Delineation of a deep neck abscess with magnetic resonance imaging

Global profiling of phosphorylation-dependent changes in cysteine reactivity

Proteomics has revealed that the ~20,000 human genes engender a far greater number of proteins, or proteoforms, that are diversified in large part by post-translational modifications (PTMs). How such PTMs affect protein structure and function is an active area of research but remains technically challenging to assess on a proteome-wide scale. Here, we describe a chemical proteomic method to quantitatively relate serine/threonine phosphorylation to changes in the reactivity of cysteine residues, a parameter that can affect the potential for cysteines to be post-translationally modified or engaged by covalent drugs. Leveraging the extensive high-stoichiometry phosphorylation occurring in mitotic cells, we discover numerous cysteines that exhibit phosphorylation-dependent changes in reactivity on diverse proteins enriched in cell cycle regulatory pathways. The discovery of bidirectional changes in cysteine reactivity often occurring in proximity to serine/threonine phosphorylation events points to the broad impact of phosphorylation on the chemical reactivity of proteins and the future potential to create small-molecule probes that differentially target proteoforms with PTMs.

Malignant Aspergillus flavus Otitis Externa with Jugular Thrombosis

We report a case of malignant otitis externa with jugular vein thrombosis caused by Aspergillus flavus. Magnetic resonance imaging revealed an unusual ink smudge pattern deep in a cervical abscess. The pattern was consistent with mycetoma and may be important for diagnosing these life-threatening infections.

The role of colour Doppler ultrasonography in the diagnosis of fascial space infections - a cross sectional study

AIMS AND OBJECTIVES

(1) To evaluate the role of ultrasonography with colour Doppler in the diagnosis of fascial space infections, (2) To determine the nature, size and extent of the odontogenic infections which involve the primary and secondary fascial spaces of the maxilla and the mandible (3) To evaluate the sensitivity of ultrasonography in determining whether the inflammatory process is in a stage of cellulitis or abscess and to thus determine the appropriate time for a surgical intervention during the course of the infection and to correlate the clinical and radiographic findings with the ultrasonographic findings and (4) to determine the treatment plan.

METHODOLOGY

Thirty four patients with odontogenic infections which involved the superficial and the deep fascial spaces of the head and neck were subjected to ultrasonographic examinations over the suspected area in the transverse and axial directions to determine the stage of the infection, its anatomic location and the treatment plan.

RESULTS

Ultrasonography showed 95.7% sensitivity and 100% specificity as compared to the clinical and radiographic diagnoses and it proved to be an effective investigation modality in the diagnosis of fascial space infections.

Evaluation of ultrasonography as a diagnostic tool in maxillofacial space infections

Objectives

The purpose of the study was to establish the role of ultrasonography in determining the involvement of specific fascial spaces in maxillofacial region and the stage of infection, in indicating the appropriate time for surgical intervention and to compare clinical and ultrasonographic findings.

Material and Methods

Twenty five patients with fascial space infection in maxillofacial region were subjected to ultrasonographic examination following a detailed clinical and radiological examination. Ultrasonography guided needle aspiration was performed. Based on the findings, patients diagnosed with abscess were subjected to incision and drainage and those with cellulitis were subjected to medical line of treatment.

Results

More than one fascial space was involved in all patients. On clinical examination 64 spaces were involved, of them 34 spaces had abscess formation and 30 spaces were in the stage of cellulitis. On ultrasonography examination, 28 spaces were reported to have abscess formation and 36 spaces were diagnosed to be in the stage of cellulitis. On comparative analysis of both clinical and ultrasonographic findings, ultrasonography was found to be sensitive in 65% of the cases and having specificity of 80%. It was registered statistically significant (P < 0.001) agreement between these two methods of assessment (kappa index = 0.814).

Conclusions

Ultrasonography is a quick, widely available, relatively inexpensive, and painless procedure and can be repeated as often as necessary without risk to the patient. Thus ultrasonography is a valuable diagnostic aid to the oral and maxillofacial surgeon for early and accurate diagnosis of fascial space infection, their appropriate treatment and to limit their further spread.

Deep neck infection with dental origin: analysis of 85 consecutive cases (2000-2006)

CONCLUSIONS

Diagnostic work-up should include contrast-enhanced computed tomography (CT) and mandible orthopantogram. When a dental origin of deep neck infection is suspected, the intravenous antibiotic regimen has to be active against gram-positive bacteria, both aerobes and anaerobes. Surgical exploration and drainage may be mandatory at presentation, or in cases not responding to medical therapy within the first 24 h.

OBJECTIVES

Deep neck infections are still associated with significant morbidity and mortality rates when complications occur. Despite worldwide improvement in dental care and oral hygiene, a significant prevalence of deep neck infections caused by dental infections has been described recently (> 40%).

PATIENTS AND METHODS

We analysed retrospectively 85 cases of deep neck infection with dental origin out of 206 consecutive cases of deep neck infection diagnosed in our institution between 2000 and 2006.

RESULTS

The most frequent dental source was a periapical infection of the first mandibular molar, followed by second and third molar, respectively. Submandibular space infection involvement was diagnosed in 73 of 85 patients (85.9%), masticatory space infection in 28 (32.9%); in 56 patients (65.9%) the infection involved more than one space. Twenty-four patients (28.2%) were treated only with intravenous antibiotic therapy; 61 patients (71.8%) required both medical and surgical procedures.

Transtonsillar drainage of parapharyngeal abscess

We report a parapharyngeal abscess in an adult patient that was drained transorally by performing ipsilateral tonsillectomy and aspirating the pus through the tonsillar bed. This approach is unusual as most previous studies report the aspiration of such abscesses through the lateral pharyngeal mucosa. In addition, the majority of these studies are limited to pediatric cases. Our approach was effective and resulted in a rapid resolution of the symptoms. The management and different approaches to parapharyngeal abscess are discussed, and the literature is reviewed.

[Retropharyngeal and lateral pharyngeal abscesses in children]

OBJECTIVE

Review of the diagnostic and management of retropharyngeal and lateral pharyngeal abscesses in children.

PATIENTS AND METHODS

Retrospective study of 5 children's cases hospitalized during year 2003.

RESULTS

Diagnosis included CT scan which is often helpful to differentiate cellulitis from abscesses. First medical management consists in an intravenous broad-spectrum antibiotics. Surgical drainage may be considered in cases of failure or clinical aggravation. Closed observation is mandatory in all cases to prevent major complication.

CONCLUSION

Retropharyngeal and lateral pharyngeal abscesses in children are life-threatening infectious. Therapeutic consists in intravenous broad-spectrum antibiotics associated, if necessary, with surgical drainage in cases of persistent abscess.

Accuracy of computerized tomography in deep neck infections in the pediatric population

OBJECTIVES

Computerized tomography (CT) is used widely to diagnose deep neck infections (DNIs), and, generally, the decision of surgical intervention is based on findings of a CT study. This study examines the accuracy of CT in differentiating abscess versus cellulitis in DNIs (lateral pharyngeal and retropharyngeal).

STUDY DESIGN

This is a retrospective chart review study with re-evaluation of the CT scans by a blinded observer.

METHODS

A retrospective review of medical records of 80 patients with DNIs who were evaluated with a CT study was performed. CT scans of these patients were reviewed by a radiologist who was blinded to the clinical and surgical findings and to the original CT study report. To diagnose the infection and differentiate abscess from cellulitis, our radiologist scored the CT scans regarding the following variables: low-density core, rim enhancement, soft-tissue swelling, obliterated fat planes, and mass effect. Radiologic diagnosis was compared with operative findings (whether pus found at surgery or not) in all cases treated surgically. Accuracy, sensitivity, specificity, and positive and negative predictive values of CT study were calculated.

RESULTS

Thirty-nine (49%) patients were treated medically with intravenous (IV) antibiotics alone, and 41 (%51) patients were treated both surgically and medically. The overall accuracy of CT in DNI was 63%. The sensitivity, specificity, and positive and negative predictive values were 68%, 56%, 71%, and 53%, respectively.

CONCLUSION

CT study has important limitations in differentiating abscess versus cellulitis in DNIs. Clinical findings as well as CT diagnosis should guide the decision of surgery.

Intraoperative ultrasound imaging to aid abscess drainage--a technical note

Diagnostic ultrasound is used widely to identify the presence of fluid collections preoperatively. Although its role in other parts of the body is well established, this report describes the technique of using diagnostic ultrasound intraoperatively to aid drainage of a large fascial space abscess in the head and neck. Following previously inadequate drainage of a large superficial abscess from a blindly placed drain, a second procedure was carried out, using ultrasound imaging to locate the persisting abscess. Furthermore, ultrasound demonstrated the adequacy of drainage and helped the surgeon to position the drain in the correct tissue space. We consider that intraoperative use of ultrasound has a role as a guidance tool to drain superficial fascial space abscesses in the head and neck region.

The use of ultrasonography as a diagnostic tool for superficial fascial space infections

PURPOSE

This study examined the value of ultrasonography as a diagnostic tool in the treatment of superficial acute odontogenic fascial space infections.

PATIENTS AND METHODS

The study group consisted of 50 patients in whom both radiographic and sonographic examinations, as well as a needle aspiration, were performed.

RESULTS

Purulent fluid was aspirated in 22 of the 50 patients. Six patients diagnosed as suffering from cellulitis had a repeated ultrasonography scan. In four, abscess formation was diagnosed on the third day.

CONCLUSIONS

Ultrasonography is an effective diagnostic tool to confirm abscess formation in the superficial fascial spaces and is highly predictable in detecting the stage of infection.

Characterization and management of deep neck infections

A retrospective review was conducted of 91 patients with deep neck infections to determine the pattern of clinical disease and formulate a management plan. The spaces involved, as determined by clinical, radiologic, and operative findings, were the peritonsillar space (72 patients), parapharyngeal space (eight patients) submandibular space (seven patients), retropharyngeal space (one patient) superficial space (one patient), anterior visceral space (one patient), and visceral vascular space (one patient). Of the 19 patients who did not have a peritonsillar space infection the origin of the infection was found in eight; four of these were odontogenic. Thirty-eight patients required surgical drainage of the abscess. Five patients underwent tracheotomy due to increasing dyspnea. One patient with diabetes mellitus and a past history of myocardial infarction died of unknown cause. All other patients had an uneventful recovery without major complications. The combination of early radiologic diagnosis, effective antimicrobial therapy, and intensive surgical management contributed to the good prognosis.

Considerations in the management of maxillofacial infections in the pregnant patient

PURPOSE

The pregnant patient who presents with a maxillofacial infection requires additional management considerations. The maternal-fetal unit requires particular attention to maintain fetal viability, assure a normal pregnancy, and obtain a desirable outcome. The purpose of this article is to inform the oral and maxillofacial surgeon of the clinically relevant material that one needs to understand and consider when treating maxillofacial infections in this particular patient population.

Major maxillofacial infections. An evaluation of 107 cases

A review of 107 cases of acute maxillofacial infections managed at the Royal Melbourne Hospital was undertaken, and details of the presentations, demography, management, and outcomes of these patients are presented. The results indicated that many of the patients had sought treatment from dentists in general practice, and that a significant proportion had received sub-optimal management prior to referral. Thus a review of the principles of management and guidelines for the referral of patients with maxillofacial infections is also presented.

New trends in head and neck imaging

The development of novel imaging techniques has exerted a larger influence on medical science than have any other advances in the last decade. The following occurrence are now evident in imaging for all medical disciplines: reduced use of ionizing radiation, abandonment of invasive methods, real-time properties, visualization of functional parameters, digitalization and pooling of information, as well as interaction of user with image information. A wide variety of imaging methods is now available clinically for the study of head and neck diseases. However, only picture archiving and communication systems (PACS) can efficiently handle and integrate information coming from multiple imaging modalities, such as computed tomography, magnetic resonance imaging, positron emission tomography, digital subtraction angiography and digital radiography. Such systems also incorporate image workstations that the surgeon can use for preoperative planning and even perioperative assistance. Current PACS are reviewed, since their future use may change the operating theater and also change surgical strategies.

Thoracic complications of deeply situated serous neck infections

Nine cases of complicated deep neck infections, occurring during a period of twelve years are presented. Complications observed were cervico-thoracic necrotizing fasciitis in 3 cases, purulent pleural effusion in 6 cases, pericardial effusion in 2, mediastinitis in 8 cases, jugular vein thrombosis and rupture of the innominate artery in one case each. Although 2 cases were managed initially with blind endotracheal intubation, all cases finally required tracheostomy. A cervico-mediastinal approach was useful for the early mediastinal involvement. Two patients died because of inadequacy of the multiple surgical procedures resulting in persistent infection and multi-organ failure and one because of uncontrollable bleeding after innominate artery rupture.

Parapharyngeal (retrostyloid)--third branchial cleft cyst

This is the first description of successful surgical excision of a parapharyngeal (retrostyloid compartment) cyst remnant of the third branchial arch.