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Koç RH, ABakay MA, Sayın İ. Determining the prognostic value of CRP and neutrophil lymphocyte ratio in patients hospitalized for deep neck infection. Braz J Otorhinolaryngol 2024; 90:101492. [PMID: 39205364 PMCID: PMC11399593 DOI: 10.1016/j.bjorl.2024.101492] [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: 03/26/2024] [Revised: 07/25/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES This study aims to assess the impact of the Neutrophil/Lymphocyte Ratio (NLR) and C-Reactive Protein (CRP), both markers of systemic inflammation, on the duration of hospitalization for Deep Neck Infections (DNIs). METHODS The research encompassed patients of all age groups admitted between January 2016 and January 2021 due to DNIs. Patient data, including demographic details, etiology, comorbidities, radiological findings, treatment specifics, laboratory results (CRP values, leukocyte counts, neutrophil counts, lymphocyte counts, NLR), culture outcomes, length of stay, complications, mortalities were retrospectively evaluated. Patients were categorized into two groups based on their hospitalization duration: less than 7-days and 7-days or more. Univariate and multivariate analyses were conducted to examine the association between age, NLR, CRP, and hospital stay length. RESULTS The study encompassed 275 patients, with a mean age of 36 ± 20.2 years. The mean hospital stay was 9.6 ± 6.6 days. Tonsillopharyngeal infections were the most common etiology (34%). Notably, in both univariate and multivariate analyses, age, NLR, and CRP values demonstrated significant (p < 0.05) predictive influence on hospitalization duration. CONCLUSION Age emerges as a determinant that affects hospital stay duration in DNIs. Moreover, NLR is proven to be comparable to CRP in predicting hospitalization length for these patients. NLR's feasibility as a cost-effective predictive marker, being conveniently derived from routine complete blood count assessments, adds to its clinical significance. This study underscores the potential value of NLR and CRP in informing patient management and care strategies for DNIs.
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Affiliation(s)
- Recep Haydar Koç
- Sultangazi Haseki Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey.
| | - Mehmet Akif ABakay
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey
| | - İbrahim Sayın
- Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey
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Toloczko AJ, Davis TS, Issa MH. Bezold's abscess, an uncommon complication of otitis media and cholesteatoma: a case report. J Med Case Rep 2024; 18:317. [PMID: 38992780 PMCID: PMC11241866 DOI: 10.1186/s13256-024-04631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/12/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Mastoiditis frequently occurs in children as they are more susceptible to middle ear infections, but infrequently occurs in adults. A rare complication that results from mastoiditis and an obstructing cholesteatoma is a Bezold's abscess, of which there are less than 100 reported cases in literature to date. CASE PRESENTATION Here, we present a case of a 72-year-old Caucasian man who has had no history of prior ear infections and was found to have a cholesteatoma and advanced acute coalescent mastoiditis complicated by a Bezold's abscess. CONCLUSIONS Bezold's abscess is a rare entity infrequently encountered in the modern era, likely owing to more prompt treatment of otitis media. Cholesteatoma poses a great risk for both the development of otitis media and further progression to mastoiditis and its associated complications, such as Bezold's abscess. Knowledge of said abscess is crucial; without prompt recognition, further spread of infection can occur with vascular or mediastinal involvement.
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Affiliation(s)
| | - Thomas S Davis
- Department of Internal Medicine, Carilion Clinic, Roanoke, VA, USA
| | - Mayada H Issa
- Department of Internal Medicine, Carilion Clinic, Roanoke, VA, USA.
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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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Hsiao FY, Ho CY, Chan KC, Wang YC, Chin SC, Chen SL. Assessment of the Elderly Adult Patients with Deep Neck Infection: A Retrospective Study. EAR, NOSE & THROAT JOURNAL 2023:1455613231177184. [PMID: 37278212 DOI: 10.1177/01455613231177184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Background: Deep neck infection (DNI) is a potentially lethal infectious disease affecting middle-aged adults and can compromise the airway. There are limited data on the prognosis and outcomes of elderly (aged > 65 years) DNI patients, who tend to be immunocompromised. This study analyzed the clinical characteristics of elderly and adult (aged 18-65 years) DNI patients. Methods: Between November 2016 and November 2022, 398 patients with DNIs, including 113 elderly patients, were admitted to our hospital and enrolled in this study. The relevant clinical variables were investigated and compared. Results: The elderly DNI patients had longer hospital stays (P < .001), higher C-reactive protein levels (P = .021), higher blood sugar levels (P = .012), and a higher likelihood of diabetes mellitus (P = .025) than the adult patients. The higher blood sugar level is an independent risk factor for elderly (odds ratio = 1.005, 95% confidence intervals 1.002-1.008, P < .001). Moreover, the rates of intubation to protect the airway (P = .005) and surgical incision and drainage (I&D; P = .010) were higher in the elderly group. However, there were no group differences in pathogen distributions. Conclusion: The elderly DNI patients in this study had a more severe disease course, and poorer prognosis than the adult patients, as well as higher rates of intubation and I&D. However, the pathogen distributions did not differ significantly between the groups. Prompt intervention and treatment are important for elderly DNI patients.
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Affiliation(s)
- Fu-Yuan Hsiao
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kai-Chieh Chan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chien Wang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Lung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Dudhe P, Burse K, Kulkarni S, Bhardwaj C, Patel R. Clinical Profile and Outcome of Head and Neck Abscesses in 68 Patients at a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2023; 75:668-674. [PMID: 37275021 PMCID: PMC10235303 DOI: 10.1007/s12070-022-03409-2] [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: 09/16/2021] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
An abscess in head and neck region causes life threatening complications which may result in death. Because of challenging early recognition and wide range of its presenting features the present study was carried out to study in detail the clinico- demographic profile of the patients with head and neck abscesses. An observational cross sectional study was carried out on 68 cases of head and neck abscesses in a tertiary care center in Maharashtra. Out of 68 cases, 43(63.23%) were males and 25(36.77%) were females. Around 57% of the cases were in the age group of 11 to 40 years. 36(52.94%) cases had abscesses in the neck region while 32(47.06%) cases had it in the head region. Majority of the cases were of submandibular abscesses (18; 26.47%) followed by mastoid abscess (11;16.18%), Ludwig's angina (9;13.24%) and others. Most common etiology was odontogenic in origin (24; 35.29%) followed by otogenic (23; 33.82%). Pain and swelling (56; 82.35%) were the most common presenting features followed by fever (32, 47.06%) and others. 25% cases had history of diabetes mallitus. Incision and drainage was the most common mode of treatment used. Majority abscesses can be treated successfully by incision and drainage with the cover of antibiotics. Diabetic cases of abscesses can be managed successfully without any complications or prolonged hospital stay with good sugar control.
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Affiliation(s)
- Preeti Dudhe
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
| | - Kirankumar Burse
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
| | - Shreeya Kulkarni
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
| | - Chaitanya Bhardwaj
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
| | - Rushika Patel
- Department of Otorhinolaryngology, Dr Vasantrao Pawar Medical College and Research Center, Nashik , Maharashtra India
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Descending necrotizing mediastinitis: etiopathogenesis, diagnosis, treatment and long-term consequences-a retrospective follow-up study. Eur Arch Otorhinolaryngol 2023; 280:1983-1990. [PMID: 36478116 PMCID: PMC9988808 DOI: 10.1007/s00405-022-07769-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The primary aim of this retrospective study was to analyze the progression of descending necrotizing mediastinitis (DNM), evaluate the impact of comorbidities on complications and mortality and to observe long-term consequences of DNM on dysphagia and measurements quality of life. DNM is a serious infectious disease that requires multimodal treatment. Current literature varies in conclusions of risk factors, management and outcome of DNM. In addition, little is known about persisting effects on quality of life. METHODS Retrospective data analysis of 88 patients with DNM representing the largest single-center study. Recording data of patients and diseases as well as clinical progression from 1997 to 2018. Two questionnaires were sent to the participants to measure quality of life and to detect dysphagia. RESULTS 88 patients were included. The most frequently found pathogen were Streptococcus spp. (52%). 75% of the patients underwent multiple surgeries, mean count of surgical procedures was 4.3 times. 84% received intensive care treatment. Median length of stay on the intensive care unit was 7 days. 51% had pre-existing comorbidities associated with reduced tissue oxygenation (e.g., diabetes). The most common complication was pleural effusion (45%). During the observation period, the mortality rate was 9%. 12 questionnaires could be evaluated. 67% of the participants were affected by dysphagia at the time of the survey. CONCLUSIONS Descending necrotizing mediastinitis (DNM) is a severe disease requiring an immediate initiation of multimodal treatment. Although quality of life usually isn´t impaired permanently, dysphagia may often persist in patients after DNM.
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Wang X, Xu F, Liu D, Luo X, Zhou X, Huang X, Shen N. A comparison of patients with neck abscesses caused by esophageal foreign body impaction vs. inflammatory disease: a retrospective study. BMC Surg 2022; 22:410. [PMID: 36460980 PMCID: PMC9717482 DOI: 10.1186/s12893-022-01860-0] [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: 07/17/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES During clinical practice, we have detected a few cases of neck abscesses in patients diagnosed with esophageal foreign body impaction (EFB) but without the primary inflammatory disease. However, we do not know if neck abscesses caused by an inflammatory source are more like to be associated with a more severe progression or poorer prognosis. In this study, we aimed to identify differences between these two groups of patients by comparing progression and prognosis. MATERIALS AND METHODS We retrospectively reviewed all patients who underwent neck abscess incisions between January 2011 and March 2022 and divided these patients into two groups: an EFB group and an inflammation group. Data were described by percentages, means, and standard deviations (SDs). Fisher's precision probability test was used to compare differences between the EFB and inflammation groups. Categorical variables were analyzed by Pearson's Chi-squared test. In addition, three factors including hospital days, intensive care unit (ICU) stay, and drainage-tube removal time were used for multivariate analysis to identify independent correlations separately. RESULTS We enrolled a total of 33 patients with neck abscesses who received surgical incisions; the EFB group included 14 (42%) cases, while the inflammatory group included 19 (58%) cases. No significant differences were identified between the two groups in terms of surgery type (with or without mediastinotomy) and postoperative management (negative pressure drainage or postoperative irrigation). There were no significant differences between the two groups in terms of hospital stay, the timing of drainage-tube removal, the risk of ICU admission, and the probability of receiving intubation and tracheotomy. The incidence rate of esophageal perforation differed significantly between the two groups (p < 0.001). However, there were no significant differences in terms of other preoperative or postoperative comorbidities. The multivariate analysis revealed that the application of mediastinotomy (HR = 0.216 [0.049, 0.963]; p = 0.044) was correlated with a longer stay in the hospital. The time from symptoms to surgery was associated with a longer drainage tube removal time (HR = 0.392 [0.159, 0.967]; P = 0.042) and longer ICU stay (OR = 79.754[1.513, 4203.182]; P = 0.03). CONCLUSION Patients with neck abscesses associated with EFB and inflammation received the same therapeutic management, and there were no significant differences between these two groups in terms of prognosis. Furthermore, esophageal perforation was found to be irrelevant to the aggravation of neck abscesses, and there was no need for additional surgery to repair a perforated esophagus in patients with neck abscesses. LEVEL OF EVIDENCE Retrospective cohort (2b).
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Affiliation(s)
- Xuewei Wang
- grid.8547.e0000 0001 0125 2443Department of Otolaryngology-Head & Neck Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032 People’s Republic of China
| | - Feng Xu
- grid.8547.e0000 0001 0125 2443Department of Otolaryngology-Head & Neck Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032 People’s Republic of China
| | - Danzheng Liu
- grid.8547.e0000 0001 0125 2443Department of Otolaryngology-Head & Neck Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032 People’s Republic of China
| | - Xuemei Luo
- grid.8547.e0000 0001 0125 2443Department of Otolaryngology-Head & Neck Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032 People’s Republic of China
| | - Xu Zhou
- grid.8547.e0000 0001 0125 2443Department of Otolaryngology-Head & Neck Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032 People’s Republic of China
| | - Xinsheng Huang
- grid.8547.e0000 0001 0125 2443Department of Otolaryngology-Head & Neck Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032 People’s Republic of China
| | - Na Shen
- grid.8547.e0000 0001 0125 2443Department of Otolaryngology-Head & Neck Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032 People’s Republic of China
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Liang J, Jiang L, Li M, Liu L, Li H. Should preoperative computed tomography be routine examination for cervicofacial space infections? BMC Infect Dis 2022; 22:566. [PMID: 35733094 PMCID: PMC9215011 DOI: 10.1186/s12879-022-07545-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/16/2022] [Indexed: 02/08/2023] Open
Abstract
Background Cervicofacial space infections are potentially life-threatening, which require accurate diagnosis, early incision, and adequate drainage. The utilization of computed tomography (CT) in cervicofacial space infections has significantly increased for its advantages in the evaluation of abscesses, its availability, and low cost. However, the clinical value of preoperative CT imaging in cervicofacial space infections remains controversial for its poor specificity, radiation exposure, potential complications, and extra cost. We, therefore, investigated whether CT examination should be used as a routine examination in the treatment of patients with cervicofacial space infections. Methods A retrospective study of all patients affected by cervicofacial space infections that received incision and drainage surgery from Jan 2016 to Dec 2020 was performed at West China Hospital of Stomatology at Sichuan University. Patients were divided into two groups: the group with preoperative CT and without preoperative CT. Outcomes, including reoperation rate, missed diagnosis rate, days of symptom relief, length of stay, duration of surgery, and total cost of hospitalization, were analyzed. Results Out of n = 153 patients, 108 patients underwent surgery with preoperative CT and 45 patients without preoperative CT. The reoperation rate in the preoperative CT group (6/108, 5.6%) was significantly lower (P = 0.00) than that in the group without preoperative CT (10/45, 22.2%). Significant reduction of missed diagnosis rate (P = 0.00), days of symptom relief (P = 0.01), length of stay(P = 0.03), and duration of surgery (P = 0.01) were detected in the preoperative CT group. The results demonstrated that the utilization of preoperative CT can reduce the missed diagnosis rate and repeated surgery complications. Conclusions We recommend preoperative CT as a routine examination in cervicofacial space infections.
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Affiliation(s)
- Jiayu Liang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Linli Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Maoye Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hui Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Valeggia S, Minerva M, Muraro E, Bovo R, Marioni G, Manara R, Brotto D. Epidemiologic, Imaging, and Clinical Issues in Bezold’s Abscess: A Systematic Review. Tomography 2022; 8:920-932. [PMID: 35448708 PMCID: PMC9030105 DOI: 10.3390/tomography8020074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Bezold’s abscess is a deep neck abscess related to otomastoiditis. Due to the insidious clinical presentation, diagnosis can be extremely challenging, leading to delays in treatment and possible life-threatening complications. The literature currently provides a fragmented picture, presenting only single or small number of cases. The present study aims at examining our experience and the literature findings (based on PRISMA criteria) of 97 patients with Bezold’s abscess, summarizing their epidemiology, pathogenesis, clinical presentation, imaging findings, and treatments. Bezold’s abscess is found at any age, with overt male prevalence among adults. The clinical presentation, as well as the causative pathogens, are strikingly heterogeneous. Otomastoiditis and cholesteatoma are major risk factors. A clinical history of otitis is commonly reported (43%). CT and MRI are the main diagnostic tools, proving the erosion of the mastoid tip in 53% of patients and the presence of a concomitant cholesteatoma in 40%. Intracranial vascular (24%) or infectious (9%) complications have also been reported. Diagnosis might be easily achieved when imaging (CT) is properly applied. MRI has a limited diagnostic role, but it might be crucial whenever intracranial complications or the coexistence of cholesteatoma are suspected, helping to develop proper treatment (prompt antibiotic therapy and surgery).
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Affiliation(s)
- Silvia Valeggia
- Department of Medicine, Radiology Institute, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (S.V.); (M.M.)
| | - Matteo Minerva
- Department of Medicine, Radiology Institute, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (S.V.); (M.M.)
| | - Eva Muraro
- Camposampiero Hospital, 35012 Camposampiero, Italy;
| | - Roberto Bovo
- Section of Otorhinolaryngology, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (R.B.); (D.B.)
| | - Gino Marioni
- Section of Otorhinolaryngology, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (R.B.); (D.B.)
- Correspondence: ; Tel.: +39-0498212029
| | - Renzo Manara
- Neuroradiology Unit, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
| | - Davide Brotto
- Section of Otorhinolaryngology, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (R.B.); (D.B.)
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Aliabadi E, Farshad MM, Kheirkhah M, Jafari SH. Clinical, CT scan, and laboratory changes of abscess patients with odontogenic origin admitted to Shiraz acute surgical care center, Iran. J Family Med Prim Care 2021; 10:3314-3318. [PMID: 34760750 PMCID: PMC8565145 DOI: 10.4103/jfmpc.jfmpc_1047_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/10/2021] [Accepted: 07/29/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Rapid diagnosis of maxillofacial abscess with the odontogenic origin is effective in the treatment of patients. This study aimed to check the clinical evaluation, head, and neck computed tomography (CT) scan, and microbial sensitivity of hospitalized patients diagnosed with maxillofacial abscess admitted to the Maxillofacial Surgery Ward Shaheed Rajaie Surgical Acute Care Center of Shiraz, Iran from 2019-2021. Method A cross-sectional study was conducted. The sample included patients diagnosed with the abscess of odontogenic origin. Data collection tools included personal profile registration form, chief complainant and clinical evaluation, laboratory test results, pus culture, antibiogram results, and head and neck CT scan changes form. Data was reported with descriptive statistics by SPSS-16 software. Results The majority of patients were male; infection duration was 10 days; maximum mouth opening size was less than 20 mm in more than half of patients. The scan revealed 41.8% abscess, 36.4% cellulite, and 21.8% mixed abscess and cellulitis. There was 29.1% involvement of salivary glands. The majority of abscesses were unifocal involved in the submandibular space, and the least involvement was in peri mandibular space and carotid sheath. The most common organism causing was staphylococcal abscess coagulase-negative. Conclusion In patients with maxillofacial abscess requiring hospitalization, the most common clinical features were trismus, toxic appearance, and dysphagia, and the most common source of abscess in scanning patients with mandibular molars was the most involved submandibular space and pterygomandibular space. Vancomycin, cotrimoxazole, and cefazolin had the greatest effect in the treatment of odontogenic infections in terms of antibiogram results and microbial culture.
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Affiliation(s)
- Ehsan Aliabadi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Farshad
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoomeh Kheirkhah
- Nursing Care Research Center (NCRC), Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamed Jafari
- Medical Imaging Research Center, Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Ricciardiello F, Mazzone S, Viola P, Guggino G, Longo G, Napolitano A, Russo G, Sequino G, Oliva F, Salomone P, Perrella M, Romano GM, Cinaglia P, Abate T, Gargiulo M, Pisani D, Chiarella G. Deep Neck Infections: decisional algorithm for patients with multiple spaces involvement. Rev Recent Clin Trials 2021; 17:46-52. [PMID: 34514992 DOI: 10.2174/1574887116666210910153033] [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: 01/11/2021] [Revised: 05/20/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Deep Neck Infections (DNIs) spread along fascial planes and involve neck spaces. Recently, their incidence has decreased due to the introduction of antibiotics; nevertheless, complications related to DNIs are often life-threatening. OBJECTIVE The purpose of this article is focused on the identification of predisposing factors of these complications, as well as on the development of a reliable therapeutic algorithm. METHOD Sixty patients with DNIs were enrolled from 2006 to 2019 for a retrospective study. The exclusion criteria for the present study was cellulitis, small abscesses responding to empiric or specific antibiotic therapy or with involvement of only one deep neck space. During the analysis the following parameters of interest have been evaluated: gender, age, site of origin, pathways of spread, comorbidities, clinical features, bacteriology data, type of surgical approach required, complications, duration of hospitalization and mortality rate. On admission, microbial swab analysis was performed. RESULTS Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), iron deficiency anemia and the involvement of multiple spaces have been associated with a significantly higher risk of developing complications. Most of our patients had polymicrobial infections. All patients underwent surgical drainage. The complication rate had occurred in 56.6% of patients, while death in 18.3%. CONCLUSION DNIs represent a medical and surgical emergency with potential serious complications, thus avoiding diagnostic delay is mandatory. Our preliminary data suggest the importance of evaluating the extent of infections because the involvement of multiple spaces requires timely surgery due to the higher risk of complications and mortality.
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Affiliation(s)
| | | | - Pasquale Viola
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro. Italy
| | - Gianluca Guggino
- Thoracic Surgery Department, AORN Cardarelli Hospital, Napoli. Italy
| | - Giuseppe Longo
- Direzione Generale,"A. Cardarelli" Hospital, Naples. Italy
| | | | - Giuseppe Russo
- Direzione Sanitaria, AORN Cardarelli Hospital, Naples. Italy
| | - Giulio Sequino
- Ear Nose and Throat Unit, AORN Cardarelli Hospital, Napoli. Italy
| | - Flavia Oliva
- Ear Nose and Throat Unit, AORN Cardarelli Hospital, Napoli. Italy
| | | | - Marco Perrella
- Department of Anesthesia and Intensive Care, AORN Cardarelli Hospital, Naples. Italy
| | - Giovanni Marco Romano
- Department of Anesthesia and Intensive Care, AORN Cardarelli Hospital, Naples. Italy
| | - Pietro Cinaglia
- Department of Surgical and Clinical Science, Magna Graecia University, Catanzaro. Italy
| | - Teresa Abate
- Ear Nose and Throat Unit, AORN Cardarelli Hospital, Napoli. Italy
| | - Maurizio Gargiulo
- Thoracic Surgery Department, AORN Cardarelli Hospital, Napoli. Italy
| | - Davide Pisani
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro. Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro. Italy
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Gehrke T, Scherzad A, Hagen R, Hackenberg S. Deep neck infections with and without mediastinal involvement: treatment and outcome in 218 patients. Eur Arch Otorhinolaryngol 2021; 279:1585-1592. [PMID: 34160666 PMCID: PMC8897324 DOI: 10.1007/s00405-021-06945-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
Purpose Infections of the deep neck, although becoming scarcer due to the widespread use of antibiotics, still represent a dangerous and possibly deadly disease, especially when descending into the mediastinum. Due to the different specialities involved in the treatment and the heterogenous presentation of the disease, therapeutic standard is still controversial. This study analyzes treatment and outcome in these patients based on a large retrospective review and proposes a therapeutic algorithm. Methods The cases of 218 adult patients treated with deep neck abscesses over a 10-year period at a tertiary university hospital were analyzed retrospectively. Clinical, radiological, microbiological and laboratory findings were compared between patients with and without mediastinal involvement. Results Forty-five patients (20.64%) presented with abscess formation descending into the mediastinum. Those patients had significantly (all items p < 0.0001) higher rates of surgical interventions (4.27 vs. 1.11) and tracheotomies (82% vs. 3.4%), higher markers of inflammation (CRP 26.09 vs. 10.41 mg/dl), required more CT-scans (3.58 vs. 0.85), longer hospitalization (39.78 vs 9.79 days) and more frequently needed a change in antibiotic therapy (44.44% vs. 6.40%). Multi-resistant pathogens were found in 6.67% vs. 1.16%. Overall mortality rate was low with 1.83%. Conclusion Despite of the high percentage of mediastinal involvement in the present patient collective, the proposed therapeutic algorithm resulted in a low mortality rate. Frequent CT-scans, regular planned surgical revisions with local drainage and lavage, as well as an early tracheotomy seem to be most beneficial regarding the outcome.
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Affiliation(s)
- Thomas Gehrke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Agmal Scherzad
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Stephan Hackenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
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13
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Nurminen J, Velhonoja J, Heikkinen J, Happonen T, Nyman M, Irjala H, Soukka T, Mattila K, Hirvonen J. Emergency neck MRI: feasibility and diagnostic accuracy in cases of neck infection. Acta Radiol 2021; 62:735-742. [PMID: 32660316 PMCID: PMC8167911 DOI: 10.1177/0284185120940242] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Computed tomography (CT) has traditionally been the first-line imaging method in neck emergencies such as deep neck infections. Due to superior soft-tissue contrast, magnetic resonance imaging (MRI) may be an alternative to CT, also in emergency situations. Purpose To characterize the use of routine MRI in neck emergencies, with an emphasis on clinical feasibility and diagnostic accuracy in cases of neck infection. Material and Methods We conducted a retrospective cohort study of all primary neck MRI scans performed using a 3-T MRI device during a five-year follow-up period in a tertiary emergency radiology department. Imaging data were compared with final clinical diagnosis and surgical findings as reference standards. Results The search identified 461 primary neck MRI scans, of which 334 (72%) were performed on the basis of clinical suspicion of infection. Radiological evidence of infection was observed in 95% of these scans, and at least one abscess was detected in 229 cases (72% of confirmed infection). MRI had an overall technical success rate of 95% and had high positive predictive value for both infection (0.98) and detection of abscess (0.95). Conclusion We found that emergency neck MRI can be successfully performed on most patients, and that MRI detects neck infection with a high accuracy. These results suggest that MRI may be an alternative to CT as the first or only imaging modality in neck emergencies.
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Affiliation(s)
- Janne Nurminen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Jarno Velhonoja
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Jaakko Heikkinen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Tatu Happonen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Mikko Nyman
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Tero Soukka
- Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland
| | - Kimmo Mattila
- Department of Radiology, Turku University Hospital, Turku, Finland
- Department of Radiology, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, Turku, Finland
- Department of Radiology, University of Turku, Turku, Finland
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14
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Bal KK, Unal M, Delialioglu N, Oztornaci RO, Ismi O, Vayisoglu Y. Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients. Braz J Otorhinolaryngol 2020; 88:511-522. [PMID: 32868223 PMCID: PMC9422577 DOI: 10.1016/j.bjorl.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/20/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
Introductıon Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options. Objectives Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media. Methods A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years. Results According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008). Conclusions Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.
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Affiliation(s)
- Kemal Koray Bal
- University of Health Sciences Adana City Hospital, Department of Otorhinolaryngology & Head and Neck Surgery, Adana, Turkey.
| | - Murat Unal
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Nuran Delialioglu
- University of Mersin, Faculty of Medicine, Department of Microbiology, Mersin, Turkey
| | - Ragip Onur Oztornaci
- University of Mersin, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin, Turkey
| | - Onur Ismi
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Yusuf Vayisoglu
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
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15
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Uittamo J, Löfgren M, Hirvikangas R, Furuholm J, Snäll J. Severe odontogenic infections: focus on more effective early treatment. Br J Oral Maxillofac Surg 2020; 58:675-680. [DOI: 10.1016/j.bjoms.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/02/2020] [Indexed: 12/19/2022]
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16
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Descending Necrotizing Mediastinitis Resulting from Pharyngitis with Perforation of the Aryepiglottic Fold. Case Rep Emerg Med 2020; 2020:4963493. [PMID: 32099689 PMCID: PMC7040390 DOI: 10.1155/2020/4963493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/13/2020] [Indexed: 11/17/2022] Open
Abstract
Descending necrotizing mediastinitis and pharyngeal perforation are uncommon complications of pharyngitis that are associated with high morbidity and mortality. This case report describes a previously healthy 18-year-old male who presented to the emergency room with 5 days of severe sore throat, intermittent fevers, and vomiting and was found to have extensive posterior pharyngeal and mediastinal air along with extravasation of contrast on computed tomography, consistent with perforation of the left aryepiglottic fold as well as descending necrotizing mediastinitis. The patient had a complicated hospital course including multiple operative interventions, abscess formation, and development of pericardial and pleural effusions. Successful treatment required swift resuscitation including broad-spectrum antibiotics and significant coordination of emergent operative intervention between otolaryngology and cardiothoracic surgery. It is important to recognize descending necrotizing mediastinitis as a clinical entity that may result from oropharyngeal infections as early intervention significantly decreases subsequent complications and mortality. Furthermore, pharyngeal perforation is an extremely rare complication which requires either CT with oral contrast or esophagram for diagnosis.
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Fusconi M, Greco A, Galli M, Polimeni A, Yusef M, Di Cianni S, De Soccio G, Federici Stanganelli FR, Lombardi R, de Vincentiis M. Odontogenic phlegmons and abscesses in relation to the financial situation of Italian families. ACTA ACUST UNITED AC 2019; 68:236-241. [PMID: 31822047 DOI: 10.23736/s0026-4970.19.04276-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In recent years, we have recorded an increase in the number of hospital admissions due to odontogenic abscesses and neck phlegmons requiring surgery. We believe that the cause may be related both to the rationalization of funding allocation procedures in public health service making access to public dental healthcare more difficult, and the financial situation of Italian families. METHODS Fifty-five patients admitted between January 2013 and November 2017 with a diagnosis of "neck abscess" and/or "neck phlegmon" and/or "neck infection" were enrolled in this longitudinal retrospective study. RESULTS The results of this study showed that the number of cases of abscesses and neck phlegmons with an odontogenic origin have quadrupled, with reference to gender was 31 males (56%) and 24 females (44%). The average age was 46 and most cases involved patients between 30 and 50. Eighteen patients (33%) were not EU citizens and had been living in Italy for over 5 years. These data indicate an increase in the incidence of odontogenic neck infections. The data gathered by ISTAT (Istituto Nazionale di Statistica), Eurostat Data Explorer, Fondazione Giuseppe Di Vittorio and Tecnè revealed that these outcomes are directly related to the financial difficulties Italian families are experiencing. The exclusion of essential dental assistance from public healthcare forced Italians to consult expensive private facilities that not everyone can afford. CONCLUSIONS Connections were found between odontogenic neck infection complications and the financial difficulties Italian families are suffering from; Italians are reducing their budget for dental healthcare becoming exposed to serious neck pathologies.
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Affiliation(s)
- Massimo Fusconi
- Section of Ear Nose and Throat, Department of Sense Organs, Sapienza University, Rome, Italy -
| | - Antonio Greco
- Section of Ear Nose and Throat, Department of Sense Organs, Sapienza University, Rome, Italy
| | - Massimo Galli
- Department of Oral and Maxillofacial Science, Sapienza University, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Science, Sapienza University, Rome, Italy
| | - Marco Yusef
- Department of Oral and Maxillofacial Science, Sapienza University, Rome, Italy
| | - Simone Di Cianni
- Section of Ear Nose and Throat, Department of Sense Organs, Sapienza University, Rome, Italy
| | - Giulia De Soccio
- Section of Ear Nose and Throat, Department of Sense Organs, Sapienza University, Rome, Italy
| | | | - Roberto Lombardi
- Department of Oral and Maxillofacial Science, Sapienza University, Rome, Italy
| | - Marco de Vincentiis
- Section of Ear Nose and Throat, Department of Sense Organs, Sapienza University, Rome, Italy
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18
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Beka D, Lachanas VA, Doumas S, Xytsas S, Kanatas A, Petinaki E, Skoulakis C. Microorganisms involved in deep neck infection (DNIs) in Greece: detection, identification and susceptibility to antimicrobials. BMC Infect Dis 2019; 19:850. [PMID: 31615449 PMCID: PMC6794762 DOI: 10.1186/s12879-019-4476-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background To determine, from October 2010 to October 2018, the epidemiology of Deep Neck Infections (DNIs), regarding the detection, the identification and the susceptibility to antimicrobials of causative microorganisms, in Thessaly-Central Greece. Methods An analysis of data from a prospective database was conducted on 610 consecutive patients with DNIs treated in the Otolaryngology / Head & Neck Surgery Department of University Hospital of Larissa. Demographics, clinical features and microbiological data were analyzed. Results Among the 610 patients (1,9/1 male to female ratio, mean age: 39,24 ± 17,25) with DNIs, 579 had a single space (94,9%), while the remaining 31 had a multi-space (5,1%) DNI. The most common areas affected were the peritonsillar space (84,6%) followed by the submandibular space (6,5%). Clinical samples were obtained from 462 patients, and were tested by culture and by the application of 16S rRNA PCR. Two hundred fifty-five samples (55,2%) gave positive cultures, in which Streptococcus pyogenes and Staphylococcus aureus were predominant. The application of the 16S rRNA PCR revealed that 183 samples (39,6%) were positive for bacterial DNA; 22 of them, culture negative, were found to be positive for anaerobic (Fusobacterium necrophorum, Actinomyces israellii etc) and for fastidious microorganisms (Brucella mellitensis, Mycobacterium avium). Conclusion DNIs represent a medical and surgical emergency and evidence-guided empirical treatment with intravenous infusion of antibiotics at the time of diagnosis is mandatory, highlighting the importance of epidemiological studies regarding the causative microorganisms. Although, in our study, the predominant pathogens were S. pyogenes and S. aureus, the combination of culture and molecular assay revealed that anaerobic bacteria play also a significant role in the pathogenesis of DNIs. Based on the local epidemiology, we propose as empirical therapy the intravenous use of a beta-lactam /beta-lactamase inhibitor; metronidazole or clindamycin can be added only in specific cases such as in immunocompromised patients.
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Affiliation(s)
- Despoina Beka
- Department of Otorhinolaryngology, University Hospital of Larissa, Larissa, Greece
| | - Vasileios A Lachanas
- Department of Otorhinolaryngology, University Hospital of Larissa, Larissa, Greece
| | - Stergios Doumas
- OMFS Department, Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Stelios Xytsas
- Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece
| | - Anastasios Kanatas
- OMFS Department, Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Efi Petinaki
- Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece.
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Nasir SB, Shuaibu IY, Labaran SA, Inusa A. Management of Deep Neck Space Infections in a Tertiary Center in North West Nigeria. Niger J Surg 2019; 25:183-187. [PMID: 31579374 PMCID: PMC6771174 DOI: 10.4103/njs.njs_19_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Deep neck space infection (DNSI) is a potentially fatal condition that more commonly results from dental and tonsillar infections. Timely intervention is, therefore, crucial when such patients present to the managing physician. Objective The objective of this study is to review the etiology, clinical presentation, and treatment outcome of patients managed for DNSIs over a period of 7 years at National Ear Care Centre, Kaduna. Methodology The record of patients managed for DNSIs over a 7-year period between January 2010 and December 2016 was reviewed. Data obtained included demographic characteristics such as age, sex, occupation, level of education, main presenting symptoms, duration of symptoms, etiology of the DNSI, location of the infection, comorbidity, bacteriology, duration of hospital stay, and type of treatment given. The data were analyzed using the Statistical Package of the Social Sciences version 23.0. Results A total of 55 patients presented with DNSIs, and there were 34 (61.8%) females and 21 (38.2%) males, with a sex ratio of 1.6:1. The age range of the patients was 1-71 years, with a mean age of 30.7 years (standard deviation of 18.1). The most common etiologic factor among these patients was tonsillar-related infection which accounted for 24 (43.6%). The most common symptom at presentation was fever (96.4%), followed by odynophagia (60%). Peritonsillar space infection as seen in 25 (45.5%) patients was the most common region affected, followed by submandibular space infection. Of the 35 (64%) patients who had incision and drainage, Staphylococcus aureus was the most common organism isolated in 16 (45.7%), followed by Streptococcus pneumoniae (11, 31.4%). Majority (38, 69.1%) of the patients spent <5 days on admission. Conclusion This study shows that oropharyngeal and orodental infections are the most common causes of DNSIs. Educating the populace about orodental health may help in reducing cases of DNSIs in Nigeria.
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Affiliation(s)
| | - Iliyasu Yunusa Shuaibu
- Department of Surgery, Division of Otorhinolaryngology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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20
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Maharaj S, Ahmed S, Pillay P. Deep Neck Space Infections: A Case Series and Review of the Literature. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619871274. [PMID: 31496858 PMCID: PMC6716171 DOI: 10.1177/1179550619871274] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022]
Abstract
Deep neck spaces are regions of loose connective tissue filling areas between the
3 layers of deep cervical fascia, namely, superficial, middle, and deep layers.
The superficial layer is the investing layer, The pretracheal layer is the
intermediate layer and the prevertebral layer is the deepest layer. Deep neck
space infection (DNI) is defined as an infection in the potential spaces and
actual fascial planes of the neck. Once the natural resistance of fascial planes
is overcome, spread of infection occurs along communicating fascial boundaries.
More recent trends include the increasing prevalence of resistant bacterial
strains, a decline in DNIs caused by pharyngitis or tonsillitis, and a relative
increase in DNIs of odontogenic origin. Most DNIs are polymicrobial. Only 5% are
purely aerobic and 25% with isolated anaerobes. The epidemiology of DNIs needs
to be monitored for changing trends and the impact of underlying host immunity
and developing microbial multidrug resistance is established. Surveillance at
laboratory level should include mandatory susceptibility testing of all empiric
antibiotics against microbes commonly identified in adult DNI microscopy,
culture, and sensitivity (MC&S) specimens. The role of susceptibility
testing of microbes not commonly identified in adult DNI MC&S specimens
needs further review, on a clinical case-by-case basis.
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Affiliation(s)
- Shivesh Maharaj
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Sumaya Ahmed
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Preba Pillay
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
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21
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Lee MH, Carmichael RA, Read-Fuller AM, Reddy LV. Fatal deep neck infection and respiratory arrest. Proc (Bayl Univ Med Cent) 2019; 32:67-69. [PMID: 30956586 DOI: 10.1080/08998280.2018.1533313] [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: 08/24/2018] [Revised: 09/26/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022] Open
Abstract
Despite the wide availability of antibiotics and medical care, deep neck infections requiring hospitalization are associated with significant morbidity and mortality. Thus, early recognition and aggressive treatment are key in preventing unfavorable outcomes. We present the case of a patient who rapidly progressed from nonspecific upper respiratory symptoms to obstructive airway loss and death due to a swiftly worsening deep neck infection.
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Affiliation(s)
- Michael H Lee
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center and Texas A&M College of DentistryDallasTexas.,Dental Corps, United States Navy
| | - Ryan A Carmichael
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center and Texas A&M College of DentistryDallasTexas
| | - Andrew M Read-Fuller
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center and Texas A&M College of DentistryDallasTexas
| | - Likith V Reddy
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center and Texas A&M College of DentistryDallasTexas
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22
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Marioni G, Fasanaro E, Favaretto N, Trento G, Giacomelli L, Stramare R, Ottaviano G, de Filippis C. Are panels of clinical, laboratory, radiological, and microbiological variables of prognostic value in deep neck infections? An analysis of 301 consecutive cases. Acta Otolaryngol 2019; 139:214-218. [PMID: 30887898 DOI: 10.1080/00016489.2018.1532606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Deep neck infections (DNIs) are often clinically challenging, and may be life-threatening. OBJECTIVE The present retrospective study aimed to identify panels of clinical, laboratory, radiological, and microbiological parameters that could identify patients with DNIs at higher risk of complications or long-term hospitalization. MATERIALS AND METHODS The investigation concerned 301 consecutive patients with DNIs treated at our institution between 2000 and 2014. RESULTS The discriminatory power of a combination of two variables (unknown origin of the infection and the need for surgical treatment) in terms of deep neck infection complications occurrence featured an AUC (ROC) of 0.6701. The power of a panel of four variables (age, leukocyte count, need for surgical treatment, days elapsing from hospitalization to surgical procedure) to identify DNIs necessitating long-term hospitalization featured an AUC (ROC) of 0.7929. CONCLUSION Using the scale proposed by Hosmer and Lemeshow, the four-variable panel showed an amply acceptable, nearly excellent discriminatory power for long-term hospitalization. SIGNIFICANCE Although this panel achieved promising results for prognostic purposes, other parameters potentially capable of predicting the outcome of DNIs and orienting treatment decisions need to be investigated.
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Affiliation(s)
- Gino Marioni
- Department of Neuroscience DNS, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Elena Fasanaro
- Radiotherapy Department, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Niccolò Favaretto
- Department of Neuroscience DNS, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Giacomo Trento
- Department of Neuroscience DNS, Section of Otolaryngology, University of Padova, Padova, Italy
| | | | | | - Giancarlo Ottaviano
- Department of Neuroscience DNS, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, Audiology Unit, University of Padova, Treviso, Italy
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Priyamvada S, Motwani G. A Study on Deep Neck Space Infections. Indian J Otolaryngol Head Neck Surg 2019; 71:912-917. [PMID: 31742093 DOI: 10.1007/s12070-019-01583-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/04/2019] [Indexed: 11/29/2022] Open
Abstract
Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. These are commonly seen in low socioeconomic group with poor oral hygiene, and nutritional disorders. These are bacterial infections originating from the upper aerodigestive tract. The incidence of this disease was relatively high before the advent of antibiotics. Treatment of DNSI includes antibiotic therapy, airway management and surgical intervention. Management of DNSI is traditionally based on prompt surgical drainage of the abscess followed by antibiotics or nonsurgical treatment using appropriate antibiotics in the case of cellulitis. This study was conducted to investigate the age and gender, clinical symptoms, site involved, etiology, co-morbidities, bacteriology, complications and outcomes in the patients of DNSI. A prospective study of deep neck space infections was conducted during the period July 2017 to July 2018 on the patients who attended the outpatient department and were admitted as inpatient in Safdarjung hospital, New Delhi. 40 Cases with DNSI all ages and both genders were included in the study. Patients who didn't require surgical intervention to drain pus were excluded. All parameters including age, gender, co-morbidities, presentation, site, bacteriology, complications, and investigations were studied. Due to advent of antibiotics, deep neck space infections are in decreasing trend. The common age group found to be affected is in 2nd and 3rd decade in our study. Out of all deep neck space infections, submandibular space infections were common (37.5%) followed by peritonsillar infections (12.5%). Infection of deep neck space remains fairly common and challenging disease for clinicians. Prompt recognition and treatment of DNSI are essential for an improved prognosis. Odontogenic and tonsillopharyngitis are the commonest cause. Key elements for improved results are the prompt recognition and early intervention. Special attention is required to high-risk groups such as diabetics, the elderly and patients with underlying systemic diseases as the condition may progress to life-threatening complications.
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Affiliation(s)
- Shaili Priyamvada
- Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Gul Motwani
- Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Prabhu SR, Nirmalkumar ES. Acute Fascial Space Infections of the Neck: 1034 cases in 17 years follow up. Ann Maxillofac Surg 2019; 9:118-123. [PMID: 31293939 PMCID: PMC6585228 DOI: 10.4103/ams.ams_251_18] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim The aim of this study was to provide insight about all the common fascial space infections of the neck, their presentation, their etiology, complaints, length of stay, and the treatment given. Patients and Methods It was conducted in a tertiary center in Nadiad, Gujarat, India. A total of 1034 patients were treated for fascial space infections of the neck in the hospital from 2001 to 2017. There were 63.24% male and 36.75% female with age ranging from 21 days to 96 years having the mean age of 31.4 years. Results Odontogenic infection with poor oral hygiene as a cause was found in most (78.43%) of the abscesses. Diabetes was the most common comorbid condition found in 98 (9.47%) patients along with HIV found in ten (0.96%) patients. Pain (99.41%), fever (86.07%), swelling (86.94%), and dysphagia/odynophagia (67.21%) were the most common presenting symptoms. Ludwig's angina and submandibular abscess were found to be the most common deep head-and-neck space infection making up for 52% cases. The most common group of microorganisms isolated were Streptococcus sp. (19.82%) and Staphylococcus aureus (18.66%). Conclusion Treatment was given in the form of incision and drainage of the abscesses (83.69%) and systemic antibiotics (100%). The most common space infection among the deep neck infections is the submandibular space infection (52%). If the etiological factor was not removed which mostly was carious teeth, high chances of recurrence were found (27.27%). Four patients required tracheostomy, and there was one mortality in the entire series.
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Affiliation(s)
- Supreet Ratnakar Prabhu
- Department of Otorhinolaryngology, Dr. N D Desai Faculty of Medical Science and Research, Nadiad, Gujarat, India
| | - Enosh Steward Nirmalkumar
- External Faculty, Department of Otorhinolaryngology, Knowledge Institute of Physiotherapy, Anand, Gujarat, India
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Kauffmann P, Cordesmeyer R, Tröltzsch M, Sömmer C, Laskawi R. Deep neck infections: A single-center analysis of 63 cases. Med Oral Patol Oral Cir Bucal 2017; 22:e536-e541. [PMID: 28809368 PMCID: PMC5694174 DOI: 10.4317/medoral.21799] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/02/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND PURPOSE With the use of antibiotic therapy, the incidence of deep neck infections has decreased in recent decades. The aim of this investigation was to review the clinical course and the management of deep neck infections in our department, compare them to the experiences of the common literature and identify predisposing factors for lethal complications. MATERIAL AND METHODS In this single-center analysis, 63 patients with deep neck infections were treated surgically. The following clinical data were analyzed and compared: age, gender, laboratory data, spatial manifestation, therapeutic modalities, comorbidities, length of hospitalization and complications. RESULTS There was a predominance of male patients (58.7%) and a mean age of 57.9 years. The most common symptoms at diagnosis were sore throat (96.8%) and neck swelling (92.0%). Cardio/pulmonary diseases and diabetes mellitus were the most common comorbidities. There was a significantly longer hospital stay for patients with diabetes mellitus. The most common manifestation was a parapharyngeal abscess in 24 patients (38.1%), followed by peri-/retrotonsillar infections in 19 patients (30.2%). In 29 patients, a multiple space infection was observed, with a significantly longer duration of hospitalization and a higher rate of complications. The main life-threatening complication was the development of airway obstruction in 20 patients (31.7%), who all received a tracheostomy. The duration of hospitalization for patients with complications was significantly longer. CONCLUSION Close attention must be paid to the management of patients with deep neck infections, especially patients with diabetes mellitus and cardio/pulmonary diseases or patients with multiple space infections.
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Affiliation(s)
- P Kauffmann
- Department of Oral and Maxillofacial Surgery, University of Göttingen, Robert-Koch-Str 40, 37075 Göttingen, Germany,
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26
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Gujrathi AB, Ambulgekar V, Kathait P. Deep neck space infection - A retrospective study of 270 cases at tertiary care center. World J Otorhinolaryngol Head Neck Surg 2016; 2:208-213. [PMID: 29204568 PMCID: PMC5698542 DOI: 10.1016/j.wjorl.2016.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/28/2016] [Accepted: 11/01/2016] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To review the clinical findings in deep neck infections and identification predisposing factors of these complications. METHODS In this study, 270 patients with deep neck infections were studied retrospectively, study conducted in the Department of Ear, Nose and Throat, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India, from March 2013 to March 2016. RESULTS Analysis showed that males are most likely to have deep neck space infections (DNSI). Odontogenic and tonsillar causes were the more frequent ones. Staphylococcus aureus and Streptococcus species were the microorganisms more commonly isolated. CONCLUSION DNSI remains a common and challenging disease for otorhinolaryngologists, and should be treated on emergency basis. In developing countries, lack of adequate nutrition, poor oral hygiene, tobacco chewing, smoking and beetle nut chewing has led to an increased prevalence of dental and periodontal diseases. In present study, Odontogenic infections were the most common etiological factor for DNSI.
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Affiliation(s)
- Atishkumar B. Gujrathi
- Department of Ear, Nose and Throat, Dr. S. C. Government Medical College, Nanded, Maharashtra 431601, India
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27
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Deep neck infections originating from the major salivary glands. Am J Otolaryngol 2015; 36:559-64. [PMID: 25630849 DOI: 10.1016/j.amjoto.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/06/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Before the widespread use of antibiotics, most deep neck infections (DNIs) stemmed from complicated pharyngeal infections. Nowadays, they seem to be due mainly to dental infections. In 2010, our group reported that DNIs originated from a major salivary gland in 14% of cases. The main endpoint of the present investigation was to review our experience of the diagnosis and treatment of DNIs of salivary gland origin. We also compared the characteristics of DNIs originating from salivary glands with those originating elsewhere. METHODS Between 2000 and 2011, 44 patients were treated for DNIs of salivary origin at our institution. These patients were compared with 191 cases of DNI diagnosed as having other sites of origin. RESULTS/CONCLUSIONS In the present series, DNIs originating from a major salivary gland accounted for 19% of all cases of DNI of known origin. Patients with DNI of salivary gland origin were more likely to be elderly than those whose DNI originated from elsewhere (p=0.000). Our multivariate statistical model showed that comorbidities (p=0.051, statistical trend) and the need for surgical treatment (p=0.028) independently predicted long-term hospitalization for DNIs originating from a major salivary gland.
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Celakovsky P, Kalfert D, Smatanova K, Tucek L, Cermakova E, Mejzlik J, Kotulek M, Vrbacky A, Matousek P, Stanikova L, Hoskova T. Bacteriology of deep neck infections: analysis of 634 patients. Aust Dent J 2015; 60:212-5. [DOI: 10.1111/adj.12325] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- P Celakovsky
- Department of Otorhinolaryngology and Head and Neck Surgery; University Hospital Hradec Kralove; Charles University in Prague; Faculty of Medicine in Hradec Kralove; Czech Republic
| | - D Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery; University Hospital Hradec Kralove; Charles University in Prague; Faculty of Medicine in Hradec Kralove; Czech Republic
| | - K Smatanova
- Department of Otorhinolaryngology and Head and Neck Surgery; University Hospital Hradec Kralove; Charles University in Prague; Faculty of Medicine in Hradec Kralove; Czech Republic
| | - L Tucek
- Department of Dentistry; University Hospital Hradec Kralove; Charles University in Prague; Faculty of Medicine in Hradec Kralove; Czech Republic
| | - E Cermakova
- Department of Computed Technology; Charles University in Prague; Faculty of Medicine in Hradec Kralove; Czech Republic
| | - J Mejzlik
- Department of Otorhinolaryngology and Head and Neck Surgery; University Hospital Hradec Kralove; Charles University in Prague; Faculty of Medicine in Hradec Kralove; Czech Republic
| | - M Kotulek
- Department of Otorhinolaryngology and Head and Neck Surgery; Regional Hospital Pardubice; Faculty of Health Studies; University of Pardubice; Czech Republic
| | - A Vrbacky
- Department of Oral and Maxillofacial Surgery; Regional Hospital Pardubice; Faculty of Health Studies; University of Pardubice; Czech Republic
| | - P Matousek
- Department of Otorhinolaryngology; University Hospital Ostrava; Faculty of Medicine Ostrava; Czech Republic
| | - L Stanikova
- Department of Otorhinolaryngology; University Hospital Ostrava; Faculty of Medicine Ostrava; Czech Republic
| | - T Hoskova
- Department of Oral and Maxillofacial Surgery; University Hospital Ostrava; Czech Republic
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Yilmaz S, Bas B, Ozden B, Selcuk U, Cengel Kurnaz S. Deep neck infection after third molar extraction. J Istanb Univ Fac Dent 2015; 49:41-45. [PMID: 28955535 PMCID: PMC5573484 DOI: 10.17096/jiufd.82633] [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: 06/12/2014] [Accepted: 12/02/2014] [Indexed: 11/25/2022] Open
Abstract
Odontogenic and oropharyngeal infections are
relatively common in the cervicofacial region. In rare
cases, odontogenic or peritonsillar abscesses may
spread through the deep fascial cervical spaces and
cause life-threatening complications. Odontogenic
infection is the most common cause of deep neck
infections and it accounts for 43% of the cases.
Early diagnosis, immediate antibiotic treatment, and
surgical drainage are the basis of therapeutic success.
Deep neck infections are potentially life threatening
complications if they are not diagnosed in time and
treated quickly. This case report presents clinical,
radiological features and treatment of the spread of
abscesses through cervical spaces of an unusual case
of deep neck infection that was caused by the secondary
infection of the root remnants after extraction.
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Affiliation(s)
- Seda Yilmaz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul Aydın University, Turkey
| | - Burcu Bas
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Turkey
| | - Bora Ozden
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Turkey
| | | | - Senem Cengel Kurnaz
- Department of Ear Nose and Throat, Faculty of Medicine, Ondokuz Mayıs University, Turkey
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Chen PN, Shih CK, Li YH, Cheng WC, Hsu HT, Cheng KI. Gastric perforation after accidental esophageal intubation in a patient with deep neck infection. ACTA ANAESTHESIOLOGICA TAIWANICA : OFFICIAL JOURNAL OF THE TAIWAN SOCIETY OF ANESTHESIOLOGISTS 2014; 52:143-145. [PMID: 25085018 DOI: 10.1016/j.aat.2014.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 04/17/2014] [Accepted: 04/22/2014] [Indexed: 06/03/2023]
Abstract
Deep neck infection with airway obstruction may complicate endotracheal intubation with limited neck motion, pharyngeal swelling, and prominent secretion. Unrecognized esophageal intubation (EI) may unduly overinflate the stomach to inhibit effective ventilation, increase the incidence of hypoxia, and produce a ruptured visceral organ. We report an 81-year-old female patient with deep neck infection and impending respiratory failure who suffered gastric perforation after accidental EI in the intensive care unit. After failed attempts of intubation, EI was recognized rapidly as the culprit, although roughly audible bilateral breathing sounds were present but not gastric bubble sounds. A catastrophic complication of gastric rupture occurred due to ambu-bagging and mechanical ventilation. Surgical intervention was performed immediately. Possible mechanisms are discussed.
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Affiliation(s)
- Po-Nien Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Chih-Kai Shih
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Ya-Hui Li
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Wei-Ching Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Hung-Te Hsu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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31
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Ottaviano G, Staffieri C, Favaretto N, Fasanaro E, Abate D, de Filippis C, Staffieri A, Marioni G. Burkholderia cepacia complex isolation in non-polypoid chronic rhinosinusitis. Am J Otolaryngol 2014; 35:598-602. [PMID: 24976594 DOI: 10.1016/j.amjoto.2014.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/12/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE Burkholderia cepacia complex (Bcc) infections of the head and neck have been infrequently reported in immunocompetent patients, while their association with cystic fibrosis is quite well known. One of the main problems associated with Bcc is their intrinsic resistance to most clinically-available antimicrobials. Bcc has already been isolated in sinonasal polyposis, while here we report for the first time on its isolation in patients with chronic rhinosinusitis (CRS) but no nasal polyposis. MATERIALS AND METHODS Thirty-four consecutive surgically-treated CRS patients without cystic fibrosis were recruited. RESULTS Bcc was isolated in 4 cases of CRS without polyposis, and in another case in sinonasal polyposis. All tested Bcc strains isolated in non-polypotic CRS were resistant to ciprofloxacin, amikacin, ertapenem, amoxicillin/clavulanate, cefotaxime, and gentamicin. CONCLUSIONS The novel finding of Bcc species in CRS without polyposis as well suggests that the mechanism by which these bacteria adhere to the epithelium of the upper respiratory tract may be important in the host's colonization.
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Cho YS, Choi JH. Descending necrotizing mediastinitis with diffuse ST elevation mimicking pericarditis: a case report. J Emerg Med 2014; 47:408-11. [PMID: 25060009 DOI: 10.1016/j.jemermed.2014.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 03/12/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Descending necrotizing mediastinitis (DNM) is a potentially fatal disease that requires aggressive treatment, including mediastinal exploration. The inflammation associated with DNM may involve the heart, which produces acute changes in the electrocardiogram (ECG). As a result, the ECG may mimic pericarditis, causing some diagnostic confusion. OBJECTIVES The objectives of this case report are to describe a case of DNM presenting electrocardiographically with pericarditis, and to discuss how to differentiate between benign viral pericarditis and DNM, and the management of these two diseases. CASE REPORT We present the case of a previously healthy 50-year-old man who presented to the Emergency Department for chest pain and presumed pericarditis. The patient presented with ST elevation on multiple leads on ECG, tenderness in the neck, widened mediastinum on the chest radiograph, and nonspecific laboratory test results. Echocardiography revealed normal ventricle function and the presence of mild pericardial effusion. The emergency physician performed contrast-enhanced neck computed tomography (CT) to rule out deep-neck infection. The CT scan showed marginal rim-enhancing abscesses in the retropharyngeal, bilateral submandibular, and anterior visceral spaces with extension into the thoracic cavity. Contrast-enhanced chest CT was performed consecutively. The final diagnosis was deep-neck infection with DNM. The patient underwent mediastinoscopy-assisted drainage and neck fasciotomy twice and received 7 weeks of therapy with intravenous meropenem. CONCLUSION The present case highlights the importance of considering a mediastinal cause for acute ECG changes.
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Affiliation(s)
- Young Soon Cho
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Bucheon-si, Gyeonggi-do, Korea
| | - Jae Hyung Choi
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Bucheon-si, Gyeonggi-do, Korea
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Dalla Torre D, Burtscher D, Höfer D, Kloss FR. Odontogenic deep neck space infection as life-threatening condition in pregnancy. Aust Dent J 2014; 59:375-8. [PMID: 24819888 DOI: 10.1111/adj.12189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2013] [Indexed: 12/18/2022]
Abstract
Odontogenic deep neck space infections represent a severe disease with possible life-threatening complications. Despite knowledge of these infectious diseases, treatment remains a challenge for every maxillofacial surgeon. Therapy of severe neck infections is even more crucial during pregnancy because of the possible life-threatening situation for both the mother and the foetus. The possible compromise of oral health during pregnancy is well known, however severe odontogenic infections are rarely considered in the literature. The following case report describes the dramatic course of a deep neck space infection in a pregnant patient, commencing with typical symptoms of localized odontogenic infection and ending in a critical, life-threatening condition for the patient and a lethal condition for the foetus. The case represents the first description of intrauterine, foetal death caused by a deep neck space infection. Implications for dental and medical treatment during pregnancy, especially regarding odontogenic infections, are presented and discussed with findings in the international literature.
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Affiliation(s)
- D Dalla Torre
- Clinical Department of Craniomaxillofacial and Oral Surgery, Innsbruck Medical University, Austria
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Chi TH, Tsao YH, Yuan CH. Influences of Patient Age on Deep Neck Infection. Otolaryngol Head Neck Surg 2014; 151:586-90. [DOI: 10.1177/0194599814542589] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To analyze the differences in clinical features, etiology, treatment modalities, and microbiology of the deep neck infections between the elderly and the adults. Study Design Cases series. Setting Single hospital. Subjects and Methods A retrospective review was performed on patients older than 18 years of age with diagnosis of deep neck infection from January 2008 to December 2012. A total of 148 patients were enrolled in this study, including 32 elderly (older than 65 years of age) and 116 adults who aged between 18 and 65. Data collected included age, gender, clinical presentations, etiology, treatment modalities, and microbiology. Results Odontogenic and salivary origin were the most common sources of infection for the elderly group, whereas the odontogenic and tonsillar origin were the most common sources of deep neck infections in the adult group. Compared to the adult group, the elderly group had significantly higher ratio with multiple spaces involved (53.1% vs 30.2%, P = .016), complication (15.6% vs 4.3%, P = .024), and surgical interventions (75.0% vs 38.8%, P < .001), in addition to longer hospital stay (11.1 ± 7.2 days vs 8.2 ± 4.5 days, P = .029). Conclusion Compared to the adult group, the elderly patients with deep neck infection had more cases with multiple spaces involvement, complications, surgical interventions, and longer hospital stay. However, the outcome of the elderly group was the same as the adult group. Therefore, the benefits of aggressive management for deep neck infection should not be withheld from patients simply because of the old age.
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Affiliation(s)
- Tzu-Hang Chi
- Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Otolaryngology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Yuan-Heng Tsao
- Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Chien-Han Yuan
- Department of Otolaryngology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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Mª de Los Ángeles F, R. PG, Marcelo Mardones M, Rodrigo Bravo A. Complicaciones severas de infecciones odontogénicas. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70066-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Staffieri C, Fasanaro E, Favaretto N, La Torre FB, Sanguin S, Giacomelli L, Marino F, Ottaviano G, Staffieri A, Marioni G. Multivariate approach to investigating prognostic factors in deep neck infections. Eur Arch Otorhinolaryngol 2014; 271:2061-7. [PMID: 24522964 DOI: 10.1007/s00405-014-2926-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/29/2014] [Indexed: 11/26/2022]
Abstract
Deep neck infections (DNI) spread along fascial planes and involve neck spaces. Very few studies have investigated potentially prognostic factors using multivariate statistical models. Our aim was to analyze 282 consecutive cases of DNI using multivariate (logistic) statistical models to identify independent significant factors influencing prognosis in terms of complications and long-term hospitalization (>6 days). In our series, only involvement of more than one neck space was independently significant in prognosticating complications of DNI (odds ratio [OR] 2.46). The presence of comorbidities (OR 2.13), non-odontogenic sites of origin (OR 1.88), leukocyte counts above 11.0 cells × 10(9)/L at presentation (OR 3.57), and the need for both medical and surgical treatments (OR 4.66) was significantly and independently prognostic of long hospital stays. Multivariate analysis can distinguish between risk factors and their relative contribution to outcome. The few published studies using multivariate models to analyze DNI prognosis considered quite large cohorts, but no clinical variables persistently revealed an independent significant prognostic role. This evidence seems to underscore the complex interdependence of several clinical variables in contributing to DNI prognosis, and the heterogeneity of the diagnostic/therapeutic approaches adopted.
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Affiliation(s)
- Claudia Staffieri
- Otolaryngology Section, Department of Neurosciences, Treviso Branch, University of Padova, Padua, Italy
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Life-threatening complications of deep neck space infections. Wien Klin Wochenschr 2013; 125:680-6. [PMID: 24146325 DOI: 10.1007/s00508-013-0428-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
Odontogenic infections represented a challenge for every craniomaxillofacial surgeon in the pre-antibiotic era, not least due to the frequent association with septic complications and lethal consequences. Nowadays, the incidences of serious infection-related complications are less frequent thanks to the medical progress. Nevertheless, the development of severe infections is still hard to foresee. The following analysis provides an overview of four patients with severe, life-threatening odontogenic deep neck space infections treated at the University Clinic for Oral and Maxillofacial Surgery in Innsbruck and describes the etiology, therapy, and outcome for each patient while analyzing differences between the single cases. Crucial aspects in origin, progression, and treatment of DNIs are highlighted, comparing the results with the international literature.
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Celakovsky P, Kalfert D, Tucek L, Mejzlik J, Kotulek M, Vrbacky A, Matousek P, Stanikova L, Hoskova T, Pasz A. Deep neck infections: risk factors for mediastinal extension. Eur Arch Otorhinolaryngol 2013; 271:1679-83. [PMID: 23925695 DOI: 10.1007/s00405-013-2651-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/23/2013] [Indexed: 11/30/2022]
Abstract
The goal of the study was to find out the risk factors for the development of mediastinitis in patients with deep neck infections (DNI) and describe the differences in symptoms and clinical image between uncomplicated DNI and infections with mediastinal spread. Our study represents the retrospective analysis of 634 patients with DNI. The file was divided into two groups. There were 619 patients (97.6%) in the first group who had an uncomplicated course of DNI without spread of infection into mediastinum (DNI group). The second group included 15 patients (2.4%) with descending mediastinitis as a complication of DNI (mediastinitis group). The most frequent comorbidities were cardiac and pulmonary diseases, which were more frequent in the mediastinitis group comparing to DNI group. Dental origin of the infection was more frequent in DNI group than in the mediastinitis group. On the other hand, tonsillar origin of the infection was more frequent in the mediastinitis group than in DNI group. In both mediastinitis and DNI groups, the typical presenting symptoms were pain, oedema and dysphagia. Furthermore, dysphagia, dyspnoea, dysphonia and restriction of neck movements were more significant in the mediastinitis group than in DNI group. The incidence of airway obstruction, sepsis, pneumonia and death was significantly higher in the mediastinitis group than in DNI group. Due to our results, the predisposing factors for mediastinal extension of DNI are cardiovascular and pulmonary diseases. Mediastinitis is associated with higher morbidity and mortality than DNI. The most common complications are airway obstruction, pneumonia and sepsis.
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Affiliation(s)
- Petr Celakovsky
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Sokolska 581, Hradec Kralove, 50005, Czech Republic
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Liao YS, Lai CC, Tan CK, Lin SH. Deep neck infection with descending necrotizing mediastinitis presenting with out-of-hospital cardiac arrest. QJM 2013; 106:663-5. [PMID: 23417909 DOI: 10.1093/qjmed/hct047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y-S Liao
- Department of Prosthodontic, Chang-Gung Memorial Hospital, Taipei, Taiwan
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Eisler L, Wearda K, Romatoski K, Odland RM. Morbidity and cost of odontogenic infections. Otolaryngol Head Neck Surg 2013; 149:84-8. [PMID: 23585157 DOI: 10.1177/0194599813485210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cost analysis of deep neck space infections from odontogenic origin and review of the morbidity of potentially preventable complications. STUDY DESIGN Case series with chart review. SETTING Level 1 trauma center and academic safety net hospital. SUBJECTS AND METHODS Patients treated for deep neck space infections due to an odontogenic source between 2001 and 2010 were reviewed. Two hundred patients were included in the study. Ninety-eight patients required inpatient admission. Twelve percent of these patients had difficult airways, and 16% had at least 1 day in the intensive care unit. Cost data were available only for the later 3.5 years of the study period. RESULTS The overall cost of treatment for these 71 individuals exceeded $1.1 million. CONCLUSION The cost of treatment for odontogenic infections is staggering. Based on assumptions of the percentage of infections in the metropolitan area captured at Hennepin County Medical Center, extrapolation to the total national cost of inpatient care approaches $200 million annually. This study highlights the importance of access to medical and preventative dental care for the general population and demonstrates the cost benefit that could be achieved through prevention of disease and, therefore, avoidance of its complications.
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Affiliation(s)
- Lindsay Eisler
- Department of Otolaryngology, Hennepin County Medical Center; Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota 55415, USA
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Costales-Marcos M, López-Álvarez F, Núñez-Batalla F, Moreno-Galindo C, Álvarez Marcos C, Llorente-Pendás JL. Peritonsillar Infections: Prospective Study of 100 Consecutive Cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012. [DOI: 10.1016/j.otoeng.2012.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Costales-Marcos M, López-Álvarez F, Núñez-Batalla F, Moreno-Galindo C, Alvarez Marcos C, Llorente-Pendás JL. [Peritonsillar infections: prospective study of 100 consecutive cases]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:212-7. [PMID: 22425204 DOI: 10.1016/j.otorri.2012.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/23/2011] [Accepted: 01/02/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Peritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis. MATERIAL AND METHODS We prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration. RESULTS Seventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%. CONCLUSIONS Due to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed.
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Affiliation(s)
- María Costales-Marcos
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Principado de Asturias, España.
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Bakir S, Tanriverdi MH, Gün R, Yorgancilar AE, Yildirim M, Tekbaş G, Palanci Y, Meriç K, Topçu İ. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol 2012; 33:56-63. [PMID: 21414684 DOI: 10.1016/j.amjoto.2011.01.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 01/12/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to review our recent experience with deep neck infections and emphasize the importance of radiologic evaluation and appropriate treatment selection in those patients. MATERIALS AND METHODS The records of 173 patients treated for deep neck infection at the Department of Otolaryngology and Head and Neck Surgery of Dicle University Hospital during the period from 2003 to 2010 were retrospectively reviewed. Their demography, symptoms, etiology, seasonal distribution, bacteriology, radiology, site of deep neck infection, durations of the hospital admission and hospital stay, treatment, complications, and outcomes were evaluated. The findings were compared to those in the available literature. RESULTS Dental infection was the most common cause of deep neck infection (48.6%). Peritonsillar infections (19.7%) and tuberculosis (6.9%) were the other most common cause. Pain, odynophagia, dysphagia, and fever were the most common presenting symptoms. Radiologic evaluation was performed on almost all of the patients (98.3%) to identify the location, extent, and character (cellulitis or abscesses) of the infections. Computed tomography was performed in 85.3% of patients. The most common involved site was the submandibular space (26.1%). In 29.5% of cases, the infection involved more than one space. All the patients were taken to intravenous antibiotic therapy. Surgical intervention was required in 95 patients (59.5%), whereas 78 patients (40.5%) were treated with intravenous antibiotic therapy alone. Life-threatening complications were developed in 13.8% of cases; 170 patients (98.3%) were discharged in stable condition. CONCLUSION Despite the wide use of antibiotics, deep neck space infections are commonly seen. Today, complications of deep neck infections are often life threatening. Although surgical drainage remains the main method of treating deep neck abscesses, conservative medical treatment are effective in selective cases.
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Chang PC, Wang WL, Hwang TZ, Cheng YJ. Intramural dissection with mucosal rupture alleviating phlegmonous esophagitis. Eur J Cardiothorac Surg 2011; 41:442-4. [PMID: 21807529 DOI: 10.1016/j.ejcts.2011.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We report a woman presenting with unrelenting odynophagia and chest pain. Computed tomography identified a deep neck infection with acute phlegmonous esophagitis. However, esophageal intramural dissection with mucosal rupture occurred after routine nasogastric-tube insertion, and pus was vomited thereafter. The patient was treated with antibiotics and delayed endoscopic closure of the rupture site and made a full recovery. Although the definite pathogenesis remained unclear, esophageal intramural dissection with mucosal rupture, a possible and rare complication of nasogastric-tube insertion, eventually alleviated the acute phlegmonous esophagitis in our patient.
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Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, E-DA Hospital/I-Shou University, Kaohsiung City, Taiwan.
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Chen TC, Wu MH, Cheng YJ, Chang PC. Spontaneous pharyngoesophageal perforations. Eur J Cardiothorac Surg 2011; 40:1250-2. [DOI: 10.1016/j.ejcts.2011.02.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/16/2011] [Accepted: 02/22/2011] [Indexed: 11/28/2022] Open
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Marioni G, Rinaldi R, Manzato E, Sari M, Prosenikliev V, Accordi D, Staffieri C, Giacomelli L, Staffieri A. Aging and deep neck infection. The experience of a tertiary referral center (2000-2009). J Am Geriatr Soc 2010; 58:1609-11. [PMID: 20942885 DOI: 10.1111/j.1532-5415.2010.03000.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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