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Analysis of Clinical Symptoms and Biochemical Parameters in Odontogenic Cellulitis of the Head and Neck Region in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010172. [PMID: 36670722 PMCID: PMC9857093 DOI: 10.3390/children10010172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
Many cases of cellulitis in the head and neck region among hospitalized pediatric patients are related to odontogenic infections. C-reactive protein (CRP), white blood cell (WBC) count, neutrophils to lymphocytes ratio (NLR), D-dimer, and prealbumin can be used to assess the severity of odontogenic inflammation. The aim of the study is to evaluate the biochemical parameters as a predictor factor of the severity of odontogenic cellulitis in children. This study was conducted from 2020 to 2021 on patients admitted to the Department of Pediatric Otolaryngology and Pediatric Head and Neck Surgery of the Upper Silesian Children’s Health Center in Katowice. We included 40 patients aged 2−16 in the study, who were divided into two groups: research (SS-Study subject) (n = 20) and control (CS-Control subject) (n = 20). The patients underwent an interview and physical examination to assess the presence of intraoral and extraoral swelling and the presence of trismus. The patients who qualified for the study had blood taken to determine the level of CRP, WBCs, NLR, D-dimers, and prealbumin. Differences in biochemical test results in the SS and CS were statistically significant (p < 0.05). In the SS group, the mean values of biochemical parameters exceeded the clinical norm. A statistically significant positive relationship was found between CRP and extraoral swelling. The NLR correlates significantly with extraoral swelling and the length of hospitalization. D-dimer statistically correlated with trismus, extraoral swelling, and the number of anatomical spaces involved. The NLR and CRP ratio can be considered a prognostic marker of the course of infection and hospitalization time.
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Neal TW, Schlieve T. Complications of Severe Odontogenic Infections: A Review. BIOLOGY 2022; 11:biology11121784. [PMID: 36552293 PMCID: PMC9775288 DOI: 10.3390/biology11121784] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Severe odontogenic infections are routinely treated with little associated morbidity and mortality. Improvements in surgical techniques, antibiotic treatments, and imaging modalities have made associated complications exceedingly rare. A number of complications have been described in the literature including airway obstruction, descending necrotizing mediastinitis, orbital abscess, septic cavernous sinus thrombosis, cerebral abscess, sepsis, necrotizing fasciitis, and Lemierre's syndrome. The purpose of this article is to discuss the pathophysiology of severe odontogenic infections and the risk factors associated with the development of complications. Given the morbidity and mortality of these conditions, it is important to review the clinical features of each and the diagnostic tools that aid in early recognition.
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Ma Y, Wu T, Yao Z, Zheng B, Tan L, Tong G, Lian Y, Baek JH, Ren J. Continuous, Large-Volume Hydrodissection to Protect Delicate Structures around the Thyroid throughout the Radiofrequency Ablation Procedure. Eur Thyroid J 2021; 10:495-503. [PMID: 34956921 PMCID: PMC8647085 DOI: 10.1159/000519625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Small-volume hydrodissection liquid dissipates rapidly and confers only short-term protection during radiofrequency ablation (RFA) of benign thyroid nodules. The aim of this study was to establish a safe method for continuous, large-volume hydrodissection. METHODS A long needle was inserted and positioned outside the thyroid capsule; 5% glucose was injected to maintain a 3- to 5-mm continuous safety buffer. From October 2015 to July 2020, 166 patients underwent hydrodissection with different volumes, and ablation efficacy and complications associated with different liquid volumes (≤40 mL vs. >40 mL) were compared at 1-month postprocedure. Moreover, 20 mL liquid (equivalent to 250 mL in the human body) was injected around the thyroid of a rhesus monkey, after which CT scans were used to visualize the liquid's fate and verify its safety. RESULTS The 51 patients with 10-40 mL injections and 116 patients with larger injections (45-450 mL) showed similar complete ablation rates (88.46% vs. 90.44%, p = 0.582), comparable 6-month VRR (82.79% vs. 76.62%, p = 0.079), and complication incidences, although the latter group had larger nodules (9.11 mL vs. 13.79 mL, p = 0.003), more energy delivered (3.44 kcal vs. 6.04 kcal, p < 0.001), and longer operation times (51.37 min vs. 69.2 min, p < 0.001). In the animal experiment, the 20 mL of liquid diffused quickly (within 10 min) from the vicinity of the thyroid to the mediastinum and retropharyngeal space. It was observed in the kidneys at 10 min and disappeared from the neck and chest space by 24 h. CONCLUSIONS Continuous, large-volume hydrodissection can protect the delicate structures around the thyroid throughout the RFA procedure and might be beneficial in large thyroid nodule ablation.
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Affiliation(s)
- Yanping Ma
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
- *Jung Hwan Baek, , Jie Ren,
| | - Tao Wu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Zhicheng Yao
- General Surgery Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Bowen Zheng
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Lei Tan
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Ge Tong
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Yufan Lian
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
- *Jung Hwan Baek, , Jie Ren,
| | - Jie Ren
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
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Cefazolin versus ampicillin/sulbactam as an empiric antibiosis in severe odontogenic neck infection descending from the lower jaw-retrospective analysis of 350 cases. Clin Oral Investig 2020; 25:563-570. [PMID: 32779014 DOI: 10.1007/s00784-020-03492-1] [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: 03/20/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Odontogenic infections descending from the lower jaw may lead to severe health conditions. Commonly, a biphasic treatment of surgical drainage and antibiotic therapy is conducted. The choice of the administered empiric antibiotic agent remains debatable. MATERIAL AND METHODS Retrospectively, we analyzed 350 medical records of patients who were consecutively treated with odontogenic infections descending from the lower jaw. All patients received surgical drainage and either cefazolin or ampicillin/sulbactam as empiric antibiosis. In particular, the number of secondary operations, infectious parameters, and length of in-hospital stay were investigated. RESULTS The most frequently infected space was the perimandibular/buccal space for both groups followed by the submandibular space. Number of revision procedures, early recurrence, and length of stay presented no significant difference between both groups (p > 0.05). Inflammatory parameters (c-reactive protein, leukocytes) similarly decreased in both groups. CONCLUSION Cefazolin targets the majority of the pathogens detected in severe odontogenic neck infections descending from the lower jaw and reveals comparable results to AMP/S in regard to the inflammatory parameters and in-hospital stay. CLINICAL RELEVANCE Cefazolin is a feasible empiric antibiosis for odontogenic neck infections descending from the lower jaw if surgical drainage is performed.
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Puth MT, Tutz G, Heim N, Münster E, Schmid M, Berger M. Tree-based modeling of time-varying coefficients in discrete time-to-event models. LIFETIME DATA ANALYSIS 2020; 26:545-572. [PMID: 31709472 DOI: 10.1007/s10985-019-09489-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
Hazard models are popular tools for the modeling of discrete time-to-event data. In particular two approaches for modeling time dependent effects are in common use. The more traditional one assumes a linear predictor with effects of explanatory variables being constant over time. The more flexible approach uses the class of semiparametric models that allow the effects of the explanatory variables to vary smoothly over time. The approach considered here is in between these modeling strategies. It assumes that the effects of the explanatory variables are piecewise constant. It allows, in particular, to evaluate at which time points the effect strength changes and is able to approximate quite complex variations of the change of effects in a simple way. A tree-based method is proposed for modeling the piecewise constant time-varying coefficients, which is embedded into the framework of varying-coefficient models. One important feature of the approach is that it automatically selects the relevant explanatory variables and no separate variable selection procedure is needed. The properties of the method are investigated in several simulation studies and its usefulness is demonstrated by considering two real-world applications.
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Affiliation(s)
- Marie-Therese Puth
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Institute of General Practice and Family Medicine, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Gerhard Tutz
- Department of Statistics, Ludwig-Maximilians-University Munich, Ludwigstrasse 33, 80539, Munich, Germany
| | - Nils Heim
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Moritz Berger
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients. J Craniomaxillofac Surg 2019; 47:334-340. [DOI: 10.1016/j.jcms.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/18/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022] Open
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Zirk M, Buller J, Goeddertz P, Rothamel D, Dreiseidler T, Zöller JE, Kreppel M. Empiric systemic antibiotics for hospitalized patients with severe odontogenic infections. J Craniomaxillofac Surg 2016; 44:1081-8. [PMID: 27369813 DOI: 10.1016/j.jcms.2016.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/16/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Odontogenic infections may lead to severe head and neck infections with potentially great health risk. Age, location of purulent affected sites and beta-lactam allergy are some mentionable factors regarding patients' in-hospital stay and course of disease. Are there new challenges regarding bacteria' antibiotic resistance for empiric treatment and what influences do they have on patients' clinical course? METHODS We analyzed in a 4-year retrospective study the medical records of 294 in-hospital patients with severe odontogenic infections. On a routine base bacteria were identified and susceptibility testing was performed. Length of stay in-hospital was evaluated regarding patients' age, beta-lactam allergy profile, affected sites and bacteria susceptibility to empiric antibiotics. RESULTS Length of stay in-hospital was detected to be associated with affected space and penicillin allergy as well (p < 0.05). Isolates presented large amounts of aerobic gram-positive bacteria (64.2%), followed by facultative anaerobic bacteria (gram+/15.8%, gram-/12.7%). Tested ampicillin in combination with sulbactam (or without) and cephalosporins displayed high susceptibility rates, revealing distinguished results regarding clindamycin (p < 0.05). Co-trimoxazol and moxifloxacin showed high overall susceptibility rates (MOX: 94.7%, COTRIM: 92.6%). DISCUSSION This study demonstrates ampicillin/sulbactam in addition to surgical intervention is a good standard in treatment of severe odontogenic neck infections. Cephalosporins seem to be a considerable option as well. If beta-lactam allergy is diagnosed co-trimoxazol and moxifloxacin represent relevant alternatives. CONCLUSION Age, allergic profile and bacteria' resistance patterns for empiric antibiotics have an influence on patients in-hospital stay. Ampicillin/sulbactam proves itself to be good for empiric antibiosis in severe odontogenic infections. Furthermore cephalosporins could be considered as another option in treatment. However moxifloxacin and co-trimoxazol deserves further investigation as empiric antibiosis in odontogenic infections if beta-lactam allergy is diagnosed.
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Affiliation(s)
- Matthias Zirk
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany.
| | - Johannes Buller
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Peter Goeddertz
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Daniel Rothamel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Timo Dreiseidler
- Dreifaltigkeits-Krankenhaus Wesseling, University Teaching Hospital, Germany
| | - Joachim E Zöller
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
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Opitz D, Camerer C, Camerer DM, Raguse JD, Menneking H, Hoffmeister B, Adolphs N. Incidence and management of severe odontogenic infections-a retrospective analysis from 2004 to 2011. J Craniomaxillofac Surg 2014; 43:285-9. [PMID: 25555896 DOI: 10.1016/j.jcms.2014.12.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022] Open
Abstract
The management of odontogenic infections is a typical part of the spectrum of maxillofacial surgery. Normally these infections can be managed in a straight forward way however under certain conditions severe and complicated courses can arise which require interdisciplinary treatment including intensive care. A retrospective analysis of all patients affected by an odontogenic infection that received surgical therapy from 2004 to 2011 under stationary conditions was performed. Surgical treatment consisted in incision and drainage of the abscess supported by additional i.v. antibiotic medication in all patients. Detailed analysis of all patients that required postoperative intensive medical care was additionally performed with respect to special risk factors. During 8 years 814 patients affected by odontogenic infections received surgical treatment under stationary conditions representing 4% of all patients that have been treated during that period (n = 18981). In 14 patients (1.7%) intensive medical therapy after surgery was required, one lethal outcome was documented (0.12%). In all of these 14 patients a history of typical risk factors was present. According to these results two patients per week affected by an odontogenic infection required stationary surgical treatment, about two patients per year were likely to require additional intensive medical care. If well-known risk factors are present in patients affected by odontogenic infection appropriate interdisciplinary management should be considered as early as possible.
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Affiliation(s)
- Daniel Opitz
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany.
| | - Christian Camerer
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Doris-Maria Camerer
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Jan-Dirk Raguse
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Horst Menneking
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Bodo Hoffmeister
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Nicolai Adolphs
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Clinical Navigation, University Hospital Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
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Ottaviani G, Costantinides F, Perinetti G, Luzzati R, Contardo L, Visintini E, Tirelli G, Di Lenarda R, Gobbo M, Biasotto M. Epidemiology and variables involved in dental abscess: survey of dental emergency unit in Trieste. Oral Dis 2013; 20:499-504. [PMID: 23879656 DOI: 10.1111/odi.12164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 07/01/2013] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this epidemiologic study was to estimate the healing time of acute dental abscesses and to evaluate the main variables involved in the healing process itself. SUBJECTS AND METHODS Among a sample of over 24 000 patients visited at the emergency dental unit, 688 subjects were diagnosed with dental abscess and enrolled in the study. Case histories of all patients were collected to investigate the clinical course and healing time of dental abscess according to anamnestic and diagnostic data and therapeutic management. A multiple logistic regression model was performed to evaluate the association of each variable with the healing time required for dental abscess. RESULTS Variables associated with increased healing time were spring seasonality at admission, pyretic state, trismus, involvement of multiple anatomic spaces, and spontaneous drainage. Moreover, administration of some, but not all, classes of antibiotics was also associated with an increased healing time. CONCLUSIONS The knowledge of variables involved in healing time for dental abscess is crucial in the optimization of managing such infections in terms of cost-benefit ratio. This would represent a valuable way to ensure a shortened and more effective healing.
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Affiliation(s)
- G Ottaviani
- Department of Dental Science, University of Trieste, Trieste, Italy
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Abstract
Necrotizing fasciitis (NF) is a highly aggressive infectious process, polymicrobial in nature, involving soft tissues with a high risk of rapid spread through superficial and deep fascial planes and muscular layers. Cervical NF is quite rare, is mostly of odontogenic origin, and may be complicated by descendant mediastinitis with a very high mortality rate. Systemic conditions impairing the patient's immune competence, such as diabetes, may play a predisposing role. An effective treatment strategy includes prompt diagnosis (clinical findings, local microbiological tests, blood culture and, if deemed necessary, histopathology), broad-spectrum antibiotic therapy as early as possible which should be later adjusted according to antibiogram results, stabilization of vital functions and, if possible, elimination/ treatment of predisposing factors. This paper describes a complex and emblematic case.
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Choi YK. Poster 024: Cervical Necrotizing Fascitis & Mediastinitis Caused Odontogenic Infection: Cases Report. J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.joms.2007.06.293] [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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Misthos P, Katsaragakis S, Kakaris S, Theodorou D, Skottis I. Descending Necrotizing Anterior Mediastinitis: Analysis of Survival and Surgical Treatment Modalities. J Oral Maxillofac Surg 2007; 65:635-9. [PMID: 17368356 DOI: 10.1016/j.joms.2006.06.287] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 12/19/2005] [Accepted: 06/13/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE Descending necrotizing anterior mediastinitis (DNAM) is a severe infectious disease with a very high mortality rate. The aim of this study was to define the impact of several clinical factors on survival. PATIENTS AND METHODS Between 1985 and 2002, 27 patients were managed for DNAM, 11 with combined transthoracic mediastinal and cervical drainage (group A) and 16 with a less aggressive surgical approach, such as cervical drainage and transcervical mediastinal drainage (group B). The records of all patients were statistically analyzed for the impact of several clinical factors on survival. RESULTS Although patients in group A were admitted to the hospital faster, treated with antibiotics as outpatients earlier, and operated on much sooner after hospital admission compared with the patients in group B, multivariate analysis revealed that early combined transthoracic mediastinal and cervical debridement and drainage was the only favorable factor for survival in patients DNAM patients (odds ratio = 9.99; 95% confidence interval = 1.02 to 97.49). CONCLUSIONS Less extensive surgical approaches (ie, thoracic drainage without cervical drainage or combined cervical and subxiphoid thoracic drainage) led to unsatisfactory results and high reoperation rates. In contrast, early, aggressive combined cervical and thoracic drainage proved to be an effective method for managing DNAM.
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Affiliation(s)
- Panagiotis Misthos
- First Propaedeutic Surgical Department, University of Athens Medical School, Athens, Greece.
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Bartsch MS, von Bernstorff W, Schäfer FKW, Wiltfang J, Warnke PH. Kritische odontogene Infektion mit Mediastinalbeteiligung. ACTA ACUST UNITED AC 2005; 9:257-62. [PMID: 15926085 DOI: 10.1007/s10006-005-0619-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Occasionally, trivial odontogenic infections may develop into complex diseases. This may even result in an unrestrained phlegmonous spread causing life-threatening complications. These problems have decreased since the introduction of antibiotics and also due to improved oral hygiene and improved diagnostic measures resulting in optimized medical treatment. However, life-threatening forms are still seen, in particular if infections spread along the cervical fascial sheaths down towards to the mediastinum. Over the past decade the number of critical infections has increased in other medical specialties. This is usually explained by the development of multiresistant pathogens in the context of nosocomial infections. PATIENTS AND METHODS We reviewed the patients' records of the past 15 years at the Department of Oral and Maxillofacial Surgery of the University Hospital Kiel to assess a possible increase of odontogenic infections with life-threatening complications. From 1990 to 2004, four patients with odontogenic infections exhibiting critical phlegmonous spread were treated in the intensive care unit. Two patients developed bacterial mediastinitis which could be controlled by intravenous antibiotics only. One patient progressed to general septic mediastinitis and eventually died of cardiorespiratory arrest. The last patient also had septic mediastinitis and developed right pleural empyema. Several operations were necessary before the disease could be controlled. This patient's case report is presented in detail. CONCLUSION The prognosis of patients with mediastinitis crucially depends on (a) early diagnosis including computed tomography of the neck and thorax, (b) early radical surgical intervention, and (c) optimized pathogen-oriented antibiotic treatment.
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Affiliation(s)
- M S Bartsch
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Christian-Albrechts-Universität zu Kiel.
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Mora R, Jankowska B, Catrambone U, Passali GC, Mora F, Leoncini G, Passali FM, Barbieri M. Descending Necrotizing Mediastinitis: Ten Years’ Experience. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408301116] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Descending necrotizing mediastinitis is a rare disease that is usually caused by a spreading, diffuse inflammatory reaction (phlegmon) to an odontogenic infection or peritonsillar abscess. Reported mortality rates range from 25 to 40%. The use of antibiotics and advances in resuscitation procedures and critical care techniques have not essentially improved survival, and an effective treatment has not been clearly established. We report the findings of our 10-year study of 21 patients affected by phlegmon and/or fasciitis of the neck. The aim of our contribution is to help define the clinical criteria and diagnostic procedures that will improve the early diagnosis of mediastinal sepsis secondary to neck fasciitis and to suggest optimal treatment approaches. Our experience indicates that (1) cervical drainage alone is sufficient for cases of cervical phlegmon or mediastinal involvement that are limited to a single superior mediastinal space and (2) thoracotomy and drainage of mediastinal collections is necessary when mediastinal sepsis is more extensive.
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Affiliation(s)
- Renzo Mora
- ENT Department, University of Genoa, Italy
| | | | - Ugo Catrambone
- Regional Division of Thoracic Surgery, San Martino Hospital, Genoa
| | | | | | - Giacomo Leoncini
- Regional Division of Thoracic Surgery, San Martino Hospital, Genoa
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