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Pucci R, Cassoni A, Di Carlo D, Bartolucci P, Della Monaca M, Barbera G, Di Cosola M, Polimeni A, Valentini V. Odontogenic-Related Head and Neck Infections: From Abscess to Mediastinitis: Our Experience, Limits, and Perspectives-A 5-Year Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3469. [PMID: 36834169 PMCID: PMC9965740 DOI: 10.3390/ijerph20043469] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Head and neck infections are commonly caused by affections with an odontogenic origin. Untreated or non-responsive to treatment odontogenic infections can cause severe consequences such as localized abscesses, deep neck infections (DNI), and mediastinitis, conditions where emergency procedures such as tracheostomy or cervicotomy could be needed. METHODS An epidemiological retrospective observational study was performed, and the objective of the investigation was to present a single-center 5-years retrospective analysis of all patients admitted to the emergency department of the hospital Policlinico Umberto I "Sapienza" with a diagnosis of odontogenic related head and neck infection, observing the epidemiological patterns, the management and the type of surgical procedure adopted to treat the affections. RESULTS Over a 5-year period, 376,940 patients entered the emergency room of Policlinico Umberto I, "Sapienza" University of Rome, for a total of 63,632 hospitalizations. A total of 6607 patients were registered with a diagnosis of odontogenic abscess (10.38%), 151 of the patients were hospitalized, 116 of them were surgically treated (76.8%), and 6 of them (3.9%) manifested critical conditions such as sepsis and mediastinitis. CONCLUSIONS Even today, despite the improvement of dental health education, dental affections can certainly lead to acute conditions, necessitating immediate surgical intervention.
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Affiliation(s)
- Resi Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Andrea Cassoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Daniele Di Carlo
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Piero Bartolucci
- Surgical Sciences and Emergency Department, AOU Policlinico Umberto I Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marco Della Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giorgio Barbera
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Michele Di Cosola
- Department of Clinical and Experimental Medicine, Università Degli Studi di Foggia, 71122 Foggia, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Valentino Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
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Risk Factors of Descending Necrotizing Mediastinitis in Deep Neck Abscesses. Medicina (B Aires) 2022; 58:medicina58121758. [PMID: 36556959 PMCID: PMC9788205 DOI: 10.3390/medicina58121758] [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: 10/10/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives: Cervical space infection could also extend to the mediastinum due to the anatomical vicinity. The mortality rate of descending necrotizing mediastinitis is 85% if untreated. The aim of this study was to identify risk factors for the progression of deep neck abscesses to descending necrotizing mediastinitis. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing surgical treatment of deep neck abscesses from August 2017 to July 2022. Computed tomography (CT) was performed in all patients. Before surgery, lab data including hemoglobulin (Hb), white blood cell count, neutrophil percentage, C-reactive protein (CRP) level, and blood glucose were recorded. Patients' characteristics including gender, age, etiology, and presenting symptoms were collected. Hospitalization duration and bacterial cultures from the wound were also analyzed. Results: The C-reactive protein (CRP) level was higher in patients with a mediastinal abscess than in patients without a mediastinal abscess (340.9 ± 33.0 mg/L vs. 190.1 ± 72.7 mg/L) (p = 0.000). The submandibular space was more commonly affected in patients without a mediastinal abscess (p = 0.048). The retropharyngeal (p = 0.003) and anterior visceral (p = 0.006) spaces were more commonly affected in patients with a mediastinal abscess. Conclusions: Descending necrtotizing mediastinitis results in mortality and longer hospitalization times. Early detection of a mediastinal abscess on CT is crucial for treatment. Excluding abscesses of the anterior superior mediastinum for which transcervical drainage is sufficient, other mediastinal abscesses require multimodal treatment including ENT and thoracic surgery to achieve a good outcome.
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Measures of Corticalization. J Clin Med 2022; 11:jcm11185463. [PMID: 36143109 PMCID: PMC9500652 DOI: 10.3390/jcm11185463] [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: 07/09/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
After the insertion of dental implants into living bone, the condition of the peri-implant bone changes with time. Implant-loading phenomena can induce bone remodeling in the form of the corticalization of the trabecular bone. The aim of this study was to see how bone index (BI) values behave in areas of bone loss (radiographically translucent non-trabecular areas) and to propose other indices specifically dedicated to detecting corticalization in living bone. Eight measures of corticalization in clinical standardized intraoral radiographs were studied: mean optical density, entropy, differential entropy, long-run emphasis moment, BI, corticalization index ver. 1 and ver. 2 (CI v.1, CI v.2) and corticalization factor (CF). The analysis was conducted on 40 cortical bone image samples, 40 cancellous bone samples and 40 soft tissue samples. It was found that each measure distinguishes corticalization significantly (p < 0.001), but only CI v.1 and CI v.2 do so selectively. CF or the inverse of BI can serve as a measure of peri-implant bone corticalization. However, better measures are CIs as they are dedicated to detecting this phenomenon and allowing clear clinical deduction.
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Vodička J, Geiger J, Židková A, Andrle P, Mírka H, Svatonˇ M, Kostlivý T. Acute Mediastinitis - Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience). Ann Thorac Cardiovasc Surg 2022; 28:171-179. [PMID: 35264480 PMCID: PMC9209895 DOI: 10.5761/atcs.oa.21-00147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors’ worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy. Methods: During the period 2006–2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment. Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times. Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.
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Affiliation(s)
- Josef Vodička
- Department of Surgery, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Jan Geiger
- Department of Surgery, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Alexandra Židková
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Pavel Andrle
- Department of Stomatology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Hynek Mírka
- Department of Imaging Methods, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Svatonˇ
- Department of Pneumology and Phthisiology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Tomáš Kostlivý
- Department of Otorhinolaryngology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
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Does Soluble Urokinase-Type Plasminogen Activator Receptor Level Predicts the Occurrence of Inflammatory Complications in Maxillofacial Surgery? APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of immune activation and reflects a more distinct aspect of inflammation than C-reactive protein (CRP) does. The study concerns a clinically silent state of the immune system expressed by the level of suPAR, which could affect the occurrence of complications (non-life threatening) after scheduled procedures. The purpose was the evaluation of suPAR predictive value in minor maxillofacial surgery complication incidents. Eighty patients were tested for suPAR, CRP and a series of basic laboratory serum tests on 1 day before surgery. Complications of orthognathic and minor injuries treatments were reported. The suPAR level, expressed as a measure independent of the patient’s age (Index of Body Inflammation, IBI), was analyzed. The protein level was also assessed on postoperative day 3. Basic statistical analysis did not reveal any relevant dependence between suPAR (or IBI) and occurrence of minor complications. The application of factor analysis, artificial neural network and inclusion of chlorides, glycaemia, alanine transaminase (ALT), albumin and hemoglobin levels allowed to indicate the suPAR/IBI ranges associated with an increased risk of minor postoperative complications. Concluding, it seems that, in the current state of the knowledge, the monitoring of pre-operational suPAR level solely does not include sufficient predictive information for the occurrence of minor complications after maxillofacial surgery. The suPAR/IBI level should be combined with other patient characteristics to predict healing complications.
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Palmes D, Kebschull L, Bahde R, Senninger N, Pascher A, Laukötter MG, Eichelmann AK. Management of Nonmalignant Tracheo- and Bronchoesophageal Fistula after Esophagectomy. Thorac Cardiovasc Surg 2020; 69:216-222. [PMID: 32114691 DOI: 10.1055/s-0039-1700970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Tracheo- or bronchoesophageal fistula (TBF) occurring after esophagectomy represent a rare but devastating complication. Management remains challenging and controversial. Therefore, the purpose of this study was to evaluate the outcome of different treatment approaches and to propose recommendations for the management of TBF. METHODS From 2008 to 2018, 15 patients were treated because of TBF and were analyzed with respect to fistula appearance, treatment strategy (stenting, endoscopic vacuum therapy and/or surgical reintervention) and outcome. RESULTS In each case, the fistula was small, located close to the tracheal bifurcation and associated simultaneously (n = 6, 40%) or metachronously (n = 9, 60%) with an anastomotic leakage. Latter was covered by esophageal stents in six patients which in turn resulted in occurrence of TBF at a later time in five patients. Management of TBF included conservative therapy (n = 3), stenting (n = 6), or suturing (n = 6). Ten patients underwent rethoracotomy. Treatment failure was observed in eight patients (53%). In all patients, treatment was accompanied by progressive sepsis. On the contrary, all seven patients with successful defect closure remained in good general condition. CONCLUSION Fistula appearance was similar in all patients. Implementation of esophageal stents cannot be recommended because of possibility of TBF at a later time point. Surgery is usually required and should preferably be performed when the patient's condition has been optimized at a single-stage repair. Esophageal diversion can only be recommended in patients with persisting mediastinitis. The key element for successful treatment of TBF, however, is control over sepsis; otherwise, outcome of TBF is devastating.
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Affiliation(s)
- Daniel Palmes
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Linus Kebschull
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Ralf Bahde
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Norbert Senninger
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Mike G Laukötter
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Ann-Kathrin Eichelmann
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
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Park IH, Lim HK, Song SW, Lee KH. Perforation of esophagus and subsequent mediastinitis following mussel shell ingestion. J Thorac Dis 2016; 8:E693-7. [PMID: 27621902 DOI: 10.21037/jtd.2016.07.88] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Esophageal perforation is a very rare occurrence because accidental swallowing of foreign bodies is uncommon in adults. Thus, perforation due to swallowing of a foreign body and subsequent development of mediastinitis is rarely encountered by physicians. We experienced such a case and described an adult male patient who had perforated esophagus after accidentally swallowing a mussel shell. The patient visited our emergency department complaining of painful dysphagia for 4 days. A review of history revealed that he consumed a spicy seafood noodle soup containing mussel shells 4 days ago. Computed tomography (CT) of the chest showed the foreign body in the esophagus and pneumomediastinum was identified. We removed the mussel shell fragment using rigid esophagoscopy; explo-thoracotomy, debridement of mediastinal abscess and irrigation were performed.
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Affiliation(s)
- Il Hwan Park
- Departments of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Kyo Lim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung Woo Song
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kwang Ho Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Cross MR, Greenwald MF, Dahhan A. Esophageal Perforation and Acute Bacterial Mediastinitis: Other Causes of Chest Pain That Can Be Easily Missed. Medicine (Baltimore) 2015; 94:e1232. [PMID: 26266352 PMCID: PMC4616702 DOI: 10.1097/md.0000000000001232] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Esophageal perforation is a rare condition that is commonly missed. Male gender and alcohol use are predisposing risk factors. Most of the cases are iatrogenic or traumatic; nonetheless, spontaneous cases are not uncommon. It typically occurs after vomiting or straining as the increased intra-abdominal pressure transmits into the esophagus and results in the tear. One of the main complications is acute bacterial mediastinitis from contamination with esophageal flora. This condition can be life-threatening because it is very frequently misdiagnosed and appropriate management is often delayed.A 49-year-old man presented with worsening sudden-onset interscapular back pain that then changed to chest pain with odynophagia and was found to have fever and leukocytosis.Chest computed tomography revealed signs of mediastinitis with possible esophageal perforation. He reported symptoms started 2 days ago after lifting of heavy objects. Empiric antimicrobial was begun with conservative management and avoidance of oral intake. Barium esophagram and esophagogastroduodenoscopy revealed no signs of perforation or inflammation. His symptoms resolved and he gradually resumed oral intake. Blood cultures grew Methicillin-sensitive Staphylococcus aureus and he was discharged on appropriate antibiotics for 4 weeks. He did well on follow-up 3 months after hospitalization.The case highlights the importance of considering esophageal etiologies of chest pain.
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Affiliation(s)
- Madeline R Cross
- From the Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA (MRC, MFG, AD)
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