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Méndez Gutiérrez JC, García-Covarrubias L, Reding-Bernal A, Velázquez Chong HA, Fernández Ángel DF, García Covarrubias A, Hernández-Rivera JC. Utility of a clinical risk scale to predict the requirement of advanced airway management in patients with a diagnosis of deep neck abscess. Braz J Otorhinolaryngol 2024; 90:101360. [PMID: 38035470 PMCID: PMC10698535 DOI: 10.1016/j.bjorl.2023.101360] [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: 09/28/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES To analyze the clinical utility of a clinical risk scale to predict the need for advanced airway management in patients with deep neck abscess. METHODS Observational, analytical, cross-sectional study. Patients over 18 years old, both genders, with surgical management of a deep neck abscess, between January 1st, 2015 to December 31th, 2021, who were applied the clinical risk scale (https://7-414-5-19.shinyapps.io/ClinicalRiskScore/). The sensitivity, specificity, and predictive values of the scale were calculated based on the identified clinical outcomes. A p<0.05 was considered significant. RESULTS A sample of 213 patients was obtained, 121 (56.8%) men, of whom 50 (23.5%) required advanced airway management. Dyspnea was the variable with the most statistical weight in our study, (p=0.001) as well as the multiple spaces involvement, (p=0.001) the presence of air corpuscles, (p=0.001) compromise of the retropharyngeal space (p=0.001) and age greater than 55 years (p=0.001). Taking these data into account, were found for the clinical risk scale a sensitivity of 97% and a specificity of 65% (p=0.001, 95% CI 0.856-0.984). CONCLUSIONS The clinical risk scale developed to predict advanced airway management in patients with a diagnosis of deep neck abscess may be applicable in our environment with high sensitivity and specificity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Juan Carlos Méndez Gutiérrez
- Hospital de Especialidades Dr. Bernardo Sepúlveda Gutiérrez, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Head and Neck Department, Mexico City, Mexico
| | - Luis García-Covarrubias
- Hospital de Especialidades Dr. Bernardo Sepúlveda Gutiérrez, CMN XXI, Instituto Mexicano del Seguro Social, Gastro-Surgery Department, Mexico City, Mexico; Hospital General de México "Dr. Eduardo Liceaga", Surgery Department, Mexico City, Mexico.
| | - Arturo Reding-Bernal
- Hospital General De México "Dr. Eduardo Licega", Research Department, Mexico City, Mexico
| | - Héctor A Velázquez Chong
- Hospital de Especialidades Dr. Bernardo Sepúlveda Gutiérrez, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Head and Neck Department, Mexico City, Mexico
| | | | | | - Juan Carlos Hernández-Rivera
- Hospital de Especialidades Dr. Bernardo Sepúlveda Gutiérrez, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Medical Research Unit on Nephrological Diseases, Mexico City, Mexico
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Mehmed M, Walters B, Keys H, Hnynn Si PE, Athavale N, Abdelhafiz AH. Spontaneous retropharyngeal abscess presenting as delirium in a frail older woman: a case-based review. Hosp Pract (1995) 2024; 52:39-45. [PMID: 38466020 DOI: 10.1080/21548331.2024.2329043] [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: 10/13/2023] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Retropharyngeal abscess (RPA) is an uncommon infection in older people, which usually presents with localized upper airway symptoms. CASE PRESENTATION We present a case of RPA in a 69-year-old frail woman with co-morbidities, who presented atypically with delirium. She initially complained of general symptoms of malaise, body aches and general decline. Her symptoms progressed to hypoactive delirium before she started to localize her complaints to the upper airway. The delirium presentation of RPA is not commonly reported in the literature. Co-morbidities and frailty are likely to be the underlying risk factors for delirium presentation in this case. Most of the RPA cases reported in older people in the literature presented typically with localized symptoms, however these cases had lower burden of morbidities and reported no frailty. In our case report, poor mouth hygiene and dental caries were thought to be the source of infection. Early intervention with antibiotic treatment for total of four weeks resulted in a full recovery. CONCLUSION RPA may present with delirium in older people with frailty and co-morbidities. Poor oral hygiene and dental caries, if left untreated, may progress into serious deep space neck infection.
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Affiliation(s)
- Melisa Mehmed
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | - Ben Walters
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | - Heather Keys
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | - Pann Ei Hnynn Si
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | | | - Ahmed H Abdelhafiz
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
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Sakkas A, Weiß C, Zink W, Rodriguez CA, Scheurer M, Pietzka S, Wilde F, Thiele OC, Mischkowski RA, Ebeling M. Airway Management of Orofacial Infections Originating in the Mandible. J Pers Med 2023; 13:950. [PMID: 37373939 DOI: 10.3390/jpm13060950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
The primary aim of this study was to assess the incidence of a difficult airway and emergency tracheostomy in patients with orofacial infections originating in the mandible, and a secondary aim was to determine the potential predictors of difficult intubation. This retrospective single-center study included all patients who were referred between 2015 and 2022 with an orofacial infection originating in the mandible and who were surgically drained under intubation anesthesia. The incidence of a difficult airway regarding ventilation, laryngoscopy, and intubation was analyzed descriptively. Associations between potential influencing factors and difficult intubation were examined via multivariable analysis. A total of 361 patients (mean age: 47.7 years) were included in the analysis. A difficult airway was present in 121/361 (33.5%) patients. Difficult intubation was most common in patients with infections of the massetericomandibular space (42.6%), followed by infections of the mouth floor (40%) and pterygomandibular space (23.5%). Dyspnea and stridor were not associated with the localization of infection (p = 0.6486/p = 0.4418). Multivariable analysis revealed increased age, restricted mouth opening, higher Mallampati scores, and higher Cormack-Lehane classification grades as significant predictors of difficult intubation. Higher BMI, dysphagia, dyspnea, stridor and a non-palpable mandibular rim did not influence the airway management. Patients with a difficult airway were more likely to be admitted to the ICU after surgery than patients with regular airway were (p = 0.0001). To conclude, the incidence of a difficult airway was high in patients with orofacial infections originating in the mandible. Older age, limited mouth opening, a higher Mallampati score, and a higher Cormack-Lehane grade were reliable predictors of difficult intubation.
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Affiliation(s)
- Andreas Sakkas
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Christel Weiß
- Medical Statistics and Biomathematics, Mannheim Medical Faculty of the Heidelberg University, 68167 Mannheim, Germany
| | - Wolfgang Zink
- Department of Anesthesiology and Intensive Care Medicine, Ludwigshafen Hospital, 67063 Ludwigshafen, Germany
| | | | - Mario Scheurer
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Sebastian Pietzka
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Frank Wilde
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Oliver Christian Thiele
- Department of Cranio-Maxillo-Facial-Surgery, Ludwigshafen Hospital, 67063 Ludwigshafen, Germany
| | | | - Marcel Ebeling
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, 89081 Ulm, Germany
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Loperfido A, Stasolla A, Giorgione C, Mammarella F, Celebrini A, Acquaviva G, Bellocchi G. Management of Deep Neck Space Infections: A Large Tertiary Center Experience. Cureus 2023; 15:e34974. [PMID: 36938157 PMCID: PMC10019553 DOI: 10.7759/cureus.34974] [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: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Deep neck space infections (DNIs) represent serious bacterial infections affecting the deep cervical space and fascial planes of the neck. This study aims to describe our clinical and surgical experience in the management of DNIs, emphasizing the importance of appropriate imaging in the diagnostic setting and the role of the multidisciplinary approach according to the severity of the infection. METHODS In this retrospective study, we describe 85 patients affected by DNIs coming to the Otolaryngology department observation from the Emergency Room of San Camillo Forlanini Hospital in Rome from January 2006 to December 2021 and treated both by pharmacological and surgical therapy. RESULTS 54 patients (64%) were male, and 31 (36%) were female, with a mean age of 50.5 years. The most common cause of DNI was odontogenic, accounting for 70% of all collected cases. In 68 patients (80% of all cases), the surgical approach consisted of an extended unilateral cervicotomy, whereas in 17 patients (20% of all cases), a bilateral cervicotomy was performed. Surgical revision was required in 15 cases (18%). A tracheostomy was necessary in seven cases. The overall survival rate was 96.5%. CONCLUSIONS DNI represents a serious and life-threatening condition, remaining a constant challenge for the head and neck surgeon. Contrast-enhanced computed tomography is critical for therapeutic planning, which requires both a surgical approach and antibiotic therapy. Surgical treatment should be performed as soon as possible. In severe cases, the multidisciplinary approach is advisable.
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Tecle NE, Hackenberg S, Scheich M, Scherzad A, Hagen R, Gehrke T. Surgical management of lateral neck abscesses in children: a retrospective analysis of 100 cases. Eur J Pediatr 2023; 182:431-438. [PMID: 36378330 PMCID: PMC9829626 DOI: 10.1007/s00431-022-04676-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/09/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022]
Abstract
UNLABELLED Cervical abscesses are relatively common infections in pediatric patients. There is an ongoing debate about the necessity and time point of surgical drainage. The identification of a focus of infection might play an important role in facilitating a therapeutic decision. In a retrospective study, 100 pediatric patients aged 1-18 years who underwent incision and drainage of a lateral cervical abscess at our institution were analyzed. Patients were divided into two groups based on whether a focus of infection could be identified or not. Data collection included patient characteristics, microbiological results, antibiotic regimen, and clinical course. A focus of infection was found in 29% (29/100) of the patients, most frequently in the tonsils. A causative microorganism was found in 75% (75/100) of all patients, with Staphylococcus aureus and Streptococcus pyogenes being the most common pathogens. All patients received an empiric antibiotic therapy in addition to surgery. Antibiotic medication was changed in 31% in both groups (9/29 with a focus of infection and 22/71 without a focus of infection) during therapy. Children without an identified focus of infection generally were younger and had more comorbidities reducing immune response while also showing differences in the pathogens involved. There were no complications associated to surgery or antibiotic therapy in any of the patients involved. CONCLUSION Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding the microorganisms involved. But the focus of infection seems not to have an impact on patient's outcome. WHAT IS KNOWN • Neck abscesses are a relatively common disease in the pediatric population and may cause serious complications. • Therapy in general consists of intravenous antibiotics with or without surgery. WHAT IS NEW • The focus identification has no impact on patient's outcome. • Children with an identified focus of infection show several differences compared to those with isolated lateral abscesses, especially regarding their medical history, age, and the microorganisms involved.
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Affiliation(s)
- Nyat-Eyob Tecle
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany.
| | - Stephan Hackenberg
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany ,Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Scheich
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Agmal Scherzad
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Thomas Gehrke
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Würzburg, Würzburg, Germany
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FLORES NAJERA SS, REDING-BERNAL A, BACILIO E, HERNÁNDEZ-RIVERA JC, PRIETO-OLIVARES P, GARCÍA AC, GARCÍA-COVARRUBIAS L. Risk factors to develop mediastinitis in patients with deep neck abscess. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Khoury M, Dong SX, Alsaffar H, Johnson-Obaseki S, Caulley L. Isolated oropharyngeal abscess with hypopharyngeal extension recurring 12 years after initial surgical management: A case report and review of the literature. SAGE Open Med Case Rep 2022; 10:2050313X221089119. [PMID: 35401981 PMCID: PMC8984837 DOI: 10.1177/2050313x221089119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Pharyngeal abscesses require urgent management as they have the propensity to cause severe and life-threatening complications. The introduction of antibiotics has led to a dramatic decline in the incidence of these infections. Regardless, abscess formation continues to be observed in the peritonsillar, parapharyngeal, and retropharyngeal spaces. Oropharyngeal and hypopharyngeal abscesses that cause airway obstruction are scarcely reported and tend to be secondary to other processes. Herein, we describe the case of an 83-year-old man presenting with an idiopathic, obstructive, oropharyngeal wall abscess, extending from the infratonsillar region to the hypopharynx, which recurred after initial surgical management 12 years prior for the same process. He required reintervention during both episodes for rapid reaccumulation. A detailed electronic literature search of PubMed and MedLine was performed for studies reporting on recurrent pharyngeal abscesses and their management. Results were limited to articles published in English from inception to August 2021. The timely management of pharyngeal infections acutely obstructing the airway is crucial. Physicians should adopt close and frequent monitoring and have a low threshold for reimaging should symptoms worsen or fail to improve after the initial surgical intervention.
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Affiliation(s)
- Michel Khoury
- Department of Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Selina Xiangxu Dong
- Department of Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Hussain Alsaffar
- Department of Otolaryngology—Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology—Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Caulley
- Department of Otolaryngology—Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Knowledge Synthesis Group, Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Goenka PK, Hall M, Shah SS, Florin TA, Leone N, Narayanan S, Ishman S, Gill P, Liewehr S, Palumbo N, McGeechan S, Mestre M, Parikh K. Corticosteroids in the Treatment of Pediatric Retropharyngeal and Parapharyngeal Abscesses. Pediatrics 2021; 148:peds.2020-037010. [PMID: 34697219 DOI: 10.1542/peds.2020-037010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs) includes antibiotics, with possible surgical drainage. Although corticosteroids may decrease inflammation, their role in the management of RPAs and PPAs is unclear. We evaluated the association of corticosteroid administration as part of initial medical management on drainage rates and length of stay for children admitted with RPAs and PPAs. METHODS We conducted a retrospective study using administrative data of children aged 2 months to 8 years discharged with RPAs and PPAs from 2016 to 2019. Exposure was defined as systemic corticosteroids administered as part of initial management. Primary outcome was surgical drainage. Bivariate comparisons were made between patients in the corticosteroid and noncorticosteroid groups by using Wilcoxon rank or χ2 tests. Outcomes were modeled by using generalized linear mixed-effects models. RESULTS Of the 2259 patients with RPAs and PPAs, 1677 (74.2%) were in the noncorticosteroid group and 582 (25.8%) were in the corticosteroid group. There were no significant differences in age, sex, or insurance status. There was a lower rate of drainage in the corticosteroid cohort (odds ratio: 0.28; confidence interval: 0.22-0.36). Patients in this group were more likely to have repeat computed tomography imaging performed, had lower hospital costs, and were less likely to have opioid medications administered. The corticosteroid cohort had a higher 7-day emergency department revisit rate, but there was no difference in length of stay (rate ratio 0.97; confidence interval: 0.92-1.02). CONCLUSIONS Corticosteroids were associated with lower odds of surgical drainage among children with RPAs and PPAs.
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Affiliation(s)
- Pratichi K Goenka
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Matthew Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Samir S Shah
- Division of Hospital Medicine and Department of Pediatrics
| | - Todd A Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nicole Leone
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Sridaran Narayanan
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and School of Medicine, George Washington University, Washington, District of Columbia
| | - Stacey Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Peter Gill
- Division of Paediatric Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Sheila Liewehr
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Nancy Palumbo
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Stacy McGeechan
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Cohen Children's Medical Center-Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New Hyde Park, New York
| | - Marcos Mestre
- Division of Pediatric Hospital Medicine, Nicklaus Children's Hospital, Miami, Florida
| | - Kavita Parikh
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center and School of Medicine, George Washington University, Washington, District of Columbia
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Liu W, Gu W, Jin X, Wang J. Effects of Simultaneous versus Staged VAC Placement in the Treatment of Deep Neck Multiple-Space Infections at a Tertiary Hospital Over a Four-Year Period in China. Infect Drug Resist 2021; 14:4091-4096. [PMID: 34675554 PMCID: PMC8502109 DOI: 10.2147/idr.s334203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/28/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Surgical drainage is an essential part of treatment for deep neck infections (DNIs) or deep neck multiple-space infections (DNMIs). With the emergence and application of new technologies and new materials, vacuum-assisted closure (VAC) in the treatment of DNMIs has been reported. However, reports on the timing of VAC placement are limited. Herein, we compared simultaneous versus staged VAC placement in the treatment of DNMIs. Patients and Methods Medical data from 24 patients with DNMIs who had received VAC treatment in the last five years were analyzed. The patients were classified into a simultaneous VAC placement group (11 patients) and a staged VAC placement group (13 patients) according to the timing of VAC placement when incision and drainage were performed. Results No differences in baseline characteristics were found between the two groups. All patients in the two groups survived and recovered. The hospitalization duration (days), time to wound healing (days), number of debridement procedures, and disease course (days) in the simultaneous VAC placement group and staged VAC placement group were 10 (4–18) and 22 (8–35), 21 (4–39) and 50 (9–86), one (1–2) and two (1–4), and 31.5 (11–49) and 56 (19–98), respectively. The results in the simultaneous VAC placement group were better than those in the staged VAC placement group (P = 0.001, 0.016, 0.045, and 0.016, respectively). The numbers of VAC sponge changes in the simultaneous VAC placement group and staged VAC placement group were two (1–2) and two (1–4), respectively, with no statistically significant difference (P = 0.336). Conclusion Simultaneous VAC placement during incision and drainage may shorten the wound healing time, hospitalization duration, and disease course and may reduce the number of debridement procedures.
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Affiliation(s)
- Weijiao Liu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital Pinggu Campus, Capital Medical University, Beijing, People's Republic of China
| | - Wei Gu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaofeng Jin
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian Wang
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Cambria F, Fusconi M, Candelori F, Galli M, Stanganelli FRF, Venuta F, Valentini V, de Vincentiis M. Surgical multidisciplinary approach in the management of odontogenic or non-odontogenic neck infections. ACTA ACUST UNITED AC 2021; 41:S138-S144. [PMID: 34060529 PMCID: PMC8172099 DOI: 10.14639/0392-100x-suppl.1-41-2021-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/25/2021] [Indexed: 11/23/2022]
Abstract
In recent years, in our university hospital, the number of odontogenic and non-odontogenic abscesses has been rapidly increasing. We included 70 patients from January 4th 2018 to February 19th 2020 affected by the odontogenic ones. Deep neck infection can spread to the chest and is associated with high morbidity and mortality. The purpose of this mini-review is to demonstrate that, in case of complications, a multidisciplinary approach is needed to treat these infections, so that all practitioners should work together to achieve the patient’s rapid recovery.
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Affiliation(s)
| | - Massimo Fusconi
- Department of Sense Organs, University Sapienza of Rome, Italy
| | | | - Massimo Galli
- Department of Oral and Maxillo-Facial Surgery, University Sapienza of Rome, Italy
| | | | - Federico Venuta
- Department of Thoracic Surgery, University Sapienza of Rome, Rome, Italy
| | | | - Marco de Vincentiis
- Department of Oral and Maxillo-Facial Surgery, University Sapienza of Rome, Italy
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11
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Treviño-Gonzalez JL, Maldonado-Chapa F, González-Larios A, Morales-Del Angel JA, Soto-Galindo GA, Zafiro García-Villanueva JM. Deep Neck Infections: Demographic and Clinical Factors Associated with Poor Outcomes. ORL J Otorhinolaryngol Relat Spec 2021; 84:130-138. [PMID: 34237752 DOI: 10.1159/000517026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deep neck infections (DNIs) are abscesses located in the profound spaces of the neck and constitute one of the most common otolaryngological life-threatening emergencies. The aim of this study is to review the clinical and demographic data of patients with DNI and identify factors associated with prolonged hospitalization, reoperation, and mortality. METHODS Retrospective review and analysis of 75 patients with DNI admitted from January 2015 to December 2019 in a tertiary referral hospital. RESULTS Of 75 patients, 50 (66.6%) were males and 25 (33.3%) females. Age ranged from 18 to 91 years with a mean of 41.79 (±15.48). DNIs were odontogenic in 49 patients (65.3%). History of diabetes mellitus (DM) was positive in 26 patients (34.6%). The submandibular space was involved in 57 patients (76%). Streptococcus spp. were isolated in 35 patients (46%). Intubation for airway preservation was needed in 21 patients (28%) and tracheostomy in 6 (8%). Mediastinitis presented in 8 patients (10.67%), with a mortality rate of 62.5% (n = 5). Mean hospital stay was 9.13 days (±7.2). DM (p = 0.016), age (p = 0.001), BMI classification 3, 4, and 6 (p = 0.041), and intensive care unit (ICU) admission (p = 0.009) were associated with a longer stay. Surgical drainage was performed after 1.71 days (±1.65). Surgical reintervention was needed in 6 cases (8%) and was associated with temporal (p = 0.001) and masticator (p = 0.002) space involvement and DM (p = 0.009). Overall mortality was 8% and decreased to 1.5% when mediastinitis was excluded. Mediastinitis (p = 0.001), ICU admission (p < 0.0001), Streptococcus spp. (p = 0.019), and low hemoglobin levels (p = 0.004) were associated with mortality. DISCUSSION/CONCLUSION DNIs are entities associated with high morbimortality. Mediastinitis and airway obstruction are life-threatening possible complications and should be promptly evaluated. Low HB could be used as a predicting factor for mortality.
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Affiliation(s)
- José Luis Treviño-Gonzalez
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico,
| | - Félix Maldonado-Chapa
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | - Amalia González-Larios
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | - Josefina Alejandra Morales-Del Angel
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | - Germán Armando Soto-Galindo
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
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Borin M, Pignataro L, Ibba T, Di Cicco M, Folino F, Marchisio P, Capaccio P, Torretta S. Unrevealed foreign body in the deep neck space: A case report. Clin Case Rep 2021; 9:1478-1482. [PMID: 33768872 PMCID: PMC7981780 DOI: 10.1002/ccr3.3806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 12/04/2022] Open
Abstract
Clinical data provided by the patient are not always reliable or could be difficult to collect. In this case, a difficult history collection resulted in a diagnostic delay. Major complications were avoided performing an urgent surgical intervention.
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Affiliation(s)
- Marco Borin
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Tullio Ibba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | | | - Francesco Folino
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Pasquale Capaccio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Biomedical Surgical Dental ScienceUniversità degli Studi di MilanoMilanItaly
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
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A Nationwide Population-Based Study on the Incidence of Parapharyngeal and Retropharyngeal Abscess-A 10-Year Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031049. [PMID: 33504039 PMCID: PMC7908373 DOI: 10.3390/ijerph18031049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of over two million enrollees of the National Health Insurance system that covers over 99% of Taiwan’s citizens. During 2007–2016, 5779 patients received a diagnosis of PRPA. We calculated the population-wide incidence rates of PRPA by sex and age group (20–44, 45–64, and >64) as well as in-hospital mortality. The annual incidence rate of PRPA was 2.64 per 100,000 people. The gender-specific incidence rates per 100,000 people were 3.34 for males and 1.94 for females with a male:female gender ratio of 1.72. A slight increase in incidence rates among both genders over the study period was noted. Age-specific rates were lowest in the 20–44 age group with a mean annual incidence of 2.00 per 100,000 people, and the highest rates were noted in the age groups of 45–64 and >64 years with mean annual incidences of 3.21 and 3.20, respectively. We found that PRPA is common in Taiwan, males and older individuals are more susceptible to it, and incidence has increased in recent years.
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Ishikawa M. Clinical potential of pupillary light reflex and heart rate variability parameters as biomarkers for assessing pain relief effects on autonomic function: a prospective longitudinal study. Biomed Phys Eng Express 2020; 6:055003. [PMID: 33444234 DOI: 10.1088/2057-1976/aba132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the association between subjective pain intensity and objective parameters obtained from two autonomic function tests in a longitudinal study targeting acute pain model in otolaryngology-head and neck region: pupillary light reflex (PLR) and heart rate variability (HRV). APPROACH We enrolled 35 patients with acute otolaryngology-head and neck region inflammatory disorders at pre-treatment stage. The acute inflammatory disorders were defined as acute tonsillitis, peritonsillar abscess, acute epiglottitis, acute sinusitis, and deep neck space abscess. Patients underwent a numeric rating scale (NRS) to monitor subjective pain intensity, PLR, and HRV as objective tests at 4 time-points during the follow-up term. As main outcome variables, we used 15 analyzable PLR/HRV parameters. To improve robustness of conclusions about the association between NRS and PLR/HRV parameters, we prepared four linear mixed-effects models (LMMs) including predictor variables such as NRS, sociodemographic factors, and individual variability. And then, we selected the better-fit model based on the lowest Akaike's information criterion. MAIN RESULTS NRS significantly decreased due to treatments. In 14 out of 15 parameters, better-fit models were models including not only sociodemographic factors but also individual variability. We observed significant parameter alterations to one unit change of NRS in five PLR and four HRV parameters. SIGNIFICANCE The current study revealed that PLR/HRV parameters can be used as biomarkers reflecting pain relief effects. In addition, the findings suggest the importance of adjusting predictor variables, especially individual variability defined as random effects in LMMs, for obtaining more accurate parameter estimation in the longitudinal study.
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Affiliation(s)
- Masaaki Ishikawa
- Department of Otolaryngology, Head and Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, 6608550 Higashinaniwachou 2-17-77 Hyogo Prefecture, Japan
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