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Roh JL. Early intervention of transoral laser-assisted marsupialization for adult epiglottic abscess. Am J Otolaryngol 2023; 44:103900. [PMID: 37121098 DOI: 10.1016/j.amjoto.2023.103900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/02/2023]
Abstract
Epiglottic abscess is a potentially fatal disease by airway compromise. Emergent airway intervention and admission to an intensive care unit are frequently required for patients with epiglottic abscess. Epiglottic abscess also doubles the duration of hospitalization compared to non-abscess epiglottitis. Abscess drainage, antibiotics administration, and airway monitoring are the mainstays of treatment. Spinal needle aspiration has been introduced to treat epiglottic abscess, which shows no significant additional benefit from a comparative study. Marsupialization has been commonly utilized to treat benign cystic diseases. Early surgical intervention of epiglottic abscess may resolve patient symptoms and secure the airway. Early intervention of transoral laser-assisted marsupialization for epiglottic abscess was a safe, simple, and reliable technique that guaranteed early recovery in 12 cases. Therefore, this article presents the procedures, pros, and cons of this method for treating epiglottic abscess.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Biomedical Science, General Graduate School, CHA University, Seongnam, Republic of Korea.
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Efficacy of needle aspiration in patients with oral-maxillofacial abscesses: A retrospective study of 15 consecutive patients. Am J Otolaryngol 2022; 43:103216. [PMID: 34536922 DOI: 10.1016/j.amjoto.2021.103216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/05/2021] [Indexed: 11/22/2022]
Abstract
The aim of this study was to determine the adequacy and safety of needle aspiration (NA) as an alternative to open surgical drainage for oral-maxillofacial abscesses. Fifteen consecutive patients who were diagnosed with oral-maxillofacial abscesses via contrast-enhanced CT from January 2020 to December 2020 were included. All patients were on antibiotics and treated with NA under local anaesthesia using a 20 mL syringe. Data collection included patient characteristics, signs and symptoms, physical examinations, laboratory tests, imaging findings, and outcomes. Next-generation sequencing (NGS) was used to identify the infectious microorganisms from the abscess samples. The study included 15 patients with oral-maxillofacial abscesses. None of our 15 patients required surgical incision and drainage, although repeat aspiration was required. However, after the first NA, the pain was reportedly extremely relieved for all patients. The average duration of antibiotic treatment was 9.20 ± 5.15 days (range 4-23 days). The abscess-affected spaces mainly included the masseter space and submandibular space. Odontogenic infection was the most common aetiology in 15 patients (10/15). The average volume of the abscesses on CT was 5866.26 ± 3627.18 mm3. The main pathogens identified in this study were Prevotella oris (5/15), Peptostreptococcus stomatis (4/15) and Porphyromonas endodontalis (2/15). According to the results of our study, the data support the use of NA as an effective, minimally invasive treatment modality for oral-maxillofacial abscesses. Surgeons should familiarise themselves with this technique, as it can easily be performed in the clinic using local anaesthesia, culture samples may be obtained, and airway obstruction and pain may be relieved.
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Sideris G, Papadimitriou N, Korres GF, Karaganis A, Maragkoudakis P, Nikolopoulos T, Delides A. Clinical and Microbiological Factors Associated With Abscess Formation in Adult Acute Epiglottitis. Ann Otol Rhinol Laryngol 2021; 131:1194-1201. [PMID: 34841913 DOI: 10.1177/00034894211051817] [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: 11/17/2022]
Abstract
OBJECTIVES To evaluate clinical and microbiological findings that are correlated with abscess formation in adult acute epiglottitis (AE). METHODS We reviewed 140 cases of adult AE. Demographic, clinical, imaging, and microbiological findings are analyzed for all patients with AE in comparison to those with epiglottic abscess (EA). RESULTS A total of 113 patients presented with AE and 27 presented or progressed to EA (19.3%). Age, sex, seasonality, smoking, body mass index (BMI), and comorbidities were statistically insignificant between the 2 groups. Muffled voice (P < .013), respiratory distress (P < .001), and pre-existence of epiglottic cyst (P < .001) are symptoms and signs connected with abscess formation. A total of 120 patients were treated conservatively. Surgical treatment was performed on 20 patients with EA. About 72 out of 80 cultures revealed monomicrobial infection. Mixed flora was isolated in 8 patients with EA. Streptococcus was isolated in 51 out of 80 positive cultures (64%). Haemophilus Influenza (Hib) was not isolated in any sample. EA and mixed flora relates to a higher rate of airway intervention (P < .001). CONCLUSION A high level of suspicion for abscess formation is required if clinical examination reveals dyspnea, muffled voice, or an epiglottic cyst in adult with AE. The existence of EA doubles the duration of hospitalization. EA is typically found on the lingual surface of the epiglottis. Supraglottic or deep neck space expansion should be treated surgically. EA is associated with a mixed flora and a higher rate of airway obstruction. Streptococcus is discovered to be the most common pathogen.
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Affiliation(s)
- Giorgos Sideris
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papadimitriou
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Georgios F Korres
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Karaganis
- Department of Economic and Regional Development, Panteion University of Social and Political Sciences, Athens, Greece
| | - Pavlos Maragkoudakis
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Thomas Nikolopoulos
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Alexander Delides
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
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Wu X, Zhang J, Fang R, Wei C. Use of Indirect Laryngeal Biopsy Forceps to Treat Epiglottic Abscess. EAR, NOSE & THROAT JOURNAL 2020; 100:971S-975S. [PMID: 32520602 DOI: 10.1177/0145561320930644] [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: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of indirect laryngeal biopsy forceps in the treatment of epiglottic abscess (EA). METHODS Twenty patients were diagnosed with EA in our department and were randomly divided into group A (indirect laryngeal biopsy forceps combined antibiotics) and group B (antibiotics only). Demographics, the degree of epiglottic and arytenoid swelling, and inflammatory cells were collected for analysis. The drainage of EA was performed under local anesthesia in conscious patients with indirect laryngeal biopsy forceps and 70° direct laryngoscopes. The length of symptomatic relief and length of hospitalization were assessed. RESULTS Ten patients were treated with indirect laryngeal biopsy forceps under the view of the 70° direct laryngoscopes combined with intravenous antibiotics, whereas the other 10 patients were treated with antibiotics only. The differences between the 2 groups had no statistical significance in age, gender, white blood cell count, neutrophils count, and the percent of neutrophils, abscess size, and scope classification at the time of diagnosis. The length of hospitalization and length of symptomatic relief was significantly lower in patients treated with indirect laryngeal biopsy forceps combined antibiotics than those treated with antibiotics only. CONCLUSIONS Indirect laryngeal biopsy forceps are safe and effective method to treat EA, which shorten the hospitalization and has the advantages of cost savings and convenience.
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Affiliation(s)
- Xiufa Wu
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Jing Zhang
- Departments of Facial Plastic and Reconstructive Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Rui Fang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
| | - Chunsheng Wei
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China
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Sideris A, Holmes TR, Cumming B, Havas T. A systematic review and meta-analysis of predictors of airway intervention in adult epiglottitis. Laryngoscope 2019; 130:465-473. [PMID: 31173373 DOI: 10.1002/lary.28076] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Epiglottitis is typically considered a pediatric disease; however, there is growing evidence that the incidence of adult epiglottitis has changed since the introduction of the Haemophilus influenzae vaccine. The literature is composed of multiple small series with differing findings. To date, there has been no attempt to collaborate evidence on predictors of airway intervention in this disease. METHODS The population of interest was adults with a diagnosis of epiglottitis. The primary outcome in this review was incidence of airway intervention. A comprehensive literature search was conducted of the MEDLINE and Embase databases, and a separate random-effects model meta-analysis was undertaken for all outcome data. Moderator tests for comparison between prevaccine and postvaccine estimates were made, and absolute risk difference (RD) and relative risk (RR) calculations were made for all predictors of airway intervention. RESULTS Thirty studies and a total of 10,148 patients were finally included for meta-analysis. A significant decrease in airway intervention was seen post vaccine introduction introduction from 18.8% to 10.9% (P = 0.01). The presence of an abscess (RD 0.27, P = 0.04; RR 2.45, P < 0.001), stridor (RD 0.64, P < 0.001; RR 7.15, P < 0.001), or a history of diabetes mellitus (RD 0.11, P = 0.02; RR 2.15, P = 0.01) were associated with need for airway intervention. CONCLUSION In the postvaccine era, clinicians should expect to have to secure airways in 10.9% of cases. The presence of an epiglottic abscess, stridor, or a history of diabetes mellitus are the most reliable clinical features associated with need for airway intervention. LEVEL OF EVIDENCE NA Laryngoscope, 130:465-473, 2020.
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Affiliation(s)
- Anders Sideris
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Timothy R Holmes
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Benjamin Cumming
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Thomas Havas
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
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Wong ML. Abscess of the Base of Tongue and Epiglottis. J Emerg Med 2017; 53:e101-e103. [PMID: 28987315 DOI: 10.1016/j.jemermed.2017.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/05/2017] [Accepted: 08/08/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Matthew L Wong
- Departments of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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