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Katoumas K, Mitsopoulos G. Vacuum-assisted closure of a tissue deficit of the submental area in a patient with a necrotizing soft tissue odontogenic infection. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:e119-e124. [PMID: 38155007 DOI: 10.1016/j.oooo.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 12/30/2023]
Abstract
Odontogenic infections can rarely progress to necrotizing soft tissue infections. Cervical necrotizing fasciitis (CNF) is a rare but fulminant infection that spreads along the fascial planes, including connective tissue, muscle, and subcutaneous fat, and is typified by necrosis of the skin and other adjacent tissues. This article aims to present the treatment of a patient with submental skin and soft tissue necrosis due to an odontogenic infection and the subsequent management of the tissue deficit with a vacuum-assisted closure (VAC) system. The patient presented with extensive skin necrosis in the submental area and was immediately hospitalized, and management of the odontogenic infection was performed. When the patients' infection had been sufficiently controlled, a wound VAC device was placed in the deficit. The VAC device was removed after 12 days, and the patient was discharged. In conclusion, VAC can be used to manage tissue deficits with good aesthetic results.
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Affiliation(s)
- Konstantinos Katoumas
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "Evaggelismos" and Dental School of the National and Kapodistrian University of Athens, Athens, Greece.
| | - Georgios Mitsopoulos
- Department of Oral & Maxillofacial Surgery, 401 General Military Hospital of Athens, Athens, Greece
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Tournade C, Dusick A, Mans C. Clinical diagnosis and outcome of cervicofacial cellulitis in pyrexic rabbits: six cases (2014-2021). J Small Anim Pract 2024; 65:66-74. [PMID: 37759337 DOI: 10.1111/jsap.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES To assess the signalment, history, exam findings, diagnostics, treatment and outcome of rabbits diagnosed with pyrexia and concurrent cervicofacial cellulitis. MATERIALS AND METHODS Retrospective evaluation of medical records of rabbits diagnosed with cervicofacial cellulitis and pyrexia based on physical exam, contrast-enhanced CT, clinicopathology and microbiology findings. RESULTS Six out of 1588 rabbits met the study inclusion criteria. Rabbits presented with a median age of 6 years (range, 8 months to 8 years) with a presenting complaint of anorexia or hyporexia. All rabbits had a rectal temperature >40.2°C (104.4°F). Physical exam and contrast-enhanced CT revealed unilateral submandibular and ipsilateral cervical diffuse soft tissue swelling in five of six rabbits. No antemortem evidence of periodontal or dental disease was found on physical exam or CT. Leucopenia was present in five of six rabbits. A left shift with marked toxic changes was present in all four rabbits, for which blood smears were reviewed. Bacterial cultures of the aspirated subcutaneous soft tissue swelling cultured Escherichia coli, Pasteurella multocida, Granulicatella adiacens, Streptococcus species, Haemophilus species and Bacteroides species. Treatment was pursued in five rabbits, where all rabbits received supportive care and four of five rabbits received systemic antibiotics. One rabbit was euthanased following a diagnosis of cervicofacial cellulitis. Three out of five rabbits continued to decline clinically despite medical management, and thus, euthanasia was pursued within 24 hours of starting treatment. Two rabbits responded to initial treatment and developed subsequent multi-focal abscessation. One rabbit was euthanased due to client cost constraints, and one rabbit died shortly after achieving clinical resolution of cervicofacial cellulitis. CLINICAL SIGNIFICANCE Cervicofacial cellulitis should be considered a differential diagnosis in pyrexic rabbits with facial or cervical swelling with medical and surgical management pursued for therapy.
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Affiliation(s)
- C Tournade
- School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI, 53706, USA
| | - A Dusick
- School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI, 53706, USA
| | - C Mans
- School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI, 53706, USA
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Diagnosis and Management of Pathological Conditions. J Oral Maxillofac Surg 2023; 81:E221-E262. [PMID: 37833025 DOI: 10.1016/j.joms.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Hematologic and inflammatory parameters for determining severity of odontogenic infections at admission: a retrospective study. BMC Infect Dis 2022; 22:931. [PMID: 36503406 PMCID: PMC9743669 DOI: 10.1186/s12879-022-07934-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Severe odontogenic infections in the head and neck region, especially necrotizing soft tissue infection (NSTI) and deep neck abscess, are potentially fatal due to their delayed diagnosis and treatment. Clinically, it is often difficult to distinguish NSTI and deep neck abscess in its early stage from cellulitis, and the decision to perform contrast-enhanced computed tomography imaging for detection is often a challenge. This retrospective case-control study aimed to examine the utility of routine blood tests as an adjunctive diagnostic tool for NSTI in the head and neck region and deep neck abscesses. METHODS Patients with severe odontogenic infections in the head and neck region that required hospitalization were classified into four groups. At admission, hematologic and inflammatory parameters were calculated according to the blood test results. In addition, a decision tree analysis was performed to detect NSTI and deep neck abscesses. RESULTS There were 271 patients, 45.4% in Group I (cellulitis), 22.5% in Group II (cellulitis with shallow abscess formation), 27.3% in Group III (deep neck abscess), and 4.8% in Group IV (NSTI). All hematologic and inflammatory parameters were higher in Groups III and IV. The Laboratory Risk Indicator for Necrotizing Fasciitis score, with a cut-off value of 6 and C-reactive protein (CRP) + the neutrophil-to-lymphocyte ratio (NLR), with a cut-off of 27, were remarkably useful for the exclusion diagnosis for Group IV. The decision tree analysis showed that the systemic immune-inflammation index (SII) of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 suggests Group III + IV and the classification accuracy was 89.3%. CONCLUSIONS Hematologic and inflammatory parameters calculated using routine blood tests can be helpful as an adjunctive diagnostic tool in the early diagnosis of potentially fatal odontogenic infections. An SII of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 can be useful in the decision-making for performing contrast-enhanced computed tomography imaging.
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Gravensteen IK, Rogde S. Sudden Death Due to Cervical Necrotizing Soft Tissue Infection. Am J Forensic Med Pathol 2022; 43:e26-e27. [PMID: 35900157 DOI: 10.1097/paf.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Ida Kathrine Gravensteen
- From the Division of Laboratory Medicine, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
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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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Sizer B, Yılmaz Ü, Kınış V, Yorgancılar AE. Comparison of death and survival cervical necrotizing fasciits cases. J Cosmet Dermatol 2021; 21:1635-1641. [PMID: 34038027 DOI: 10.1111/jocd.14254] [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: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cervical Necrotizing Fasciitis (CNF) is associated with a high mortality rate. The occurrence of mediastinitis with CNF may increase mortality up to 70%. AIMS We aimed to identify the differences between surviving and deceased cases. METHODS The present study was conducted retrospectively by scanning the files of 16 patients between the ages of 19-71 who were diagnosed with CNF. Patients were divided into two groups as the surviving patient group (SPG) and the deceased patient group (DPG). Both groups were compared in terms of age, gender, Laboratory Risk Indicator for Necrotizing Fasciitis (LRİNEC) score, duration of symptom onset to hospital admission, use of antibiotherapy prior to admission, duration of hospitalization, presence of diabetes mellitus (DM), presence of dental etiology, mediastinitis, and respiratory distress at the time of admission. RESULTS Diabetes mellitus was the most common comorbid disease. 5 out of 7 deceased patients had DM. Dental events were the most common etiology. Rapid surgical debridement and airway management was the first treatment method. The most frequently isolated species in the culture was Streptococcus. 6 of 11 patients who developed mediastinitis deceased at the end of the process. CONCLUSION Dental pathologies mostly play a role in the etiology. It is obvious that dentists, another occupational group that frequently encounters this patient group, have a critical role in this process. Therefore, precise attention should be given to dental problems in patients with diabetes, and hospitalization and initiation of broad-spectrum antibiotherapy should be considered in case of suspicion of deep neck infection.
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Affiliation(s)
- Bilal Sizer
- Department of Ear, Nose and Throat, Memorial Diyarbakır Hospital, Diyarbakır, Turkey
| | - Ümit Yılmaz
- Department of Ear, Nose and Throat, Selahaddin Eyyubi Public Hospital, Diyarbakır, Turkey
| | - Vefa Kınış
- Department of Ear Nose and Throat, Dicle University Medicine Faculty, Diyarbakır, Turkey
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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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El-Rabbany M, Alhumaid J, Dalmao O, Cuddy K. Odontogenic necrotizing soft tissue infection of the scalp: A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
INTRODUCTION Cervical necrotizing fasciitis (CNF) is a rapid progressing and potentially fatal infection of connective tissues that spreads along the fascial planes. It commonly develops from odontogenic sources. In this article, the authors present a case of CNF which was developed after open reduction and internal fixation (ORIF) of a mandibular fracture. CLINICAL CASE A 19-year-old male patient with no past medical history was admitted due to a mandibular fracture. Following ORIF surgery, on third post-operative day, Physical examination revealed extensive cervical swelling extending from submandibular to suprasternal area, with tender and erythematous skin. Soon after confirmation of CNF diagnosis, surgical debridement and wide spectrum antibiotic therapy was performed. The residual soft tissue defect was reconstructed following infection subsidence. CONCLUSION Our study aims to highlight the risk of CNF development during postoperative period of a simple mandibular fracture ORIF surgery which is considered a routine maxillofacial procedure. Early detection and adequate emergency treatment including immediate surgical intervention are critical in the management of these patients.
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Mtenga AA, Kalyanyama BM, Owibingire SS, Sohal KS, Simon EN. Cervicofacial necrotizing fasciitis among patients attending the Muhimbili National Hospital, Dar es Salaam, Tanzania. BMC Infect Dis 2019; 19:642. [PMID: 31324225 PMCID: PMC6642492 DOI: 10.1186/s12879-019-4267-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervicofacial necrotizing fasciitis (NF) is a rare life-threatening infection in the head and neck region that characteristically spreads along the fascial planes to involve subcutaneous tissues, fascia and fat, however, in late stages it can involve muscles and skin. The aim of this study was to determine the occurrence of cervicofacial NF among patients attending treatment at the Muhimbili National Hospital (MNH). METHODS This was a prospective descriptive cross-sectional hospital-based study which was carried at Muhimbili National Hospital (MNH) from May 2013 to April 2014. It included 42 patients with cervicofacial NF. They were interviewed for demographic information, chief complaints, symptoms, duration and treatment received before reporting at MNH. A thorough assessment of general health condition of the patients and laboratory investigations were followed by management according to MNH protocol. Data obtained from these patients were analyzed using Statistical Package for Social Sciences SPSS 20. RESULTS During the study period, 151 patients reported at MNH with odontogenic infections. A total of 42 (27.8%) patients satisfied our diagnostic criteria for cervicofacial NF. The age range was 15 years to 83 years (mean 43.95, SD +/- 16.16). Greater (35.7%) proportion was in the age group of 30-39 years with 31 (73.8%) males and 11 (27.2%) females making a male to female ratio of 2.8:1. Fifteen (35.7%) patients had at least one co-existing systemic condition, which included anaemia in 5 (11.9%) patients, followed by diabetes mellitus (DM) and malnutrition 4 (9.5%) patients each and HIV infection 2 (4.8%) patients. Others were combination of; HIV infection and malnutrition, HIV infection and anaemia and diabetes mellitus and anaemia each in one (2.4%) patient. There was a mortality of 42.9% comprising of 14 (33.3%) males and 4 (9.6%) females. CONCLUSIONS Cervicofacial NF is a polymicrobial infection, requiring surgery, antibiotics and management of co-existing systemic conditions. Anaemia, diabetes mellitus and malnutrition were the main co-existing systemic conditions. The rather high mortality was mainly attributable to late reporting.
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Affiliation(s)
- Arnold A. Mtenga
- Department of Dental Services, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Boniphace M. Kalyanyama
- Department of oral and maxillofacial surgery, Muhimbili University of Health and Allied Sciences, P.O. Box 65014, Dar es Salaam, Tanzania
| | - Sira S. Owibingire
- Department of oral and maxillofacial surgery, Muhimbili University of Health and Allied Sciences, P.O. Box 65014, Dar es Salaam, Tanzania
| | - Karpal S. Sohal
- Department of oral and maxillofacial surgery, Muhimbili University of Health and Allied Sciences, P.O. Box 65014, Dar es Salaam, Tanzania
| | - Elison N.M. Simon
- Department of oral and maxillofacial surgery, Muhimbili University of Health and Allied Sciences, P.O. Box 65014, Dar es Salaam, Tanzania
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Gunaratne DA, Tseros EA, Hasan Z, Kudpaje AS, Suruliraj A, Smith MC, Riffat F, Palme CE. Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature. Head Neck 2018; 40:2094-2102. [PMID: 29934952 DOI: 10.1002/hed.25184] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/14/2018] [Accepted: 02/20/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. METHODS A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis." RESULTS There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. CONCLUSION Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.
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Affiliation(s)
- Dakshika A Gunaratne
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Evan A Tseros
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Zubair Hasan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Akshay S Kudpaje
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Anand Suruliraj
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Mark C Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten E Palme
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Crown Princess Mary Cancer Centre, Westmead Hospital, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
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McCoy JM, Oreadi D. Diagnosis and Management of Pathological Conditions. J Oral Maxillofac Surg 2017; 75:e224-e263. [DOI: 10.1016/j.joms.2017.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Faunø Thrane J, Pikelis A, Ovesen T. Hyperbaric oxygen may only be optional in head and neck necrotizing fasciitis: a retrospective analysis of 43 cases and review of the literature. Infect Dis (Lond) 2017. [PMID: 28644692 DOI: 10.1080/23744235.2017.1342142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis in the head and neck (NF-HN) is a rare and potentially life-threatening condition. The use of hyperbaric oxygen therapy (HBOT) in the acute regimen is disputed and there is a lack of evidence of therapeutic effect. This study aims to describe a retrospective cohort of patients with NF-HN and investigate the use of HBOT and consequences thereof. METHODS All patients treated for NF-HN at Aarhus University Hospital (AUH) between 2002 and 2014 were included in this retrospective cohort. Data regarding demographics, treatment and a one-year follow-up was registered. A review of the literature on NF-HN and HBOT was performed. RESULTS Forty-three patients were consecutively treated for NF-HN during the period. All patients were treated in accordance with current guidelines with HBOT as a variable. Thirty patients received HBOT, and 13 patients were omitted from HBOT for different reasons. In the HBOT group were no mortalities vs. three mortalities in the non-HBOT group two late deaths due to precursory underlying cancer of the head and neck, and one early death shortly after admittance. We found higher rates of complications (63% vs. 25%) and sequelae (77% vs. 40%) among the HBOT group compared to the non-HBOT group. CONCLUSIONS Our findings suggest that HBOT for NF-HN may only be optional and that the decision relies on an individual assessment of each patient. Further research is needed concerning the evidence of HBOT and towards selecting the patients benefitting from HBOT.
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Affiliation(s)
- Jens Faunø Thrane
- a Department of Otorhinolaryngology Head and Neck Surgery , Aarhus University Hospital , Aarhus , Denmark
| | - Arunas Pikelis
- a Department of Otorhinolaryngology Head and Neck Surgery , Aarhus University Hospital , Aarhus , Denmark
| | - Therese Ovesen
- b Department of Otorhinolaryngology Head and Neck Surgery , Regionshospitalet Holstebro HEV , Holstebro , Denmark.,c Department of Clinical Medicine , Aarhus University Health , Aarhus , Denmark
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Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center. Eur Arch Otorhinolaryngol 2016; 273:4461-4467. [DOI: 10.1007/s00405-016-4126-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
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16
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Choi MG. Necrotizing fasciitis of the head and neck: a case report. J Korean Assoc Oral Maxillofac Surg 2015; 41:90-6. [PMID: 25922821 PMCID: PMC4411734 DOI: 10.5125/jkaoms.2015.41.2.90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/02/2014] [Accepted: 12/09/2014] [Indexed: 11/07/2022] Open
Abstract
Necrotizing fasciitis (NF) is an infection that spreads along the fascial planes, causing subcutaneous tissue death characterized by rapid progression, systemic toxicity, and even death. NF often appears as a red, hot, painful, and swollen wound with an ill-defined border. As the infective process continues, local pain is replaced by numbness or analgesia. As the disease process continues, the skin initially becomes pale, then mottled and purple, and finally, gangrenous. The ability of NF to move rapidly along fascial planes and cause tissue necrosis is secondary to its polymicrobial composition and the synergistic effect of the enzymes produced by the bacteria. Treatment involves securing the airway, broad-spectrum antimicrobial therapy, intensive care support, and prompt surgical debridement, repeated as needed. Reducing mortality rests on early diagnosis and prompt aggressive treatment.
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Affiliation(s)
- Moon-Gi Choi
- Department of Oral and Maxillofacial Surgery, Wonkwang University School of Dentistry, Iksan, Korea
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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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18
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Georget E, Gauthier A, Brugel L, Verlhac S, Remus N, Epaud R, Madhi F. Acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children. BMC EAR, NOSE, AND THROAT DISORDERS 2014; 14:8. [PMID: 25206314 PMCID: PMC4158388 DOI: 10.1186/1472-6815-14-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022]
Abstract
Background Acute cervical adenitis can evolve into suppurative cervical lymphadenitis and may sometimes be associated with infection of the retropharyngeal and parapharyngeal spaces (i.e., retropharyngeal and poststyloid parapharyngeal abscesses). This study aimed to describe the clinical presentation of acute cervical lymphadenitis and infections of the retropharyngeal and parapharyngeal spaces in children and examine the management of these conditions. Methods This was a retrospective study including children from 3 months to 18 years old who were hospitalized in the Pediatric Department of the Centre-Intercommunal-de-Créteil between January 2003 and May 2010. Selected cases were based on the diagnosis of acute cervical lymphadenitis, suppurative cervical lymphadenitis, or infections of the retropharyngeal or parapharyngeal spaces. Case history, clinical signs, laboratory tests, imaging, treatment and clinical course were collected from patient charts. Results We included 75 children (54 males [72%]); 62 (83%) were < 6 years old. Diagnoses were acute cervical lymphadenitis in 43 patients (57%), suppurative cervical lymphadenitis in 13 (17%), retropharyngeal or poststyloid parapharyngeal abscess in 18 (24%) and cervical necrotizing fasciitis in 1 (1%). In total, 72 patients (96%) presented fever and 34 (45%) had torticollis. Suppurative cervical lymphadenitis or abscesses of the retropharyngeal or poststyloid parapharyngeal spaces was significantly higher for children with than without torticollis (52.9% vs. 4.8%, p < 0.001). In all, 21 patients among the 44 > 3 years old (48%) underwent a rapid antigen detection test (RADT) for group A beta-hemolytic Streptococcus pyogenes; results for 10 were positive (48%). Contrast-enhanced CT scan of the neck in children with torticollis (n = 31) demonstrated an abscess in 21 (68%). Fine-needle aspiration was performed in 8 patients (11%) and 8 (11%) required surgical drainage. Bacteriology was positive in 8 patients (11%), with a predominance of Staphylococcus aureus and S. pyogenes. All patients received intravenous antibiotics and the outcome was favorable regardless of surgery. Recurrence was observed in only 1 case among the 34 patients with a follow-up visit after discharge. Conclusion Our data suggest that presentation with cervical lymphadenitis associated with fever and torticollis requires evaluation by contrast-enhanced CT scan. Furthermore, abscess drainage should be restricted to the most severely affected patients who do not respond to antibiotic therapy.
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Affiliation(s)
- Emilie Georget
- Service de Pédiatrie, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, 40, allée de la source, 94195 Villeneuve Saint Georges, France
| | - Anne Gauthier
- Service d'ORL, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Lydia Brugel
- Service d'ORL, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Suzanne Verlhac
- Service de Radiologie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Natacha Remus
- Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Ralph Epaud
- Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France ; Inserm U955, Equipe 11, Faculté de Médecine, Université Paris-Est, 94000 Créteil, France
| | - Fouad Madhi
- Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
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19
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Sumi Y. Descending necrotizing mediastinitis: 5 years of published data in Japan. Acute Med Surg 2014; 2:1-12. [PMID: 29123684 DOI: 10.1002/ams2.56] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/25/2014] [Indexed: 12/29/2022] Open
Abstract
Descending necrotizing mediastinitis implies infection originating from the neck, most commonly an oropharyngeal or odontogenic focus, that spreads in the cervical fascial spaces and descends into the mediastinum. Early diagnosis is essential because descending necrotizing mediastinitis can rapidly progress to septic shock and organ failure. A comprehensive review of the current data of descending necrotizing mediastinitis in Japan was carried out using PubMed and ICHUSHI from the last 5 years. The symptoms, origins, comorbid conditions, treatment modalities, complications, and survival rates were analyzed. Tonsillar and pharyngeal origin was more identified compared to odontogenic origin. More than one-third of patients were diabetic and 28% of them were not identified as having any comorbidity. Streptococcus sp. and anaerobes were most isolated, reflecting the microflora of the oral cavity. Of the broad antibiotics, carbapenem was the most used as treatment, and clindamycin was the most co-given. Mediastinal drainage approach varied widely and the optimal approach is controversial. Twenty-one patients were treated with video-assisted thoracic surgical drainage and 15 cases by percutaneous catheter drainage, whereas transcervical approach was applied in 25 patients and thoracotomy was carried out in 21 patients. The overall mortality was 5.6%. Many authors advocated that the most effective management tool is a high degree of clinical suspicion followed by prompt and adequate drainage with intensive care including hemodynamic and nutritional support and repeat computer tomographic monitoring.
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Affiliation(s)
- Yuka Sumi
- Department of Emergency and Critical Care Medicine Juntendo University, Urayasu Hospital Chiba Japan
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20
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van Niekerk C, Khammissa RA, Altini M, Lemmer J, Feller L. Noma and cervicofacial necrotizing fasciitis: clinicopathological differentiation and an illustrative case report of noma. AIDS Res Hum Retroviruses 2014; 30:213-6. [PMID: 24304357 DOI: 10.1089/aid.2013.0259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Noma predominantly affects malnourished young children. The pathogenesis of noma is complex and multifactorial, involving interaction between local polybacterial infection on the one hand, and malnutrition, immunosuppression, or systemic bacterial or viral infections on the other hand. Noma is considered to be an opportunistic disease, but the immediate cause is uncertain. Immunosuppression associated with a high HIV load may be an important risk factor in South Africa. Cervicofacial necrotizing fasciitis, on the other hand, occurs mainly in adults. It is frequently a consequence of an odontogenic infection and is characterized by an irregular pattern of rapidly spreading necrosis of fascia, muscle, and skin. We present an unusual case of noma in a 32-year-old malnourished HIV-seropositive female with AIDS in whom, within a period of 3 days, the initial intraoral necrotizing process spread rapidly and caused circular full thickness perforating destruction of the lower lip. Prompt diagnosis and treatment brought about control of the active disease and limited the extension of the established noma and of progression of the disease at other affected oral sites.
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Affiliation(s)
- Charles van Niekerk
- Department of Maxillofacial and Oral Surgery, University of Limpopo, Medunsa Campus, Pretoria, South Africa
| | - Razia A.G. Khammissa
- Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, Pretoria, South Africa
| | - Mario Altini
- Division of Anatomical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Johan Lemmer
- Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, Pretoria, South Africa
| | - Liviu Feller
- Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, Pretoria, South Africa
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22
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Mutamba A, Verity DH, Rose GE. 'Stalled' periocular necrotising fasciitis: early effective treatment or host genetic determinants? Eye (Lond) 2013; 27:432-7. [PMID: 23412558 DOI: 10.1038/eye.2012.285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Necrotising fasciitis (NF) is a devastating disease with considerable mortality and morbidity, and early aggressive surgical debridement of devitalised necrotic tissues has traditionally been advocated. METHODS We describe three patients who were referred from other units several weeks after developing periocular necrotising fasciitis; in all the three, the disease had been managed medically without surgical debridement, with apparent 'stalling' of the inflammatory process despite persistent necrotic periocular tissue. RESULTS Following 'elective debridement' of the devitalised tissues and reconstruction with local flaps, all achieved a satisfactory aesthetic result. DISCUSSION The role of host genetic determinants, polarised cytokine responses, and early, effective medical treatment in patients with atypical 'disease phenotypes' in NF are discussed.
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Affiliation(s)
- A Mutamba
- Orbital Unit, Moorfields Eye Hospital, London, UK
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23
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Carlson ER, Ghali GE, Herb-Brower KE. Diagnosis and management of pathological conditions. J Oral Maxillofac Surg 2012; 70:e232-71. [PMID: 23128003 DOI: 10.1016/j.joms.2012.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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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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25
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Craniocervical necrotizing fasciitis of odontogenic origin with thoracic extension. J Craniofac Surg 2011; 22:1109-11. [PMID: 21586958 DOI: 10.1097/scs.0b013e3182108edb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Craniocervical necrotizing fasciitis is an uncommon but aggressive infection with high morbidity and mortality. We present a case of craniocervical necrotizing fasciitis with thoracic extension caused by a dental infection in a 56-year-old man, with a successful outcome involving broad-spectrum intravenous antibiotics and an aggressive surgical debridement.
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26
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Severe subcutaneous and deep cervicofacial emphysema of unusual etiology. Eur Arch Otorhinolaryngol 2011; 269:303-8. [DOI: 10.1007/s00405-011-1608-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
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27
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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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28
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Necrotizing fasciitis: review of the literature and case report. J Oral Maxillofac Surg 2011; 69:2786-94. [PMID: 21367503 DOI: 10.1016/j.joms.2010.11.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/21/2010] [Accepted: 11/23/2010] [Indexed: 11/20/2022]
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29
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Adolphs N, Klein M, Haberl EJ, Graul-Neumann L, Menneking H, Hoffmeister B. Necrotizing soft tissue infection of the scalp after fronto-facial advancement by internal distraction in a 7-year old girl with Gorlin-Chaudhry-Moss syndrome--a case report. J Craniomaxillofac Surg 2011; 39:554-61. [PMID: 21216154 DOI: 10.1016/j.jcms.2010.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 10/14/2010] [Accepted: 11/26/2010] [Indexed: 11/25/2022] Open
Abstract
In 1960, Gorlin, Chaudhry and Moss described a syndrome consisting of craniofacial dysostosis in association with hypertrichosis, cardiac, genital, dental and ocular anomalies. Diagnosis is based on typical clinical findings and cannot be performed by molecular genetic analysis until now. There is little in the clinical literature concerning this rare craniofacial syndrome. For functional and psychosocial reasons, surgical correction of the complex craniofacial malformation in a 7-year old Hungarian girl with Gorlin-Chaudhry-Moss syndrome was performed by fronto-facial advancement using internal distraction devices. Postoperatively necrotizing soft tissue infection of the scalp developed leading to termination of the distraction process ahead of schedule and requiring aggressive surgical management. Typical physiological and clinical characteristics were observed both during the initial craniofacial correction as well as during the management of the infectious complication suggesting that the linking of different conditions (surgical trauma plus the selection of toxic microorganisms) has caused tissue destruction rather than the syndromal disorder or the surgical technique of distraction osteogenesis. Although skeletal improvement was achieved residual damage from the infectious complication must be considered as severe.
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Affiliation(s)
- Nicolai Adolphs
- Dept. of Oral and Maxillofacial Surgery, Surgical Robotics and Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany.
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Myocapsular Pectoralis Major Flap for Pharyngeal Reconstruction after Cervical Necrotizing Fasciitis. Plast Reconstr Surg 2010; 126:2279-2281. [DOI: 10.1097/prs.0b013e3181f619c3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Sarna T. Poster Board Number: 21: Surviving Cervical Necrotizing Fasciitis With Descending Mediastinitis: A Literature Review and Case Report. J Oral Maxillofac Surg 2010. [DOI: 10.1016/j.joms.2010.06.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Ho MP, Cheung WK, Chang WH. Cervical Necrotizing Fasciitis Arising From Acute Epiglottitis in an Elderly Patient. INT J GERONTOL 2009. [DOI: 10.1016/s1873-9598(09)70037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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