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Mathieu M, Motandi I, Ouedraogo RWL, Mahamadi S, Dargani MF, Tarcissus K. Cervico-thoracic cellulitis at the Yalgado Ouedraogo University Hospital: About 50 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e724-e730. [PMID: 35853556 DOI: 10.1016/j.jormas.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/03/2022] [Accepted: 07/15/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Cervicofacial cellulitis is mainly due to neglected oral/pharyngeal diseases. Untreated or incorrectly treated, they can be complicated by thoraco-cervical necrosis, which has a gloomy prognosis and is difficult to manage, especially in an under-medicalized environment. The aim of this work was to report the difficulties of management in precarious context by underlining the interest of primary prevention. PATIENTS AND METHOD This was a descriptive cross-sectional retrospective study from January 2018 to March. RESULTS Fifty cases of thoracic-cervical necrosis were collected during this period. The man/woman sex ratio was 3.55. Dental etiology was found in 96% of cases. The main complications were: pneumopathy (n = 10), mediastinitis (n = 10), pleurisy (n = 3) and polyseritis (n = 2). The management combined medical and surgical treatment under local or general anesthesia. The mortality rate was 12.8%. The functional results were satisfactory in surviving cases. CONCLUSION The management of thoracic-cervical necrosis remains a challenge in precarious conditions. Primary must play a major role in these conditions.
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Affiliation(s)
- Millogo Mathieu
- Department of Stomatology and Maxillofacial Surgery of the Yalgado Ouedraogo University Hospital, CHU-YO Ougadougou: Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso; Department of Stomatology and Maxillofacial Surgery of the University Hospital of Tengandogo, Ouagadougou, Burkina Faso.
| | - Idani Motandi
- Department of Stomatology and Maxillofacial Surgery of the Yalgado Ouedraogo University Hospital, CHU-YO Ougadougou: Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | | | - Sanfo Mahamadi
- Department of Stomatology and Maxillofacial Surgery of the University Hospital of Tengandogo, Ouagadougou, Burkina Faso
| | - Michel Fabien Dargani
- Department of Stomatology and Maxillofacial Surgery of the University Hospital of Tengandogo, Ouagadougou, Burkina Faso
| | - Konsem Tarcissus
- Department of Stomatology and Maxillofacial Surgery of the Yalgado Ouedraogo University Hospital, CHU-YO Ougadougou: Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
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Shivalingappa S, Manjunath KN, Waiker V, Kumaraswamy M, Odeyar U. Necrotising Fasciitis: Appearances Can Be Deceptive. World J Plast Surg 2021; 10:43-52. [PMID: 33833953 PMCID: PMC8016375 DOI: 10.29252/wjps.10.1.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis is a potentially fatal infection of β hemolytic Group-A Streptococcus, often occurring in patients with other comorbidities, but can occur in healthy individuals as well. It commonly affects the extremities, perineum, and abdominal wall. The aim of this study was to highlight various presentations of necrotizing fasciitis in unusual anatomical sites with delayed diagnosis and treatment. METHODS In a retrospective analysis, seven cases of unusual presentations of necrotizing fasciitis were enrolled during a period of five years treated in a tertiary centre. RESULTS The patients were between 23 and 80 years. Four were males and three were females. Four out of seven were diabetic. All patients had septicemia (hypovolemic shock, with leucocytosis, thrombocytopenia and deranged coagulation parameters) on admission in the intensive care unit. All seven patients had minimal cutaneous manifestation and the remote primary pathology was diagnosed in two patients. Six patients out of seven survived and the morbid state continued in one patient in view of malignancy of rectum in one patient. The overall outcome was satisfactory in five out of seven cases. CONCLUSION Pain disproportionate to the local inflammation with florid constitutional symptoms should raise suspicion of necrotizing fasciitis. Early diagnosis, of stabilization of hemodynamics, emergency fasciotomy, staged debridement and the initiation of broad spectrum antibiotics reduced the morbidity and mortality. The disease may manifest with uncommon presentations and sometimes lead to the diagnosis of primary aetiology.
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Affiliation(s)
| | - K N Manjunath
- Department of Plastic and Reconstructive Surgery, Ramaiah Medical College, Bangalore, India
| | - Veena Waiker
- Department of Plastic and Reconstructive Surgery, Ramaiah Medical College, Bangalore, India
| | - M Kumaraswamy
- Department of Plastic and Reconstructive Surgery, Ramaiah Medical College, Bangalore, India
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Benedetto C, Tanzariello VN, Militi A, Fallica GE, Marco DD, Monaco F, Ugo B. Catastrophic descending necrotizing mediastinitis of the anterior and posterior compartments: A case report. Radiol Case Rep 2020; 15:1832-1836. [PMID: 32802242 PMCID: PMC7417671 DOI: 10.1016/j.radcr.2020.07.040] [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: 05/26/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/09/2022] Open
Abstract
Descending necrotizing mediastinitis (DNM) is a medical emergency with a high associated morbidity and mortality. DNM may arise secondary to primary odontogenic or neck infection in susceptible patients and it may spread contiguously via the “danger” space to the mediastinum. This case report is focused on complications following an odontogenic infection in a healthy 48-year-old male that led to a massive inflammation associated an extensive empyema. After chest and neck computed tomographic scan a diagnosis of cervical necrotizing fasciitis with DNM was made. A multidisciplinary approach with an urgent surgical intervention and the finding of the right antibiotic therapy resulted to be successful. After 2 weeks the patient was dismissed in better health condition.
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Affiliation(s)
- Caterina Benedetto
- Department of Radiology, I.R.C.C.S. Centro Neurolesi Bonino Pulejo, P.O. Piemonte, Viale Europa 45, 98124 Messina, Italy
| | | | - Annalisa Militi
- Department of Radiology, I.R.C.C.S. Centro Neurolesi Bonino Pulejo, P.O. Piemonte, Viale Europa 45, 98124 Messina, Italy
| | - Gianluca Elio Fallica
- Department of Radiology, I.R.C.C.S. Centro Neurolesi Bonino Pulejo, P.O. Piemonte, Viale Europa 45, 98124 Messina, Italy
| | - Delia Di Marco
- Department of Radiology, I.R.C.C.S. Centro Neurolesi Bonino Pulejo, P.O. Piemonte, Viale Europa 45, 98124 Messina, Italy
| | - Francesco Monaco
- Thoracic Surgery Unit, Policlinico G. Martino, Hospital of the University of Messina, 98125 Messina, Italy
| | - Barbaro Ugo
- Department of Radiology, I.R.C.C.S. Centro Neurolesi Bonino Pulejo, P.O. Piemonte, Viale Europa 45, 98124 Messina, Italy
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Ma C, Zhou L, Zhao JZ, Lin RT, Zhang T, Yu LJ, Shi TY, Wang M. Multidisciplinary treatment of deep neck infection associated with descending necrotizing mediastinitis: a single-centre experience. J Int Med Res 2019; 47:6027-6040. [PMID: 31640429 PMCID: PMC7045650 DOI: 10.1177/0300060519879308] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Deep neck infection (DNI) associated with descending necrotizing mediastinitis (DNM) is a highly lethal condition. This retrospective review was performed to share our experience performing multidisciplinary management of DNI associated with DNM during a 7-year period. Methods We reviewed 16 patients who had been surgically treated for DNM at Peking Union Medical College Hospital from April 2010 to July 2017. The clinical outcomes were analysed to determine the most appropriate therapeutic strategy. Results Five women and 11 men were included in this study. Their mean age was 54.9 ± 14.3 years. DNM-associated infections most commonly occurred secondary to odontogenic infections (n = 10). Thirteen patients required tracheotomy because of tracheal compression. All patients underwent unilateral or bilateral cervicotomy. Six patients with DNM localized in the upper mediastinal space underwent transcervical mediastinal drainage, while 10 patients with DNM extending to the lower mediastinum were treated by cervicotomy and video-assisted thoracoscopic surgery. Three patients died of multiple organ failure. Conclusion Multidisciplinary treatment can achieve favourable outcomes in >80% of patients with DNM. Early diagnosis, proper airway management, and adequate surgical drainage are crucial for reducing mortality in patients with DNM, and minimally invasive procedures also play an important role.
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Affiliation(s)
- Chao Ma
- Department of Stomatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Lian Zhou
- Department of Stomatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Ji-Zhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Run-Tai Lin
- Department of Stomatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Tao Zhang
- Department of Stomatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Li-Jiang Yu
- Department of Stomatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Tian-Yin Shi
- Department of Stomatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Mu Wang
- Department of Stomatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
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Juncar M, Juncar RI, Onisor-Gligor F. Ludwig's angina, a rare complication of mandibular fractures. J Int Med Res 2019; 47:2280-2287. [PMID: 30958072 PMCID: PMC6567769 DOI: 10.1177/0300060519840128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/06/2019] [Indexed: 11/25/2022] Open
Abstract
Traumas are a major problem worldwide. A considerable proportion of traumas are located in the cephalic extremity. Neglect of these disorders by patients or those responsible for patient management may result in particularly serious consequences. This paper presents the case of a 58-year-old male patient with an intraorally open mandibular fracture, which left untreated for 3 days, was complicated by Ludwig's angina. Following aggressive surgical treatment during which the mandibular fracture was manually reduced and immobilized with a metal splint fixed with circumdental wires and effective antibiotic therapy, the septic process was terminated and the patient's fracture and infected wound were healed. The correct and rapid treatment of open mandibular fractures is mandatory in order to avoid severe septic complications.
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Affiliation(s)
- Mihai Juncar
- Oral and Maxillofacial Surgery, Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Raluca-Iulia Juncar
- Department of Prosthetics, Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Florin Onisor-Gligor
- Department of Oral and Maxillofacial Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Cluj, Romania
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Din-Lovinescu C, Berg H. Cervical necrotising fasciitis: a rare complication of infectious mononucleosis. BMJ Case Rep 2019; 12:12/3/e228172. [PMID: 30826780 DOI: 10.1136/bcr-2018-228172] [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] [Indexed: 11/03/2022] Open
Abstract
Cervical necrotising fasciitis (NF) is an aggressive polymicrobial infection of the subcutaneous tissues in the head and neck. We present a case of a healthy 19-year-old man who developed cervical and upper mediastinal NF after an initial presentation of infectious mononucleosis (IM). He was treated with broad-spectrum antibiotics in addition to incision and drainage of an anterior neck and upper mediastinal abscess. He progressed favourably after ten days of hospitalisation and was discharged home on intravenous antibiotics. This is a unique case of cervical NF as a sequelae of IM in a previously healthy paediatric patient.
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Affiliation(s)
- Corina Din-Lovinescu
- Otolaryngology Head and Neck Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Howard Berg
- Otolaryngology Head and Neck Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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7
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Gunaratne DA, Tseros EA, Hasan Z, Kudpaje AS, Suruliraj A, Smith MC, Riffat F, Palme CE. Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature. Head Neck 2018; 40:2094-2102. [PMID: 29934952 DOI: 10.1002/hed.25184] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/14/2018] [Accepted: 02/20/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. METHODS A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis." RESULTS There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. CONCLUSION Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.
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Affiliation(s)
- Dakshika A Gunaratne
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Evan A Tseros
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Zubair Hasan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Akshay S Kudpaje
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Anand Suruliraj
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Mark C Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten E Palme
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Crown Princess Mary Cancer Centre, Westmead Hospital, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
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Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982–2016). REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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9
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Spartalis E, Triantafyllis AS, Athanasiou A, Moris D, Patsouras D, Troupis T, Dimitroulis D, Tomos P. Odontogenic Infection Complicated by Acute Descending Mediastinitis and Pericardial Effusion: A Life-Threatening Migration Path. Am Surg 2017. [DOI: 10.1177/000313481708300206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eleftherios Spartalis
- Second Department of Propaedeutic Surgery University of Athens Medical School “Laiko” General Hospital Athens, Greece
| | - Andreas S. Triantafyllis
- Second Department of Propaedeutic Surgery University of Athens Medical School “Laiko” General Hospital Athens, Greece
| | - Antonios Athanasiou
- Second Department of Propaedeutic Surgery University of Athens Medical School “Laiko” General Hospital Athens, Greece
| | - Demetrios Moris
- Second Department of Propaedeutic Surgery University of Athens Medical School “Laiko” General Hospital Athens, Greece
| | - Dimitrios Patsouras
- Second Department of Propaedeutic Surgery University of Athens Medical School “Laiko” General Hospital Athens, Greece
| | - Theodore Troupis
- Department of Cardiovascular Diseases University Hospitals Leuven Leuven, Belgium
| | | | - Periklis Tomos
- Department of Anatomy Faculty of Medicine National and Kapodistrian University of Athens Athens, Greece
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Gollapalli RB, Naiman AN, Merry D. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report. EAR, NOSE & THROAT JOURNAL 2016. [PMID: 26214679 DOI: 10.1177/014556131509400714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.
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Affiliation(s)
- Rajesh Babu Gollapalli
- Department of Otolaryngology, 5A ENT Clinic, Royal Hobart Hospital, 48 Liverpool St., Hobart 7000, Tasmania, Australia.
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Sumi Y. Descending necrotizing mediastinitis: 5 years of published data in Japan. Acute Med Surg 2014; 2:1-12. [PMID: 29123684 DOI: 10.1002/ams2.56] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/25/2014] [Indexed: 12/29/2022] Open
Abstract
Descending necrotizing mediastinitis implies infection originating from the neck, most commonly an oropharyngeal or odontogenic focus, that spreads in the cervical fascial spaces and descends into the mediastinum. Early diagnosis is essential because descending necrotizing mediastinitis can rapidly progress to septic shock and organ failure. A comprehensive review of the current data of descending necrotizing mediastinitis in Japan was carried out using PubMed and ICHUSHI from the last 5 years. The symptoms, origins, comorbid conditions, treatment modalities, complications, and survival rates were analyzed. Tonsillar and pharyngeal origin was more identified compared to odontogenic origin. More than one-third of patients were diabetic and 28% of them were not identified as having any comorbidity. Streptococcus sp. and anaerobes were most isolated, reflecting the microflora of the oral cavity. Of the broad antibiotics, carbapenem was the most used as treatment, and clindamycin was the most co-given. Mediastinal drainage approach varied widely and the optimal approach is controversial. Twenty-one patients were treated with video-assisted thoracic surgical drainage and 15 cases by percutaneous catheter drainage, whereas transcervical approach was applied in 25 patients and thoracotomy was carried out in 21 patients. The overall mortality was 5.6%. Many authors advocated that the most effective management tool is a high degree of clinical suspicion followed by prompt and adequate drainage with intensive care including hemodynamic and nutritional support and repeat computer tomographic monitoring.
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Affiliation(s)
- Yuka Sumi
- Department of Emergency and Critical Care Medicine Juntendo University, Urayasu Hospital Chiba Japan
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12
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Dajer-Fadel WL, Ibarra-Pérez C, Argüero-Sánchez R. Mediastinal drainage in descending necrotizing mediastinitis. Asian Cardiovasc Thorac Ann 2014; 21:493-5. [PMID: 24570546 DOI: 10.1177/0218492312473459] [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]
Abstract
Descending necrotizing mediastinitis has been thoroughly described in the past, but we could not find a detailed description of the technique to perform adequate drainage and lavage of all the mediastinal and thoracic spaces. We describe the procedure as we perform it, emphasizing the sites for incision and proper drainage of all the mediastinal compartments and the contralateral thoracic cavity.
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Abstract
This article outlines infections in the submandibular, lateral pharyngeal, retropharyngeal, danger, and prevertebral spaces, in conjunction with infections of the sinuses and mediastinum. By understanding the anatomy and pathophysiology, the reader will gain insight into the rationale for various therapeutic options.
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Affiliation(s)
- Denise Jaworsky
- Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
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Vural FS, Girdwood RW, Patel AR, Zigiriadis E. Descending mediastinitis. Asian Cardiovasc Thorac Ann 2012; 20:304-7. [PMID: 22718719 DOI: 10.1177/0218492311434088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied 13 patients with mediastinal abscesses caused by oropharyngeal infections, who presented between April 2007 and June 2011. All patients were operated on after maxillofacial and ear, nose and throat surgeons had treated the primary source and drained all collections in the neck. Thoracic surgery was performed in the same session. Anterior mediastinal collections were drained via a small mediastinotomy. Posterior collections were approached via a thoracotomy. Chest computed tomography was essential to delineate the extent of disease. A thoracotomy approach was used in 7 patients; 2 of them required an anterior mediastinotomy on the opposite side. The others had an anterior mediastinotomy which was bilateral in 2 cases. After repeat computed tomography, 5 patients were operated on for suspected new loculations; tissue edema had caused false imaging in 3 of them. There was no mortality. Early after eradication of the source and pathways to the mediastinum, gravity drainage of mediastinal abscesses, and good antibiotic cover, with repeat computed tomography after 3 days, was an effective approach in this highly fatal disease.
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Affiliation(s)
- Fikret S Vural
- Division of Cardiothoracic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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15
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Descending necrotising mediastinitis: a case report illustrating a trend in conservative management. Case Rep Otolaryngol 2012; 2012:504219. [PMID: 22953116 PMCID: PMC3420637 DOI: 10.1155/2012/504219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 12/25/2011] [Indexed: 11/23/2022] Open
Abstract
The mortality rate from descending necrotising mediastinitis (DNM) has declined since its first description in 1938. The decline in mortality has been attributed to earlier diagnosis by way of contrast-enhanced computed tomographic (CT) scanning and aggressive surgical intervention in the form of transthoracic drainage. We describe a case of DNM with involvement of anterior and posterior mediastinum down to the diaphragm, managed by cervicotomy and transverse cervical drainage with placement of corrugated drains and a pleural chest drain, with a delayed mediastinoscopy and mediastinal drain placement. We advocate a conservative approach with limited debridement and emphasis on drainage of infection in line with published case series.
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Sarna T, Sengupta T, Miloro M, Kolokythas A. Cervical Necrotizing Fasciitis With Descending Mediastinitis: Literature Review and Case Report. J Oral Maxillofac Surg 2012; 70:1342-50. [DOI: 10.1016/j.joms.2011.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 10/17/2022]
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Sandner A, Börgermann J. Update on necrotizing mediastinitis: causes, approaches to management, and outcomes. Curr Infect Dis Rep 2011; 13:278-86. [PMID: 21369879 DOI: 10.1007/s11908-011-0174-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Descending necrotizing mediastinitis (DNM) is one of the most feared and fatal forms of mediastinitis, occurring as a complication after odontogenic or cervicofascial infections or after cervical trauma. Delayed recognition, underestimation of the extent of disease, and insufficient therapy promote spread of infection. Primary treatment of DNM includes surgical eradication of the pharyngeal or odontogenic infection focus, and a concomitant major drainage applied to the neck and the mediastinum. However, the mortality rate of DNM remains high, even with the routine use of CT scanning, antibiotics, advancements in anesthesia and intensive care, and immediate surgical drainage. The present state of the optimal management of DNM is discussed controversially, in particular the question of whether thoracotomy should be performed routinely or if minimally invasive procedures (eg, video-assisted thoracoscopy) may be introduced. This review reports on the incidence and course of this disease and discusses management approaches to DNM.
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Affiliation(s)
- Annett Sandner
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 12, 06097, Halle/Saale, Germany,
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Kavarodi A. Necrotizing fasciitis in association with Ludwig's angina - A case report. Saudi Dent J 2011; 23:157-60. [PMID: 24151421 PMCID: PMC3770229 DOI: 10.1016/j.sdentj.2011.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 11/05/2010] [Accepted: 03/04/2011] [Indexed: 11/16/2022] Open
Abstract
A 28 year old male diabetic patient developed Ludwig's angina which subsequently evolved into cervicofacial necrotizing fasciitis. The differential characteristic of Ludwig's angina and cervicofacial necrotizing fasciitis, as it relates to this rare presentation is discussed. The clinical and radiological features, pathophysiology, diagnosis and the management that resulted in a successful outcome are presented.
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Affiliation(s)
- A.M. Kavarodi
- Oral and Maxillofacial Surgery, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
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Necrotizing fasciitis: review of the literature and case report. J Oral Maxillofac Surg 2011; 69:2786-94. [PMID: 21367503 DOI: 10.1016/j.joms.2010.11.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/21/2010] [Accepted: 11/23/2010] [Indexed: 11/20/2022]
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Abstract
The authors review their experience with thoracic esophageal perforation at Inova Fairfax Hospital, June 1, 1988, to March 1, 2009. With the exception of 6 patients with occult perforation, all of whom survived with nonoperative therapy, aggressive surgical intervention was the standard approach. Among patients treated aggressively with surgery within 24 hours of perforation, hospital survival was 97 per cent versus 89 per cent for patients treated aggressively surgically after 24 hours. In the absence of phlegmon, implacable obstruction, or delay, primary repair resulted in 100 per cent survival. Where phlegmon or resolute obstruction existed, resection and reconstruction resulted in 96 per cent survival. Even when patients were deemed too ill to undergo surgery, cervical diversion was 100 per cent effective in eradicating continuing leak and achieved 89 per cent survival. Endoesophageal stenting was applied as primary treatment or secondarily such as where leak complicated primary repair. When stenting was used as the initial and primary treatment modality, survival was 88 per cent. Targeted drainage was helpful on occasion as an adjunct to initial therapies. Comfort measures alone were appropriate when clinical circumstances merited no effort at resuscitation. Finally, survivors were asked to self-categorize their ability to swallow; 95 per cent responded good to excellent.
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Affiliation(s)
- Paul D. Kiernan
- Section of Thoracic Surgery, Department of Surgery, Inova Fairfax Hospital, Inova Health System, Falls Church, Virginia
| | - Sandeep J. Khandhar
- Section of Thoracic Surgery, Department of Surgery, Inova Fairfax Hospital, Inova Health System, Falls Church, Virginia
| | - Daniel L.C. Fortes
- Section of Thoracic Surgery, Department of Surgery, Inova Fairfax Hospital, Inova Health System, Falls Church, Virginia
| | - Michael J. Sheridan
- Inova Research Center, Inova Fairfax Hospital, Inova Health System, Falls Church, Virginia
| | - Vivian Hetrick
- Section of Thoracic Operating Room Nursing, Inova Fairfax Hospital, Inova Health System, Falls Church, Virginia
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21
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Delaney P, Rafiq R, Dodd M. Craniocervical necrotising fasciitis--an interesting case with review of the literature. Br J Oral Maxillofac Surg 2010; 48:e1-4. [PMID: 20392550 DOI: 10.1016/j.bjoms.2010.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 01/18/2010] [Indexed: 11/17/2022]
Abstract
Craniocervical necrotising fasciitis (CCNF) is an aggressive and potentially fatal infection associated with high morbidity and mortality if early intervention is not implemented. Patients are often unwell at presentation, the clinical picture is often unclear thus presenting with diagnostic difficulty. We report a case of CCNF presenting at an advanced stage and discuss the condition including its management and associated complications.
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Affiliation(s)
- Paddy Delaney
- Oral and Maxillofacial Surgery, Regional Maxillofacial Unit, University Hospital Aintree Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK.
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Scaglione M, Pezzullo MG, Pinto A, Sica G, Bocchini G, Rotondo A. Usefulness of Multidetector Row Computed Tomography in the Assessment of the Pathways of Spreading of Neck Infections to the Mediastinum. Semin Ultrasound CT MR 2009; 30:221-30. [DOI: 10.1053/j.sult.2009.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Quereshy FA, Baskin J, Barbu AM, Zechel MA. Report of a case of cervicothoracic necrotizing fasciitis along with a current review of reported cases. J Oral Maxillofac Surg 2009; 67:419-23. [PMID: 19138621 DOI: 10.1016/j.joms.2008.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Faisal A Quereshy
- Department of Oral and Maxillofacial Surgery, Case School of Dental Medicine and University Hospitals Case Medical Center, Cleveland, OH 44106-4905, USA.
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Islam A, Oko M. Cervical necrotising fasciitis and descending mediastinitis secondary to unilateral tonsillitis: a case report. J Med Case Rep 2008; 2:368. [PMID: 19055812 PMCID: PMC2613410 DOI: 10.1186/1752-1947-2-368] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 12/04/2008] [Indexed: 12/04/2022] Open
Abstract
Introduction Cervical necrotizing fasciitis is an aggressive infection with high morbidity and mortality. We present a case of cervical necrotizing fasciitis and descending mediastinitis in a healthy young man, caused by unilateral tonsillitis with a successful outcome without aggressive debridement. Case presentation A 41-year-old man was admitted to our unit with a diagnosis of severe acute unilateral tonsillitis. On admission, he had painful neck movements and the skin over his neck was red, hot and tender. Computed tomography scan of his neck and chest showed evidence of cervical necrotizing fasciitis and descending mediastinitis secondary to underlying pharyngeal disease. He was treated with broad-spectrum intravenous antibiotics. His condition improved over the next 3 days but a tender and fluctuant swelling appeared in the suprasternal region. A repeat scan showed the appearance of an abscess extending from the pretracheal region to the upper mediastinum which was drained through a small transverse anterior neck incision. After surgery, the patient's condition quickly improved and he was discharged on the 18th day of admission. Conclusion Less invasive surgical techniques may replace conventional aggressive debridement as the treatment of choice for cervical necrotizing fasciitis and descending necrotizing mediastinitis.
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Affiliation(s)
- Asad Islam
- Pilgrim hospital, Boston, Lincolnshire, UK.
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26
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Righini CA, Motto E, Ferretti G, Boubagra K, Soriano E, Reyt E. [Diffuse cervical cellulites and descending necrotizing mediastinitis]. ACTA ACUST UNITED AC 2008; 124:292-300. [PMID: 17689483 DOI: 10.1016/j.aorl.2007.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 02/01/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To give a report on the progress in physical examination, investigations and treatment of diffuse cervical cellulites (DCC) associated with descending necrotizing mediastinitis. MATERIALS AND METHODS A Retrospective study (1995-2005) of patients presenting DCC with mediastinitis was made. All had a cervical and thoracic Computed tomography (CT) scan. The references were collected by a Medline search. RESULTS Six men and 2 women, average ages 53 years were treated. Four had an immunodeficient status. Two had had an anti-inflammatory drug treatment without antibiotic treatment. The average for diagnosis and treatment was 4 days. In 2 cases we found a dental origin and in 6 cases a pharyngeal origin. The most frequently identified germs were streptococcus beta haemolytic group A and Prevotella. In 4 cases, no physical sign of mediastinitis was noted. The diagnosis of mediastinitis was made thanks to the thoracic CT scan. All the patients were treated by broad-spectrum antibiotic therapy. All had cervical and thoracic surgical drainage. Mediastinal drainage was made by cervical way in 3 cases and by thoracotomy in 5 cases. One patient died. CONCLUSIONS The DCC with mediastinum extension are serious infectious emergencies with a high mortality rate. Clinical diagnosis of mediastinitis is difficult. A thoracic CT scan should be performed systematically. Performing thoracotomy best controls mediastinal drainage.
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Affiliation(s)
- C-A Righini
- Service d'ORL et de chirurgie cervicofaciale, CHU A.-Michallon, 38043 Grenoble cedex 09, France.
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Sandner A, Börgermann J, Kösling S, Silber RE, Bloching MB. Descending necrotizing mediastinitis: early detection and radical surgery are crucial. J Oral Maxillofac Surg 2007; 65:794-800. [PMID: 17368383 DOI: 10.1016/j.joms.2005.11.075] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 11/01/2005] [Indexed: 10/23/2022]
Affiliation(s)
- Annett Sandner
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University, Halle Wittenberg, Halle, Germany.
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Scaglione M, Pinto A, Giovine S, Di Nuzzo L, Giuliano V, Romano L. CT features of descending necrotizing mediastinitis—a pictorial essay. Emerg Radiol 2007; 14:77-81. [PMID: 17406910 DOI: 10.1007/s10140-007-0606-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 03/13/2007] [Indexed: 11/29/2022]
Abstract
Descending necrotizing mediastinitis (DNM) is a relatively rare condition caused by downward spread of neck infections into the mediastinum. This infection previously had a much worse prognosis. In recent years, prompt computer topography (CT) diagnosis has been recommended. CT scan provides the earliest means of detecting DNM for optimal management and early surgical intervention. This paper provides an illustrated summary of our extensive clinical experience with DNM, involving 36 documented cases with CT over a 5-year period.
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Affiliation(s)
- Mariano Scaglione
- Department of Radiology, Emergency and Trauma CT Section, Cardarelli Hospital, Via Cardarelli 9, Naples, 80131, Italy.
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Son HS, Cho JH, Park SM, Sun K, Kim KT, Lee SH. Management of Descending Necrotizing Mediastinitis Using Minimally Invasive Video-assisted Thoracoscopic Surgery. Surg Laparosc Endosc Percutan Tech 2006; 16:379-82. [PMID: 17277652 DOI: 10.1097/01.sle.0000213726.72709.62] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Early diagnosis and aggressive surgical drainage are very important for successful treatment of descending necrotizing mediastinitis (DNM). However, the surgical techniques used for DNM treatment remain controversial. The purpose of this study was to evaluate the effectiveness of video-assisted thoracoscopic surgery (VATS) and cervical drainage for the management of DNM. Nine patients diagnosed with DNM were treated from May 2001 to April 2004. The mean age of the patients was 51.1+/-15.0 years. VATS and cervical drainage, including debridement and drainage of the mediastinum and pleura, were performed simultaneously. The mean postoperative hospital stay was 20.6+/-6.6 days. One patient (11%) died of sepsis and renal failure on the 15th postoperative day. Minimal mastication difficulty developed in 2 patients (22%). The mean postoperative follow-up period was 28.7+/-14.7(5 to 52) months. All the survivors are in good health with no recurrences. VATS was safe, effective, and a less invasive surgical option for the management of DNM and should be considered as a good alternative therapeutic modality.
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Affiliation(s)
- Ho Sung Son
- Department of Thoracic and Cardiovascular Surgery, Korea University, Seoul, Korea
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Sandner A, Börgermann J, Kösling S, Bloching MB. „Descending necrotizing mediastinitis“ infolge tiefer Halsinfektionen. HNO 2006; 54:861-7. [PMID: 16625372 DOI: 10.1007/s00106-006-1396-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND "Descending necrotizing mediastinitis" (DNM) is a rare but potentially life-threatening complication of deep neck infections caused by the rapid downward spread of a oropharyngeal infection along the facial planes into the mediastinum. MATERIAL AND METHODS Between June 1997 and December 2004, 6 patients with DNM were treated in our department. The primary etiology was a peritonsillar abscess in 2 cases, a parapharyngeal abscess in 3 cases and in 1 case an odontogenic abscess. Most patients presented with risk factors such as diabetes mellitus or alcoholism, the mean age was 44.3 years and the mean duration of signs before diagnosis was 6.3 days. Thoracotomy was associated with the cervical approach in 4 cases and tracheostomy was also performed in 4 cases. RESULTS Four patients were successfully treated, the mean duration of hospitalisation was 48.2 days and 2 patients died from sepsis and multiorgan failure despite intensive treatment. CONCLUSIONS Descending necrotizing mediastinitis must be detected as soon as possible. The mean symptoms are persistent complaints after treatment of oropharyngeal infections, which may be masked by analgetic treatment. Only an immediate computer tomographic scanning, aggressive surgical drainage and debridement of the neck and the mediastinum can reduce the high mortality rate.
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Affiliation(s)
- A Sandner
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität, Halle-Wittenberg.
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Mateo J, Petipas F, Payen D. [Severe cervical skin and soft tissue infections and necrotizing fasciitis]. ACTA ACUST UNITED AC 2006; 25:975-7. [PMID: 16675189 DOI: 10.1016/j.annfar.2006.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cervical severe skin and soft tissue infections and necrotizing fasciitis originate from dental or pharyngeal infections. When compared to other forms of skin and soft tissue infections, they are recognized late, usually after one week of evolution often in a patient receiving antibiotic treatments. Extensions toward adjacent anatomical structures including mediastinum lead to a life-threatening prognosis. The cutaneous appearance of these severe infections is usually inflammatory cervical signs combined to facial oedema. These moderate clinical signs require immediate surgery after CT scan imaging.
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Affiliation(s)
- J Mateo
- Département d'anesthésie-réanimation, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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Giuly E, Velly L, Gouin F. [Strategies of management of necrotizing soft tissue infections]. ACTA ACUST UNITED AC 2006; 25:978-81. [PMID: 16675185 DOI: 10.1016/j.annfar.2006.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Necrotizing soft tissue infections represent a group of rapidly progressive diseases requiring early and repeated debridement, associated with broad spectrum antibiotics. Delay in surgery or inadequate therapy are the main risk factors for death. Most patients need aggressive critical care management and intensive nutritional support. The management of these patients by experimented senior surgeons is mandatory. A plastic surgeon can help debridement in order to preserve possibilities of later myocutaneous or rotational skin flaps. Intravenous immunoglobulins are an efficacious adjunctive therapy for severe group A streptococcal infection.
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Affiliation(s)
- E Giuly
- Département d'anesthésie-réanimation adultes, CHU de La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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Novellas S, Kechabtia K, Chevallier P, Sedat J, Bruneton JN. Descending necrotizing mediastinitis. Clin Imaging 2005; 29:138-40. [PMID: 15752971 DOI: 10.1016/j.clinimag.2004.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Revised: 08/27/2004] [Accepted: 09/21/2004] [Indexed: 11/16/2022]
Abstract
The spreading of a cervical infection to the mediastinum is a complication rarely observed, and its prognosis is still very severe. The infectious spreading follows known anatomical tracts, leading to the invasion of definite mediastinal spaces. The cervicothoracic scanning is the ideal procedure leading to the diagnosis, the localization of the infectious sites, and to the demonstration of an abscess and the presence of air in the mediastinum. We report a case of a patient in whom the early use of specific imaging and of proper aggressive surgical intervention did not allow the elimination of a fatal outcome.
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Affiliation(s)
- S Novellas
- Service d'Imagerie Médicale, Centre Hospitalier Régional et Universitaire de Nice, Hôpital Saint Roch, 5 rue Pierre Dévoluy, Nice Cedex F-06000, France.
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