like severe pain, rapidly spreading erythema, and systemic signs of infection. Broad-spectrum antibiotics are initiated empirically, and adjusted based on culture results. Urgent surgical debridement is crucial, removing all necrotic tissue. Careful consideration must be given to preserve vital structures. Close monitoring and intensive care may be necessary, especially for severe cases. Soft tissue reconstruction may follow once the infection is controlled, aiming to restore function and aesthetics. Long-term follow-up is essential to observe for complications and recurrence.
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Affiliation(s)
- Chetan Gupta
- Oral & Maxillofacial Surgery, Sharad Pawar Dental College & Hospital, Wardha, Wardha, IND
| | - Nitin Bhola
- Oral & Maxillofacial Surgery, Sharad Pawar Dental College & Hospital, Wardha, Wardha, IND
| | - Parmarth Sonpal
- Oral & Maxillofacial Surgery, Sharad Pawar Dental College & Hospital, Wardha, Wardha, IND
| | - Nidhi Bodiwala
- Oral & Maxillofacial Surgery, Sharad Pawar Dental College & Hospital, Wardha, Wardha, IND
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2
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Hansen SUB, Jespersen FVB, Markvart M, Hyldegaard O, Plaschke CC, Bjarnsholt T, Nielsen CH, Jensen SS. Characterization of patients with odontogenic necrotizing soft tissue infections in the head and neck area. A retrospective analysis. Acta Odontol Scand 2024; 82:40-47. [PMID: 37688516 DOI: 10.1080/00016357.2023.2254389] [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: 01/18/2023] [Revised: 08/13/2023] [Accepted: 08/27/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE Necrotizing soft-tissue infection (NSTI) in the head and neck area may develop from odontogenic infections. The aim of this study was to characterize patients with NSTI in the head and neck with odontogenic origin in a well-defined prospectively collected cohort. MATERIAL AND METHODS Patients with NSTI in the head and neck, hospitalized between 2013 and 2017 at Copenhagen University Hospital and registered in the Scandinavian INFECT database were included. Medical records of identified patients and from the INFECT database were screened for a defined set of data including the primary focus of infection, comorbidities, predisposing factors, clinical and radiographic diagnostics, course of treatment, and treatment outcome. RESULTS Thirty-five patients with NSTI in the head and neck area were included in the study. A total of 54% had odontogenic origin, primarily from mandibular molars, and 94% had radiographic signs of infectious oral conditions. Overall, comorbidities were reported in 51% with cardiovascular disease being the most prevalent. In 20%, no comorbidities or predisposing conditions could be identified. The overall 30-day mortality rate was 9%. CONCLUSIONS More than half of NSTI cases in the head and neck region had an odontogenic origin, and special attention should be paid to infections related to mandibular molars.
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Affiliation(s)
| | | | - Merete Markvart
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Ole Hyldegaard
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Caroline Plaschke
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - Claus Henrik Nielsen
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
- Institute for Inflammation Research, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simon Storgård Jensen
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
- Deparment of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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3
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Grillo R, Balel Y, Brozoski MA, Ali K, Adebayo ET, Naclério-Homem MDG. A global science mapping analysis on odontogenic infections. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101513. [PMID: 37207960 DOI: 10.1016/j.jormas.2023.101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Odontogenic infections are common and a topic of core interest for dentists, and maxillofacial surgeons. The aim of this study was to conduct a bibliometric analysis of the global literature on odontogenic infection and explore the top 100 most cited papers to identify the common causes, sequelae and management trends. METHODS Following a comprehensive literature search, a list of top 100 most cited papers was created. The VOSviewer software (Leiden University, The Netherlands) was used to create a graphical representation of the data, and statistical analyses were performed to analyze the characteristics of the top 100 most cited papers. RESULTS A total of 1,661 articles were retrieved with the first article published in 1947. There is an exponential upward trend on the number of publications (R2 = 0.919) and a majority of papers are in English language (n = 1,577, 94.94%). A total of 22,041 citations were found with a mean of 13.27 per article. The highest number of publications were recorded from developed countries. There was a male predilection in the reported cases and the most common sites included the submandibular and parapharyngeal spaces. Diabetes mellitus was identified as the commonest co-morbidity. Surgical drainage was ascertained to be the preferred method of management. CONCLUSIONS Odontogenic infections remain prevalent and have a global distribution. Although prevention of odontogenic infection through meticulous dental care is ideal, early diagnosis and prompt management of established odontogenic infections is important to avoid morbidities and mortality. Surgical drainage is the most effective management strategy. There is lack of consensus regarding the role of antibiotics in the management of odontogenic infections.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Yunus Balel
- Department of Oral and Maxillofacial Surgery, Gaziosmanpasa University, Gaziosmanpasa, Turkey
| | - Mariana Aparecida Brozoski
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil
| | - Kamran Ali
- College of Dental Medicine, Qatar University, Doha, Qatar
| | - Ezekiel Taiwo Adebayo
- Department of Oral and Maxillofacial Surgery, University of Medical Sciences, Ondo, Nigeria
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil
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Ullah M, Irshad M, Yaacoub A, Carter E, Thorpe A, Zoellner H, Cox S. Dental Infection Requiring Hospitalisation Is a Public Health Problem in Australia: A Systematic Review Demonstrating an Urgent Need for Published Data. Dent J (Basel) 2023; 11:dj11040097. [PMID: 37185475 PMCID: PMC10136976 DOI: 10.3390/dj11040097] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/11/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
Background: The aim of this systematic review was to analyse the published literature on dental infections leading to hospitalisations in Australia. It was hoped that understanding the patterns and trends would form a basis for improved preventive and management policies. Methods: An electronic search was performed using Web of Science, Medline via Ovid and Google Scholar. Inclusion and exclusion criteria were applied. The included studies were analysed for demographics, aetiology, management, length of hospital stay and outcome of dental infections requiring hospitalisation. Results: Nine retrospective studies were eligible for inclusion. A total of 2196 cases of dental infections leading to hospitalisations were reported, with a male predominance (55–67%). Mental health issues, illicit substance abuse and immunosuppression were the main associated comorbidities (up to 58%). Dental caries (59–90%) and pericoronitis (10–19%) were the leading causes of dental infections. Empirical antibiotics were utilised in up to 75% of cases prior to hospital presentation. Six mortalities were reported. Conclusions: The available published data show that dental infection is a significant public health problem. However, only general conclusions were possible due to the variably small sample size and data collection that was inconsistent and incomplete across studies. Improved data collection is required to develop policies for prevention and management.
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Affiliation(s)
- Mafaz Ullah
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
| | - Muhammad Irshad
- Department of Oral Pathology, Rehman College of Dentistry, Peshawar 25000, Pakistan
- Specialised Dental Center, Ministry of Health, Sakaka Aljouf 72345, Saudi Arabia
| | - Albert Yaacoub
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Eric Carter
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
| | - Andrew Thorpe
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
| | - Hans Zoellner
- Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, NSW 2006, Australia
- Graduate School of Biomedical Engineering, University of NSW, Kensington, NSW 2052, Australia
- Strongarch Pty Ltd., Pennant Hills, NSW 2120, Australia
| | - Stephen Cox
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
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Hankey PB, Brown JR. Cervical Necrotizing Fasciitis and Shock in the Post-Operative Pediatric Patient. EAR, NOSE & THROAT JOURNAL 2022:1455613221139404. [PMID: 36356106 DOI: 10.1177/01455613221139404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Cervical necrotizing fasciitis (CNF) is a rare infection that can quickly lead to devastating patient outcomes. Considering the vital importance of surrounding neck structures, rapid control of the infection is essential. Infection is most frequently polymicrobial and occurs in the adult patient in the context of certain medical comorbidities. Complications are typically limited to tissue destruction in the form of necrosis. There are no current reports describing CNF complicated by acute shock in the post-operative pediatric patient. Here, we present a pediatric case of CNF complicated by acute shock following Sistrunk procedure for removal of a supposed thyroglossal duct cyst. This case illustrates a potential post-operative complication that can be seen within the pediatric patient. Although most reported examples of CNF are polymicrobial and result from odontogenic infection, providers should be aware of other potential sources of disease. It is important for the pediatric surgeon to rapidly identify CNF and consequent shock, as prompt medical and surgical interventions are critical to offering the best chance of patient survival.
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Affiliation(s)
- Paul Bryan Hankey
- College of Osteopathic Medicine, Kansas City University, Kansas City, MI, USA
| | - Jason R Brown
- Division of Otolaryngology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MI, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MI, USA
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6
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Fischer HG, Gey A, Fischer M, Plontke SK. [Hyperbaric oxygen therapy : Selected indications in the discipline of otorhinolaryngology]. HNO 2022; 70:848-860. [PMID: 36173420 DOI: 10.1007/s00106-022-01227-0] [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: 08/15/2022] [Indexed: 11/29/2022]
Abstract
Hyperbaric oxygenation (HBO) represents the controlled exposure to positive pressure with simultaneous inhalation of pure oxygen. It is considered to be an effective treatment option for diseases with restricted blood flow as oxygen not only binds chemically to hemoglobin but also physically dissolves in blood plasma. With the help of a hyperbaric chamber the ambient pressure of a patient can be modified and the physiological characteristics in positive pressure can be medically used. The indications relevant to otorhinolaryngology are necrotizing otitis externa and skull base osteomyelitis, other forms of osteomyelitis, gangrene, wound healing disorders and sudden loss of hearing. When choosing a treatment, not only the availability and costs of HBO treatment play a role but also the patient's tolerance of overpressure. The risks of treatment, e.g., due to oxygen toxicity or barotrauma of the middle ear or the paranasal sinuses, must be weighed up against the potential benefits.
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Affiliation(s)
- Hans-Georg Fischer
- Praxis für Hals-Nasen-Ohrenheilkunde, Schlehenweg 30, 04329, Leipzig, Deutschland. .,Abteilung für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Bundeswehrkrankenhaus Hamburg, Hamburg, Deutschland. .,Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Alexandra Gey
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Martin Fischer
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg, Leipzig, Deutschland
| | - Stefan K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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7
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Kohpe Kapseu S, Monkam CD, Doumo TT, Tchokonte-Nana V. An exceptional thoracolumbar and hypogastric necrotizing fasciitis of dental origin with favourable prognosis: Case report. Int J Surg Case Rep 2022; 98:107545. [PMID: 36029659 PMCID: PMC9424938 DOI: 10.1016/j.ijscr.2022.107545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Stéphane Kohpe Kapseu
- Cliniques Universitaires des Montagnes, Surgery Department, Université des Montagnes, Bangangté, West, Cameroon.
| | | | | | - Venant Tchokonte-Nana
- Faculty of Health Sciences, Comparative Anatomy and Experimental Histopathology and Surgery, Université des Monatgnes, Bangangté, West, Cameroon.
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8
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Chen SL, Chin SC, Wang YC, Ho CY. Factors Affecting Patients with Concurrent Deep Neck Infection and Cervical Necrotizing Fasciitis. Diagnostics (Basel) 2022; 12:diagnostics12020443. [PMID: 35204533 PMCID: PMC8870768 DOI: 10.3390/diagnostics12020443] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
Deep neck infection (DNI) is a severe disease of the deep neck spaces, which has the potential for airway obstruction. Cervical necrotizing fasciitis (CNF) is a fatal infection of the diffuse soft tissues and fascia with a high mortality rate. This study investigated risk factors in patients with concurrent DNI and CNF. A total of 556 patients with DNI were included in this study between August 2016 and December 2021. Among these patients, 31 had concurrent DNI and CNF. The relevant clinical variables were assessed. In univariate analysis, age (> 60 years, odds ratio (OR) = 2.491, p = 0.014), C-reactive protein (CRP, OR = 1.007, p < 0.001), blood sugar (OR = 1.007, p < 0.001), and diabetes mellitus (DM, OR = 4.017, p < 0.001) were significant risk factors for concurrent DNI and CNF. In multivariate analysis, CRP (OR = 1.006, p < 0.001) and blood sugar (OR = 1.006, p = 0.002) were independent risk factors in patients with concurrent DNI and CNF. There were significant differences in the length of hospital stay and therapeutic management (intubation, tracheostomy, incision and drainage) between DNI patients with and without CNF (all p < 0.05). While there were no differences in pathogens between the DNI alone and concurrent DNI and CNF groups (all p > 0.05), the rate of specific pathogen non-growth from blood cultures was 16.95% (89/525) in the DNI alone group, in contrast to 0% (0/31) in the concurrent DNI and CNF group (p = 0.008). Higher CRP and blood sugar levels were independent risk factors for the concurrence of DNI and CNF. With regard to prognosis, there were significant differences in the length of hospital stay and therapeutic management between the groups with and without CNF. While there were no significant differences in pathogens (all p > 0.05), no cases in the concurrent DNI and CNF group showed specific pathogen non-growth, in contrast to 89/525 patients in the group with DNI alone.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.-C.C.); (C.-Y.H.)
- Correspondence: ; Tel.: +886-3-3281200 (ext. 3972); Fax: +886-3-3979361
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.-C.C.); (C.-Y.H.)
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou 333, Taiwan
| | - Yu-Chien Wang
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.-C.C.); (C.-Y.H.)
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (S.-C.C.); (C.-Y.H.)
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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9
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Odontogenic Cervicofacial Necrotizing Fasciitis: Microbiological Characterization and Management of Four Clinical Cases. Pathogens 2022; 11:pathogens11010078. [PMID: 35056026 PMCID: PMC8778522 DOI: 10.3390/pathogens11010078] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
Necrotizing fasciitis of the head and neck is a rare, very severe disease, which, in most cases, originates from odontogenic infections and frequently ends with the death of the patient. Rapid surgical intervention in combination with a preferably pathogen-specific antibiotic therapy can ensure patients’ survival. The question arises concerning which pathogens are causative for the necrotizing course of odontogenic inflammations. Experimental 16S-rRNA gene analysis with next-generation sequencing and bioinformatics was used to identify the microbiome of patients treated with an odontogenic necrotizing infection and compared to the result of the routine culture. Three of four patients survived the severe infection, and one patient died due to septic multiorgan failure. Microbiome determination revealed findings comparable to typical odontogenic abscesses. A specific pathogen which could be causative for the necrotizing course could not be identified. Early diagnosis and rapid surgical intervention and a preferably pathogen-specific antibiotic therapy, also covering the anaerobic spectrum of odontogenic infections, are the treatments of choice. The 16S-rRNA gene analysis detected significantly more bacteria than conventional methods; therefore, molecular methods should become a part of routine diagnostics in medical microbiology.
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10
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Somasundaram J, Wallace DL, Cartotto R, Rogers AD. Flap coverage for necrotising soft tissue infections: A systematic review. Burns 2021; 47:1608-1620. [PMID: 34172327 DOI: 10.1016/j.burns.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/05/2020] [Accepted: 01/20/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Necrotising soft tissue infections (NSTI) are destructive and often life-threatening infections of the skin and soft tissue, necessitating prompt recognition and aggressive medical and surgical treatment. After debridement, the aim of surgical closure and reconstruction is to minimize disability and optimize appearance. Although skin grafting may fulfil this role, techniques higher on the reconstructive ladder, including local, regional and free flaps, are sometimes undertaken. This systematic review sought to determine the circumstances when this is true, which flaps were most commonly employed, and for which anatomical areas. METHODS A systematic review of the literature was conducted utilising electronic databases (Medline, Embase, Cochrane Library). Full text studies of flaps used for the management of NSTI's (including Necrotising Fasciitis and Fournier Gangrene) were included. The web-based program 'Covidence' facilitated storage of references and data management. Data obtained in the search included reference details (journal, date and title), the study design, the purpose of the study, the study findings, number of patients with NSTI included, the anatomical areas of NSTI involved, the types of flaps used, and the complication rate. RESULTS After screening 4555 references, 501 full text manuscripts were assessed for eligibility after duplicates and irrelevant studies were excluded. 230 full text manuscripts discussed the use of 888 flap closures in the context of NSTI in 733 patients; the majority of these were case series published in the last 20 years in a large variety of journals. Reconstruction of the perineum following Fournier's gangrene accounted for the majority of the reported flaps (58.6%). Free flaps were used infrequently (8%), whereas loco-regional muscle flaps (18%) and loco-regional fasciocutaneous flaps (71%) were employed more often. The reported rate of partial or complete flap loss was 3.3%. CONCLUSION Complex skin and soft tissue defects from NSTIs, not amenable to skin grafting, can be more effectively and durably covered using a spectrum of flaps. This systematic review highlights the important contribution that the plastic surgeon makes as an integral member of multidisciplinary teams managing these patients.
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Affiliation(s)
- J Somasundaram
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - D L Wallace
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - R Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - A D Rogers
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
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11
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Fukushima S, Hagiya H, Mizuta Y, Nakano Y, Takahara M, Okamoto K, Hayashi Y, Yamada K, Hasegawa K, Otsuka F. Multiple Deep-seated Dentofacial Abscesses Caused by Multidrug-resistant Viridans Group Streptococci. Intern Med 2020; 59:2067-2070. [PMID: 32389944 PMCID: PMC7492120 DOI: 10.2169/internalmedicine.4283-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Odontogenic infections, generally caused by dental caries and periodontal disease, can result in fatal illness. We herein report a 71-year-old Japanese woman with type 2 diabetes and hemodialysis who suffered from multiple dentofacial abscesses mainly caused by multidrug-resistant Streptococcus oralis. She complained of pain and swelling of her face, with an extraoral fistula from the left cheek. Following 3 surgical debridement procedures and partial mandibulectomy, in addition to 12 weeks of antimicrobial therapy, the multiple dentofacial abscesses were ameliorated. A combination of surgical and antimicrobial treatments following an early diagnosis is essential for reducing further complications.
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Affiliation(s)
- Shinnosuke Fukushima
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuki Mizuta
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yasuhiro Nakano
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Masahiro Takahara
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kayo Okamoto
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuko Hayashi
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kiyoshi Yamada
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kou Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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12
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Bal KK, Unal M, Delialioglu N, Oztornaci RO, Ismi O, Vayisoglu Y. Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients. Braz J Otorhinolaryngol 2020; 88:511-522. [PMID: 32868223 PMCID: PMC9422577 DOI: 10.1016/j.bjorl.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/20/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
Introductıon Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options. Objectives Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media. Methods A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years. Results According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008). Conclusions Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.
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Affiliation(s)
- Kemal Koray Bal
- University of Health Sciences Adana City Hospital, Department of Otorhinolaryngology & Head and Neck Surgery, Adana, Turkey.
| | - Murat Unal
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Nuran Delialioglu
- University of Mersin, Faculty of Medicine, Department of Microbiology, Mersin, Turkey
| | - Ragip Onur Oztornaci
- University of Mersin, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin, Turkey
| | - Onur Ismi
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Yusuf Vayisoglu
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
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Abstract
Ludwig's angina is a cellulitis of the submandibular, sublingual, and submental spaces, which tends to spread rapidly along fascial planes. The most common cause is a dental infection, although any other oropharyngeal infection has the potential to develop into Ludwig's angina. The most feared complication of Ludwig's angina is airway obstruction. Treatment involves early recognition so that an airway can be secured, initiation of antibiotics, and, finally, potential surgical debridement. We describe the case of a 57-year-old male with multiple comorbidities who was seen by a provider three times for dental pain prior to his admission for Ludwig's angina. Upon his index admission, he was found to have Ludwig's angina with impending airway obstruction. He required an emergency surgical airway debridement and extraction of multiple teeth. Although the patient eventually recovered, his hospital stay was prolonged and marked by multiple complications. This case is an example of a severe presentation of Ludwig's angina and the difficulties faced by the medical team in managing this condition. Early recognition and rapid intervention are paramount in the management of this serious condition.
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Affiliation(s)
- Vitaley Kovalev
- Acute Care Surgery, California Hospital Medical Center, Los Angeles, USA.,Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
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Vallée M, Gaborit B, Meyer J, Malard O, Boutoille D, Raffi F, Espitalier F, Asseray N. Ludwig’s angina: A diagnostic and surgical priority. Int J Infect Dis 2020; 93:160-162. [DOI: 10.1016/j.ijid.2020.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022] Open
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15
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Uppada UK, Sinha R. Outcome of Odontogenic Infections in Rural Setup: Our Experience in Management. J Maxillofac Oral Surg 2020; 19:113-118. [PMID: 31988573 PMCID: PMC6954943 DOI: 10.1007/s12663-019-01232-x] [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: 02/21/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE This study was intended to evaluate the various predisposing factors and to assess the causative microorganisms responsible for fascial space infections. MATERIALS AND METHODS A total of 124 patients who reported with an orofacial space infection of odontogenic origin were included. Following thorough evaluation, using a disposable syringe, pus sample was obtained and sent for culture and sensitivity test. Offending teeth were extracted under antibiotic coverage, and incision and drainage was done as and when indicated. RESULTS The results of this study show that submandibular space (34.6%) is the frequently involved fascial space. Majority of the patients are in the second and third decade of life (46.7%). Staphylococcus species (43.7%) is the most commonly isolated microorganism. Majority of the subject gives a history of hot fomentation (64.5%). Penicillin remains to be the drug of choice. Extraction of the offending tooth under antibiotic coverage and incision and drainage as indicated remains to be treatment option when the scenario is tackled in the initial stages. CONCLUSION Since the study was conducted in a semi-urban/rural setup, poor oral hygiene and lack of awareness for the dental health in addition to the delay in reporting to the clinician may have been the causes for the development of such fascial space infections from a small carious tooth.
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Affiliation(s)
- Uday Kiran Uppada
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana India
| | - Ramen Sinha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana India
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16
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Chou PY, Hsieh YH, Lin CH. Necrotizing fasciitis of the entire head and neck: Literature review and case report. Biomed J 2020; 43:94-98. [PMID: 32200961 PMCID: PMC7090320 DOI: 10.1016/j.bj.2019.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/31/2018] [Accepted: 08/11/2019] [Indexed: 12/20/2022] Open
Abstract
Necrotizing fasciitis (NF) is uncommon but potentially lethal when it is associated with systemic disorders. We report a case of odontogenic NF in a patient with uncontrolled diabetes mellitus. The patient was referred on day 10 since the onset of odontogenic NF. Protective tracheostomy, local facial-cervical fasciotomy were conducted and broadspectrum antibiotics were given, subsequent serial surgical drainage and debridement were performed in theater. Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumonia were isolated. Five staged debridements were performed to the targeted anatomic regions thus reducing surgical time and blood loss. The patient survived the acute infection and received subsequent reconstruction. Cervical NF with descending mediastinitis and periorbital NF is associated with high mortality rates. This is the only known report of an adult who survived NF affecting entire scalp, periorbital, cervical, and thoracic region. Early diagnosis and staged surgical planning minimize morbidity and mortality from NF.
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Affiliation(s)
- Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Huan Hsieh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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17
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Lee MH, Votto SS, Read-Fuller AM, Reddy LV. Necrotizing fasciitis of the scalp stemming from odontogenic infection. Proc (Bayl Univ Med Cent) 2020; 33:110-112. [PMID: 32063792 DOI: 10.1080/08998280.2019.1675419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 01/24/2023] Open
Abstract
Necrotizing fasciitis is a severe, rapidly progressive infectious process characterized by rapid spread and extensive tissue destruction. This condition stems from a variety of sources, may affect any area of the body, and requires rapid diagnosis and aggressive intervention. We present a rare case of odontogenic infection progressing to acute cervicofacial necrotizing fasciitis of the scalp and neck.
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Affiliation(s)
- Michael H Lee
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas.,United States Navy
| | - Samuel S Votto
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas.,United States Navy
| | - Andrew M Read-Fuller
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas
| | - Likith V Reddy
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center at DallasDallasTexas
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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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19
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Rajanikanth B, Madhuri B, Prasad K, Vineeth K, Kumarpal Munoyath S. Odontogenic infection progressing to necrotizing fasciitis: An unusual clinical emergence. ORAL AND MAXILLOFACIAL SURGERY CASES 2019. [DOI: 10.1016/j.omsc.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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20
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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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Bobe Alifi Leta P, Sekele Isouradi Bourley JP, Nyimi Bushabu F, Vinckier F, Lunguya Metila O, Situakibanza Nani-Tuma H. Epidemiologic analysis of dental cellulitis in Kinshasa city (the Democratic Republic of the Congo). JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2018038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: The study aimed to determine the prevalence, describe the sociodemographic profile of individuals with dental cellulitis, and identify its associated factors in a population of Kinshasa. Materials and methods: This was a cross-sectional analytical study conducted in October 2017 in five hospital departments in Kinshasa. The sample population consisted of patients with dental cellulitis. Sociodemographic data and factors associated with dental cellulitis were evaluated. Results: Dental cellulitis was found in 12.5% of the subjects, with a slight female predominance (58.2%). A significant difference between patients with cellulitis and those without cellulitis was observed for the following variables: education level, unemployment, and low socioeconomic status (p < 0.05). Dental carious lesions (93.7%) were the most common causative factor, and self-medication (100%) and poor oral hygiene (83.5%) were risk or contributing factors. Univariate analysis showed that for people of ages 16–59 and ≥60 years, education level, unemployment, sugar consumption, and low socioeconomic status were significantly associated with dental cellulitis. A multivariate logistic regression analysis showed that people of ages ≥60 years [odds ratio (OR) 3.12, 95% confidence interval (CI) 1.169–4.14, p = 0.014], non-university status (OR 2.79, 95% CI 1.68–4.64, p < 0.001), unemployment (OR 2.27, 95% CI 1.73–4.20, p = 0.005), sugar consumption (OR 3.17, 95% CI 1.71–4.94, p = 0.036), and low socioeconomic status (OR 2.60, 95% CI 1.85–3.01, p = 0.014) were independently associated with dental cellulitis in the study population. Conclusion: Dental cellulitis is a public health problem in the city of Kinshasa, the Democratic Republic of Congo.
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Re Cecconi D, Fornara R. Ludwig's angina: a case report with a 5-year follow-up. GIORNALE ITALIANO DI ENDODONZIA 2018. [DOI: 10.1016/j.gien.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gore MR. Odontogenic necrotizing fasciitis: a systematic review of the literature. BMC EAR, NOSE, AND THROAT DISORDERS 2018; 18:14. [PMID: 30127662 PMCID: PMC6094465 DOI: 10.1186/s12901-018-0059-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/11/2018] [Indexed: 02/03/2023]
Abstract
Background While odontogenic soft tissue infections of the head and neck are common, progression to necrotizing fasciitis is relatively rare. Necrotizing fasciitis is a potentially life-threatening and rapidly progressive soft tissue infection that can lead to significant skin and soft tissue loss, mediastinitis, vascular thrombosis or rupture, limb loss, organ failure, and death. Methods A PubMed literature search was conducted for case reports and case series on odontogenic necrotizing fasciitis. Individual patient data was analyzed and compiled and demographic, treatment, microbiology, and mortality data were extracted. Fisher’s exact test was used to examine the relationship between death from odontogenic necrotizing fasciitis and diabetes mellitus (DM) and human immunodeficiency virus (HIV) positivity. Results A total of 58 studies totaling 164 patients were identified. Thirty-three patients had DM and 3 were HIV +. All patients underwent aggressive surgical debridement and treatment with IV antibiotics. Twenty patients were also treated with hyperbaric oxygen. There were 16 deaths reported, for a mortality rate of 9.8%. The mortality rate among patients with DM was 30.3 and 0% among HIV positive patients. There was a statistically significant increase in the mortality rate in DM patients with odontogenic necrotizing fasciitis (p = 0.0001, odds ratio for death 9.1). Conclusions Necrotizing fasciitis arising from odontogenic infection is a rapidly progressive and life-threatening illness. Prompt recognition of the infection, aggressive and often serial surgical debridement, and aggressive broad-spectrum antibiotics are necessary to prevent serious morbidity and mortality. Patients with diabetes mellitus are at a significantly increased risk of death from odontogenic necrotizing fasciitis.
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Altug HA, Tatli U, Coskun AT, Erdogan Ö, Özkan A, Sencimen M, Kürkçü M. Effects of hyperbaric oxygen treatment on implant osseointegration in experimental diabetes mellitus. J Appl Oral Sci 2018; 26:e20180083. [PMID: 29995150 PMCID: PMC6025889 DOI: 10.1590/1678-7757-2018-0083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/17/2018] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate whether hyperbaric oxygen (HBO) treatment has a favorable effect on implant osseointegration in diabetic rabbits. Material and Methods An experimental diabetes model was induced in 32 New Zealand rabbits through IV injection of alloxan. After the state of diabetes had been confirmed, one dental implant was placed in the metaphysical region of each animal’s tibia. After the implants’ placements, the animals were divided into two groups. Half of the animals underwent HBO treatment, while the other group did not receive HBO treatment and served as the control group. The animals were euthanized at the 4th and 8th weeks. The osseointegration of the implants were compared by histomorphometry and resonance frequency analysis (RFA). Results The Bone Implant Contact (BIC) values were significantly higher in the HBO group than in the control group at the 4th week. There was no difference in the BIC values between the groups at the 8th week. There was no significant difference in the RFA scores between the groups both at the 4th and 8th weeks after the operation. Conclusion Histomorphometry findings suggest that HBO has positive effect on implant osseointegration in the early healing period in diabetic rabbits. However, implant stability is not affected by HBO treatment.
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Affiliation(s)
- Hasan Ayberk Altug
- University of Health Sciences, Gülhane Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Ufuk Tatli
- Cukurova University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Adana, Turkey
| | - Abdullah Tugrul Coskun
- University of Health Sciences, Gülhane Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Özgür Erdogan
- Okan University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| | - Aydın Özkan
- University of Health Sciences, Gülhane Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Metin Sencimen
- University of Health Sciences, Gülhane Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Mehmet Kürkçü
- Cukurova University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Adana, Turkey
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Bayetto K, Cheng A, Sambrook P. Necrotizing fasciitis as a complication of odontogenic infection: a review of management and case series. Aust Dent J 2017; 62:317-322. [PMID: 28241379 DOI: 10.1111/adj.12508] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aims of the present study were to establish the incidence of head and neck necrotizing fasciitis (NF) in the Adelaide Oral and Maxillofacial Surgery Unit; review the current literature regarding the management of head and neck NF; and determine the evidence for the role of hyperbaric oxygen therapy in the management of NF. METHODS A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006-2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. RESULTS A total of 672 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48/100 000 infections per year. CONCLUSIONS The first-line treatment of severe odontogenic infections remains conventional surgical and medical management; however, hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients.
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Affiliation(s)
- K Bayetto
- Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A Cheng
- Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - P Sambrook
- Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Cortese A, Pantaleo G, Borri A, Amato M, Claudio PP. Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature. Aging Clin Exp Res 2017; 29:159-165. [PMID: 27798811 DOI: 10.1007/s40520-016-0650-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/12/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin. METHODS In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need. CONCLUSIONS Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.
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Affiliation(s)
- Antonio Cortese
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.
| | - Giuseppe Pantaleo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Borri
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Massimo Amato
- Department of Medicine and Surgery, University of Salerno, Baronissi, SA, Italy
| | - Pier Paolo Claudio
- Department of BioMolecular Sciences, School of Pharmacy, National Center for Natural Products Research, University of Mississippi, Oxford, MS, USA
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Taneja V, Walker RJ, Tedla M. Necrotising fasciitis of the neck: Unusual presentation with aggressive management – case report with review of literature. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2016.1266636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Virangna Taneja
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Rachel J. Walker
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Miroslav Tedla
- Otorhinolaryngology Department, Warwick University and University Hospital Coventry, Coventry, UK
- Department of ORL-HNS, Faculty of Medicine, Comenius University Bratislava, Slovakia
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Lee CY, Li YY, Huang TW, Huang TY, Hsu WH, Tsai YH, Huang JC, Huang KC. Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center. Infection 2016; 44:757-763. [PMID: 27778190 PMCID: PMC5121196 DOI: 10.1007/s15010-016-0932-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/28/2016] [Indexed: 12/20/2022]
Abstract
Purpose No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF. Methods Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated. Results Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia. Conclusions Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.
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Affiliation(s)
- Ching-Yu Lee
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Yao Li
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan
| | - Tsan-Wen Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hung Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan
| | - Jou-Chen Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Chin Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Arruda JA, Figueiredo E, Álvares P, Silva L, Silva L, Caubi A, Silveira M, Sobral AP. Cervical Necrotizing Fasciitis Caused by Dental Extraction. Case Rep Dent 2016; 2016:1674153. [PMID: 27375905 PMCID: PMC4916313 DOI: 10.1155/2016/1674153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/16/2016] [Indexed: 11/18/2022] Open
Abstract
Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections.
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Affiliation(s)
- José Alcides Arruda
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Eugênia Figueiredo
- Hospital da Restauração, Avenida Governador Agamenon Magalhães, S/N, Derby, 52010-040 Recife, PE, Brazil
| | - Pâmella Álvares
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Luciano Silva
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Leorik Silva
- Universidade Federal do Rio Grande do Norte, Campus Universitário Lagoa Nova, P.O. Box 1524, 59078-970 Natal, RN, Brazil
| | - Antônio Caubi
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Marcia Silveira
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Ana Paula Sobral
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
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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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An unusual infection of cervicofacial area caused by dental pathology: flesh-eating syndrome. Am J Emerg Med 2015; 33:1543.e3-6. [PMID: 26298055 DOI: 10.1016/j.ajem.2015.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/19/2015] [Indexed: 11/20/2022] Open
Abstract
Necrotizing fasciitis (NF) of the cervicofacial area is highly rare, but physicians should be familiar with the presentation of this situation owing to the suddenness of its beginning, the rapidness of its spread, and ending with high mortality and morbidity. In this article, 5 patients with NF admitted to emergency department with dental pathology history were discussed with a review of the literature. The purpose of this case series is to raise awareness about NF of the cervicofacial area caused by dental pathologies. Five patients admitted to our emergency department between January 2012 and March 2015 and diagnosed as having cervicofacial NF were identified. All patients had dental pathologies. The parameters of the study were patients' age, sex, complaints, self- and family histories, physical examinations' findings, routine laboratory-computed tomographic findings, treatment, and complications. Two of the patients were older than 70 years. One of the patients was healthy but he lost time because of an inappropriate treatment. These 3 patients died. The remaining patients were discharged at the end of the prolonged and intensive treatment. Necrotizing fasciitis should always be remembered in the diagnosis of the infection of the cervicofacial area. Because of difficulty in its diagnosis, a delay in the treatment may result in a horrific outcome.
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Abstract
Necrotizing fasciitis (NF) is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of necrotizing fasciitis from odontogenic origin in a patient with uncontrolled diabetes mellitus. The initial diagnosis was based on clinical information, in which multiple necrosis areas in cervical and thoracic regions were observed. Wide antibiotic therapy was applied, followed by surgical drain age and debridement. Culture was positive for methicillin-resistant Staphylococcus aureus. Although the treatment is established, the patient dies after sepsis and failure of vital organs. Clearly, the morbidity associated to this infection, even in diabetic patients, can be minimized if an early diagnosis and effective debridement are done.
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Manjunath KS, Bhandage S, Kamat S. 'Potato peel dressing': a novel adjunctive in the management of necrotizing fasciitis. J Maxillofac Oral Surg 2015; 14:352-4. [PMID: 25848140 DOI: 10.1007/s12663-013-0590-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022] Open
Abstract
Management of necrotizing fasciitis, a rare and potentially fatal, polymicrobial disease comprises of aggressive debridement, intravenous antibiotics and application of various adjunctives. So far adjunctives like hyperbaric oxygen therapy, intravenous immunoglobulins, vacuum assisted or foam dressing, and guided tissue regeneration with amniotic dressing have been put to use. Each of these adjunctives has faced criticism for their shortcomings. Potato peel has been used as a dressing for chronic wounds but there is no literature available on its application over wounds afflicted with necrotizing fasciitis. Owing to various medicinal properties of potato peel and its use as a dressing in other medical conditions, same was used as an adjunctive in the present case. Here we present a case of cervical necrotizing fasciitis of dentogenous origin, treated by mainstay surgical treatment with debridement, drainage in combination with broad spectrum antibiotics and a novel adjunctive, 'potato peel dressing', which has shown promising results.
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Affiliation(s)
- K S Manjunath
- Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College and Hospital, Hassan, 573201 Karnataka India
| | - Supriya Bhandage
- Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College and Hospital, Hassan, 573201 Karnataka India
| | - Shishir Kamat
- Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College and Hospital, Hassan, 573201 Karnataka India
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Muhammad JK, Almadani H, Al Hashemi BA, Liaqat M. The value of early intervention and a multidisciplinary approach in the management of necrotizing fasciitis of the neck and anterior mediastinum of odontogenic origin. J Oral Maxillofac Surg 2014; 73:918-27. [PMID: 25795188 DOI: 10.1016/j.joms.2014.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/16/2022]
Abstract
Necrotizing fasciitis (NF) is a serious clinical condition, which, if diagnosed late, invariably leads to a fatal outcome. A high index of suspicion of the presenting clinical signs and symptoms, supported by knowledge of the clinicopathologic processes that underlie its aggressive nature, should prompt early surgical intervention. Ultimately, the success of treatment requires a robust clinical pathway in which all members of the health care team are aligned by their skill sets and competencies to manage NF. This report describes the management of a case of a young man with aggressive NF of odontogenic origin affecting the neck and anterior mediastinum. A multidisciplinary approach brought about early recognition of the disease and surgical intervention, the use of frozen section biopsies to determine the extent of fascial spread, and aggressive debridement of the affected tissue. Teamwork, critical thinking, and situational awareness ensured that the patient received optimum care in a timely manner. The psychological, clinical, radiologic, pathologic, and microbiological aspects of the patient's care are presented with a literature review.
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Affiliation(s)
- Joseph Kamal Muhammad
- Consultant and Head, Maxillofacial Surgery Service, Al Rahba Hospital, Abu Dhabi, UAE; formerly at Mafraq Hospital, Abu Dhabi.
| | - Hana Almadani
- Consultant, Department of General Surgery, Mafraq Hospital, Abu Dhabi, UAE
| | - Bader A Al Hashemi
- Consultant and Head, Department of Maxillofacial Surgery, Mafraq Hospital, Abu Dhabi, UAE
| | - Muneezeh Liaqat
- Consultant, Department of Anatomic Pathology, Mafraq Hospital, Abu Dhabi, UAE
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Cruz Toro P, Callejo Castillo À, Tornero Saltó J, González Compta X, Farré A, Maños M. Cervical necrotizing fasciitis: Report of 6 cases and review of literature. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:357-359. [DOI: 10.1016/j.anorl.2013.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 08/02/2013] [Accepted: 08/08/2013] [Indexed: 10/25/2022]
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Abstract
Objective: The aim of this retrospective study was to evaluate the involvement of fascial spaces, their bacteriology, sensitivity to antibiotics and management of odontogenic infection in 100 patients of age less than 60 years. Resuls: The mandibular 3rd molar was found to be the most commonly offending tooth, followed by the mandibular 2nd molar. The submandibular space was the most frequently involved fascial space both in single fascial space infections and multiple fascial space infections. Mixed growth (aerobic and anaerobic) was seen in culture smears of 60 patients, only aerobic bacterial growth was seen in 25 patients and anaerobic bacterial growth was seen in culture smears of 15 patients. Streptococcus viridans was the most frequently isolated bacteria among the aerobes, whereas Bacteroides and Prevotella were the most common bacterial species among anaerobes. Empirical antibiotic therapy in the form of Co amoxiclav and Metronidazole was given. Incision and drainage followed by extraction of the offending tooth/teeth was carried out. Conclusion: It was concluded that odontogenic infections were mixed aerobic–anaerobic infections. Anaerobic as well as aerobic cultures were necessary to isolate all pathogens. Successful management of these infections depends on changing the environment through decompression, removal of the etiologic factor and by choosing the proper antibiotic.
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Affiliation(s)
- Rashi Bahl
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College, Ludhiana, Punjab, India
| | - Sumeet Sandhu
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab, India
| | - Kanwardeep Singh
- Department of Microbiology, Government Medical College, Amritsar, Punjab, India
| | - Nilanchal Sahai
- Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Mohita Gupta
- Department of Pediatric Dentistry, Pacific Dental College, Rajasthan, India
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Camino Junior R, Naclerio-Homem MG, Cabral LM, Luz JGC. Cervical Necrotizing Fasciitis of Odontogenic Origin in a Diabetic Patient Complicated by Substance Abuse. Braz Dent J 2014; 25:69-72. [DOI: 10.1590/0103-6440201302336] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/28/2014] [Indexed: 11/22/2022] Open
Abstract
Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.
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Necrotizing fasciitis of the cervico-facial region due to odontogenic infection. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2014. [DOI: 10.1016/j.ajoms.2012.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cervical necrotizing fasciitis and diabetic ketoacidosis: Literature review and case report. Int J Oral Maxillofac Surg 2013; 42:1592-5. [DOI: 10.1016/j.ijom.2013.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/13/2013] [Indexed: 02/02/2023]
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Obimakinde OS, Okoje VN, Akinmoladun VI, Fasola AO, Arotiba JT. Retrospective evaluation of necrotizing fasciitis in University College Hospital, Ibadan. Niger J Clin Pract 2012; 15:344-8. [PMID: 22960973 DOI: 10.4103/1119-3077.100644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Cervicofacial necrotizing fasciitis (CNF), although a potentially fatal fulminant infection has been largely under-reported in the dental literature. AIMS To report our experience with cases seen and treated at the University College Hospital, Ibadan, Nigeria. SETTINGS AND DESIGN A descriptive retrospective clinical study. MATERIALS AND METHODS A retrospective survey of cases treated between January 2002 and January 2007 was done. Diagnosis of CNF was established by fascia necrosis found on surgical exploration. Patients' age, sex, medical status, etiology of infection, bacteriology, and treatment received and complications were reviewed. STATISTICAL ANALYSIS USED SPSS version 15. RESULTS Of the 48 cases of cervicofacial infection admitted during the study period, only 12 cases of CNF were found. Male:Female ratio was 4:8. The mean age of patients was 58.83 ± 11.91 years while the age range was 42-83 years. Those that had immunocompromised medical conditions included three cases each of diabetes mellitus and chronic nutritional anaemia and one case of retroviral infection. Mixed bacterial isolates of anaerobes and enterobacteriaceae were found in 10 cases while beta hemolytic streptococci were the sole isolate in two cases. All patients had serial debridement combined with intravenous antibiotic medications. Complications included anterior chest wall infection in three patients and one case of pleural effusion. The only mortality occurred in the patient with retroviral infection. CONCLUSIONS We advocate early recognition, surgical debridement and intensive medical care for treatment of CNF in order to reduce morbidity and mortality from this condition.
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Affiliation(s)
- O S Obimakinde
- Department of Dental and Maxillofacial Surgery, University Teaching Hospital, Ado Ekiti, Nigeria
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Leavitt BD, Van Ess JM. Rapid, early-onset group a streptococcus infection after impacted third molar removal: a review and case series. J Oral Maxillofac Surg 2012; 70:2742-7. [PMID: 23010371 DOI: 10.1016/j.joms.2012.07.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 06/30/2012] [Accepted: 07/22/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Bryce D Leavitt
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN, USA.
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Nanda S, Chakraborty S, Ray A, Inamuddin. Healing of cervical necrotizing fasciitis using amniotic membrane as a dressing material. Natl J Maxillofac Surg 2012; 2:147-51. [PMID: 22639502 PMCID: PMC3343392 DOI: 10.4103/0975-5950.94469] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVES Early recognition, aggressive surgical debridement, removal of cause, appropriate antibiotic therapy, improvement of immunocompromised state and dressing of the wound is the treatment of necrotizing cervical fasciitis. There are so many reported cases of burn and some reported cases of necrotizing fasciitis where amniotic membrane has been used as a dressing material, and that encouraged us to use it as a dressing material in our cases. MATERIALS AND METHODS Six cases of necrotizing cervical fasciitis reported to our department in a span of five years (2005 to 2010). Amniotic membrane taken from placenta of suitable donors had been used as a dressing material in these cases. Data collection included age, sex, medical history of the patients, size of the wound, pain felt by the patient, time taken for granulation tissue formation, total healing time, size of the scar and need for future reconstruction. RESULTS The sample consisted of six patients with a mean age of 45 years. Four of them were male. Etiology was always odontogenic. Five patients were immunocompromised. Three patients were chronic alcoholic. Average size of the wound was 42 square centimeter. Mean time taken for formation of granulation tissue was 22 days; mean total healing time was 36 days. In every case patient reported with pain, which gradually diminished after first application of amniotic membrane. In three cases, pain on fourth day after first application of amniotic membrane was nil (VAS scale). In rest three cases, pain on sixth day after first application of amniotic membrane was nil (VAS scale). Average size of the scar was 9 cm(2). Secondary scar revision was required in all six cases. CONCLUSION Our study concludes that amniotic membrane can be used effectively as a dressing material in necrotizing cervical fasciitis.
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Affiliation(s)
- Sidhartha Nanda
- Department of Oral and Maxillofacial Surgery, Gurunanak Institute of Dental Science and Research, 147F, Nilgunge Road, Kolkata, India
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Sarna T, Sengupta T, Miloro M, Kolokythas A. Cervical Necrotizing Fasciitis With Descending Mediastinitis: Literature Review and Case Report. J Oral Maxillofac Surg 2012; 70:1342-50. [DOI: 10.1016/j.joms.2011.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 10/17/2022]
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Mathew GC, Ranganathan LK, Gandhi S, Jacob ME, Singh I, Solanki M, Bither S. Odontogenic maxillofacial space infections at a tertiary care center in North India: a five-year retrospective study. Int J Infect Dis 2012; 16:e296-302. [PMID: 22365137 DOI: 10.1016/j.ijid.2011.12.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 12/05/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Odontogenic infections contribute to a significant proportion of maxillofacial space infections (MSI) across the world. MSI can cause several life-threatening complications despite skillful management. The objective of this study was to review the clinical characteristics, management, and outcome of odontogenic MSI treated at a tertiary care center, and to identify the factors predisposing to life-threatening complications. METHODS A retrospective chart review of all patients treated for MSI from January 2006 to December 2010 at the Christian Medical College Hospital in Ludhiana, North India, was conducted. RESULTS Out of 137 patients identified, 66.4% were men. Mean patient age was 40 years, and 24.1% of the patients were diabetic. The most common origin was pulpal (70.8%), the most common space involved was the submandibular space, and the most common teeth responsible were the lower third molars. Twenty patients (14.6%) developed complications. Diabetes, multiple space involvement, and a total leukocyte count of ≥15×10(9)/l were associated with complications. CONCLUSIONS Patients with MSI who present with multiple space involvement, a high leukocyte count, and those with diabetes are at higher risk of developing life-threatening complications and need to be closely monitored.
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Affiliation(s)
- George C Mathew
- Department of Oral and Maxillofacial Surgery, Christian Dental College, Ludhiana, Punjab, India
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Facial necrotizing fasciitis from an odontogenic infection. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:e1-4. [PMID: 22669114 DOI: 10.1016/j.tripleo.2011.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 05/17/2011] [Accepted: 06/13/2011] [Indexed: 11/20/2022]
Abstract
Necrotizing fasciitis (NF) is defined as rapidly progressive necrosis of subcutaneous fat and fascia. It is a rare but life-threatening infection characterized by a progressive, usually rapid, necrotizing process of the subcutaneous tissues and fascial planes. The condition is commonly described in the extremities, abdominal wall, and perineum but rarely seen in the head and neck. The diagnosis of NF depends mainly on clinical features, which are not always observable, so that the disease is often diagnosed late in its course, resulting in high mortality. Broad-spectrum antibiotics, aggressive surgical treatment and supportive therapy are the most widely accepted modalities of successful treatment. We describe a case of necrotizing fasciitis of the head and neck, arising from odontogenic origin.
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Kim YJ, Kim JD, Ryu HI, Cho YH, Kong JH, Ohe JY, Kwon YD, Choi BJ, Kim GT. Application of radiographic images in diagnosis and treatment of deep neck infections with necrotizing fasciitis: a case report. Imaging Sci Dent 2011; 41:189-93. [PMID: 22232730 PMCID: PMC3251794 DOI: 10.5624/isd.2011.41.4.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 08/25/2011] [Accepted: 08/30/2011] [Indexed: 11/23/2022] Open
Abstract
The advent and wide use of antibiotics have decreased the incidence of deep neck infection. When a deep neck infection does occur, however, it can be the cause of significant morbidity and death, resulting in airway obstruction, mediastinitis, pericarditis, epidural abscesses, and major vessel erosion. In our clinic, a patient with diffuse chronic osteomyelitis of mandible and fascial space abscess and necrotic fasciitis due to odontogenic infection at the time of first visit came. We successfully treated the patient by early diagnosis using contrast-enhanced CT and follow up dressing through the appropriate use of radiographic images.
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Affiliation(s)
- Young-Joo Kim
- Department of Oral and Maxillofacial Surgery, Dental School, Kyung Hee University, Seoul, Korea
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Cervical necrotizing fasciitis of odontogenic origin involving the temporal region – A case report. J Craniomaxillofac Surg 2011; 39:570-3. [DOI: 10.1016/j.jcms.2010.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 03/29/2010] [Accepted: 05/11/2010] [Indexed: 11/22/2022] Open
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Craniocervical Necrotizing Fasciitis Resulting from Dentoalveolar Infection. Oral Maxillofac Surg Clin North Am 2011; 23:425-32. [DOI: 10.1016/j.coms.2011.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Murray M, Dean J, Finn R. Cervicofacial necrotizing fasciitis and steroids: case report and literature review. J Oral Maxillofac Surg 2011; 70:340-4. [PMID: 21664745 DOI: 10.1016/j.joms.2011.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 02/03/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Matthew Murray
- Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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Rai M, Ramaraj P, Sharma A. Use of Amniotic Membrane as Dressing in Cervical Necrotizing Fasciitis. J Oral Maxillofac Surg 2011; 69:1125-8. [DOI: 10.1016/j.joms.2010.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 01/24/2010] [Accepted: 03/04/2010] [Indexed: 12/15/2022]
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