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Maiese A, Del Duca F, Ghamlouch A, Treves B, Manetti AC, Napoletano G, De Matteis A, Dimattia F, Wan H, Pignataro L, La Russa R. Sudden Death: A Practical Autopsy Approach to Unexplained Mediastinitis Due to Fatal Untreated Neck Infections-A Systematic Review. Diagnostics (Basel) 2024; 14:1150. [PMID: 38893677 PMCID: PMC11171920 DOI: 10.3390/diagnostics14111150] [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: 05/03/2024] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Neck infections are often prone to being underestimated and can manifest insidiously. The spread of infection can lead to translocation into thoracic areas, causing descending necrotizing mediastinitis (DNM). However, the application of the post-mortem approach in such cases is not well-described in the literature. A literature review was carried out according to the PRISMA methods. Nine papers were included in the final review, revealing different levels of involvement of neck layers that can be linked to different causes. Expertise with respect to the anatomy of the fasciae and spaces of the neck enables an understanding of the pathogenesis of DNM. However, a clear autoptic description was not provided in any of the articles. Therefore, we also employed a practical post-mortem approach to cases of death due to DNM. It is fundamental for pathologists to identify the exact head and neck structures involved. Providing dissectors with support from an otolaryngologist could be useful. This paper could help address such difficult cases.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Alessandro Ghamlouch
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Biancamaria Treves
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Alice Chiara Manetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy; (A.C.M.); (A.D.M.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (A.G.); (B.T.); (G.N.)
| | - Alessandra De Matteis
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy; (A.C.M.); (A.D.M.)
| | - Francesca Dimattia
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Huan Wan
- Criminal Justice School, Zhongnan University of Economics and Law, Wuhan 430073, China;
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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Gadicherla S, Manglani K, Pentapati KC, Kudva A, Aramanadka C, Chandravel R. Profile of Patients with Maxillofacial Space Infections and Associated Risk Factors. ScientificWorldJournal 2024; 2024:9304671. [PMID: 38633105 PMCID: PMC11022519 DOI: 10.1155/2024/9304671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
Objective To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay. Materials and Methods We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay. Results A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age (P = 0.015; OR: 2.98) and evidence of bacterial culture (P = 0.001; OR:6.64) were potential predictors associated with increased hospital stay. Conclusion Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.
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Affiliation(s)
- Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Kirti Manglani
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Kalyana C. Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Adarsh Kudva
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Chithra Aramanadka
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Yankov YG, Dimanov S, Nikolaev NI, Stoev L, Yotsova RV, Stoeva M. Etiology and Demographic Distribution of Odontogenic Abscesses in the Maxillofacial Area in Patients Over 18 Years of Age: A Five-Year Retrospective Study. Cureus 2024; 16:e59334. [PMID: 38817524 PMCID: PMC11137639 DOI: 10.7759/cureus.59334] [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] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Despite the constant development of medicine and the increasing accessibility to medical specialists, in the first quarter of the 21st century, odontogenic abscesses remain one of the leading causes of emergency hospitalization in maxillofacial surgery clinics. Because of the serious and lethal complications that this type of suppurative infection can lead to if not treated promptly, there is a need for constant updating of the knowledge of its origin, which is precisely what is addressed in this original article. Materials and methods It reports on a retrospective study conducted over a five-year period (2018-2023), during which 705 patients aged 18 years and older with a confirmed diagnosis of odontogenic soft tissue abscess of the head and neck underwent emergency surgery. Results The average age of the patients studied was 41 years, with the oldest being an 82-year-old woman. The proportion of males in the study population was higher - 54.18%. Young patients (18-44 years) were the most affected, with a total of 364 patients (213 males and 151 females), while the proportion of old people (75 years of age and older) was the lowest, with a total of 15 patients, including seven males and eight females. The first molars of both jaws (16, 26, 36 and 46) were the cause of the suppurative bacterial infection in the highest number among our study patients - 208 out of 705 (29.5%). Central incisors (teeth 11, 21, 31 and 41) were the least frequent direct cause of odontogenic infection, accounting for only 17 cases out of 705 (2.41%). Discussion The most logical reason for the decrease in the number of patients with odontogenic abscesses with increasing age is tooth loss in older individuals. Our study confirmed the knowledge that the first mandibular molars are the most common teeth leading to the formation of purulent exudate in the adjacent mandibular soft tissues. However, in contrast to the well-known fact for the maxilla that canines are the most frequent etiologic factor for the occurrence of odontogenic abscesses, we conclude that again the first molars (teeth 16 and 26) outnumber the other teeth of the maxillary dentition, with canines outnumbering only incisors. The teeth of the lower jaw are the cause of more than twice as many exudative infections as those of the upper jaw - the ratio between them is 2.54:1. Conclusions Knowledge of odontogenic abscesses - their demographic distribution, frequency and etiology, their diagnosis and treatment - is the basis for the prediction and treatment outcome of these diseases, mainly affecting young people. Their treatment is both surgical in order to evacuate the suppurative focus, and antibacterial.
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Affiliation(s)
- Yanko G Yankov
- Clinic of Maxillofacial Surgery, University Hospital "St. Marina", Varna, BGR
- Department of General and Operative Surgery, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR
| | - Simeon Dimanov
- Department of Oral Surgery, Medical University of Varna, Varna, BGR
| | - Nikolay I Nikolaev
- Clinic of Maxillofacial Surgery, University Hospital "St. Marina", Varna, BGR
| | - Lyuben Stoev
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
| | | | - Martina Stoeva
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
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Stathopoulos P, Rallis G. Poorly controlled diabetes mellitus is strongly associated with descending necrotizing mediastinitis of odontogenic origin. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:113-118. [PMID: 38155017 DOI: 10.1016/j.oooo.2023.09.004] [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: 07/30/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE We hypothesized that poorly controlled diabetic status may be a negative prognostic factor for acute mediastinitis of odontogenic origin, and we conducted a cohort study to verify this hypothesis. STUDY DESIGN Data were collected on all consecutive patients diagnosed with maxillofacial infections of odontogenic origin who received surgical treatment in the Oral and Maxillofacial Surgery Department. All patients included in the study were divided into 4 groups based on the presence or absence of diabetes and mediastinitis. Poorly controlled diabetic status constituted our primary predictor variable, and the occurrence of descending necrotizing mediastinitis was the outcome variable. RESULTS All 7 patients with poorly controlled diabetes mellitus were complicated with descending necrotizing mediastinitis. An exact Fischer test was conducted to investigate the association of poorly controlled diabetes mellitus with descending necrotizing mediastinitis in patients admitted for surgical treatment of their maxillofacial collection. The result was significant at P < .01. CONCLUSION This study represents the first scientific attempt to associate poorly controlled diabetes mellitus with descending necrotizing mediastinitis of odontogenic origin. Our results show evidently that these patients are more susceptible to deep space infections, which subsequently spread faster and are much more difficult to control.
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Gliga A, Săndulescu M, Amza O, Stănescu R, Imre M. Dental pathologies of endodontic origin and subsequent bacterial involvement - a literature review. Germs 2023; 13:373-380. [PMID: 38361538 PMCID: PMC10866160 DOI: 10.18683/germs.2023.1407] [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: 10/18/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 02/17/2024]
Abstract
Dental pathologies of endodontic origin are varied in nature, and include infectious and non-infectious causes. Through this review, we aim to provide a deeper understanding of the role of bacterial involvement and in the pathogenesis of endodontic pathologies, by reviewing the relevant literature on the most common bacterial species involved, and their capacity to organize as biofilms. Furthermore, we focus on the most important recent updates in the management of endodontic infections, from a multidisciplinary perspective.
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Affiliation(s)
- Alexandru Gliga
- DDS, PhD student, Department of Endodontics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Calea Plevnei, Bucharest 010221, Romania
| | - Mihai Săndulescu
- DDS, PhD, Associate Professor, Department of Implant Prosthetic Therapy, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Calea Plevnei, Bucharest 010221, Romania
| | - Oana Amza
- DDS, PhD, Associate Professor, Department of Endodontics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Calea Plevnei, Bucharest 010221, Romania
| | - Ruxandra Stănescu
- DDS, PhD, Assistant Lecturer, Department of Implant Prosthetic Therapy, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Calea Plevnei, Bucharest 010221, Romania
| | - Marina Imre
- DDS, PhD, Professor, Department of Prosthodontics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 17-23 Calea Plevnei, Bucharest 010221, Romania
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Chen SL, Chin SC, Chan KC, Ho CY. A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results. Diagnostics (Basel) 2023; 13:2736. [PMID: 37685275 PMCID: PMC10486957 DOI: 10.3390/diagnostics13172736] [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: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Deep neck infection (DNI) is a serious infectious disease, and descending mediastinitis is a fatal infection of the mediastinum. However, no study has applied artificial intelligence to assess progression to descending mediastinitis in DNI patients. Thus, we developed a model to assess the possible progression of DNI to descending mediastinitis. METHODS Between August 2017 and December 2022, 380 patients with DNI were enrolled; 75% of patients (n = 285) were assigned to the training group for validation, whereas the remaining 25% (n = 95) were assigned to the test group to determine the accuracy. The patients' clinical and computed tomography (CT) parameters were analyzed via the k-nearest neighbor method. The predicted and actual progression of DNI patients to descending mediastinitis were compared. RESULTS In the training and test groups, there was no statistical significance (all p > 0.05) noted at clinical variables (age, gender, chief complaint period, white blood cells, C-reactive protein, diabetes mellitus, and blood sugar), deep neck space (parapharyngeal, submandibular, retropharyngeal, and multiple spaces involved, ≥3), tracheostomy performance, imaging parameters (maximum diameter of abscess and nearest distance from abscess to level of sternum notch), or progression to mediastinitis. The model had a predictive accuracy of 82.11% (78/95 patients), with sensitivity and specificity of 41.67% and 87.95%, respectively. CONCLUSIONS Our model can assess the progression of DNI to descending mediastinitis depending on clinical and imaging parameters. It can be used to identify DNI patients who will benefit from prompt treatment.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, New Taipei City 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, New Taipei City 333, Taiwan
| | - Kai-Chieh Chan
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, New Taipei City 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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