Deep neck abscesses: study of 101 cases.
Brazilian journal of otorhinolaryngology
INTRODUCTION:Although the incidence of Deep Cervical Abscess (DCA) has decreased mainly for the availability of antibiotics, this infection still occurs with considerable frequency and can be associated with high morbidity and mortality. OBJECTIVE:This study aimed to present our clinical-surgical experience with deep neck abscesses. METHODS:A retrospective study analyzed 101 patients diagnosed with deep neck abscesses caused by multiple etiologies, assisted at a medical school hospital during 6 years. One hundred one patients were included and 27 (26.7%) were younger than 18 years old (the children group), 74 patients (73.3%) were older than 18 years old (the adults group). The following clinical features were analyzed and compared: age, gender, clinical symptoms, leukocyte count, the affected cervical area, lifestyle habits, antibiotic therapy, comorbidities, etiology, bacterial culture, time of hospitalization, the need of tracheostomy and complications. RESULTS:There was predominance in the male gender (55.5%) and young people (mean age 28.1 years). All of the 51 patients with associated disease comorbidity were adults. The most frequent etiologies were bacterial tonsillitis (31.68%) and odontogenic infections (23.7%). The most common cervical areas affected were the peritonsillar (26.7%), submandibular/mouth floor (22.7%) and parapharyngeal spaces (18.8%). In children group, the site most commonly involved was the peritonsillar space (10 patients, 37%). In adults group, the site most commonly involved was multispace (31 patients, 41.8%). Streptococcus pyogenes (23.3%) was the most common microorganism present. Amoxicillin associated with clavulanate (82.1%) was the more used antibiotic. The main complications of abscesses were septic shock (16.8%), pneumonia (10.8%) and mediastinitis (1.98%). Tracheostomy was necessary in 16.8% of patients. The mortality rate was 1.98%. CONCLUSION:The clinical features and severity of DCA varied according to different age groups, perhaps due to the location of the infection and a higher incidence of comorbidity in adults. Thus, DCA in adults is more facile to have multispace involvement and lead to complications and seems to be more serious than that in children.
10.1016/j.bjorl.2016.04.004
Deep Neck Infection: A Review of 130 Cases in Southern China.
Yang Weiqiang,Hu Lijing,Wang Zhangfeng,Nie Guohui,Li Xiaoling,Lin Dongfang,Luo Jie,Qin Hao,Wu Jianhui,Wen Weiping,Lei Wenbin
Medicine
The study aims to present our experience of the clinical course and management of deep neck infection and try to determine if the characteristics of this kind of infection were similar between the children and adults in southern China.Patients diagnosed with deep neck infection in the Division of Otolaryngology in the First Affiliated Hospital of Sun Yat-sen University between January 2002 and December 2011 were screened retrospectively for demographic characteristics, presenting symptoms, antibiotic therapy before admission, the history of antibiotics abuse, leucocyte count, etiology, bacteriology, disease comorbidity, imaging, treatment, complications, and outcomes.One hundred thirty patients were included and 44 (33.8%) were younger than 18 years old (the children group), 86 patients (66.2%) were older than 18 years old (the adults group). Fever, trismus, neck pain, and odynophagia were the most common symptoms in both groups. Forty children (90.9%) and 49 adults (57.0%) had been treated with broad-spectrum antibiotic therapy before admission. Thirty one children (70.5%) and 24 adults (27.9%) had a history of antibiotics abuse. In children group, the site most commonly involved was the parapharyngeal space (18 patients, 40.9%). In adults group, the site most commonly involved was multispace (30 patients, 34.9%). In children group, the most common cause was branchial cleft cyst (5 patients, 11.4%) and the cause remained unknown in 31 patients (70.5%). In adults group, the most common cause was pharyngeal infection (19 patients, 22.2%). All of the 27 patients with associated disease comorbidity were adults and 17 were diabetes mellitus (DM). Streptococcus viridans was the most common pathogen in both children and adults groups. Eighty six (66.2%) underwent surgical drainage and complications were found in 31 patients (4 children, 27 adults).Deep neck infection in adults is easier to have multispace involvement and lead to complications and appears to be more serious than that in children. Understanding the different characteristics between the children and adults with deep neck infection may be helpful in accurate evaluation and proper management.
10.1097/MD.0000000000000994
Deep neck infection in diabetic patients: comparison of clinical picture and outcomes with nondiabetic patients.
Huang Tung-Tsun,Tseng Fen-Yu,Liu Tien-Chen,Hsu Chuan-Jen,Chen Yuh-Shyang
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
OBJECTIVE:To compare the difference in the clinical picture and outcomes between diabetic and nondiabetic patients with deep neck infections. STUDY DESIGN AND SETTING:We retrospectively reviewed the records of patients who were diagnosed with deep neck infections and who received treatment at the Department of Otolaryngology of National Taiwan University Hospital between 1997 and 2002. One hundred eighty-five patients were included in our study. Fifty-six patients with diabetes mellitus were enrolled for further analysis (diabetic group) and compared with the other 129 patients without diabetes mellitus (nondiabetic group) in demography, etiology, bacteriology, treatment, duration of hospital stay, complications, and outcome. RESULTS:The parapharyngeal space was the space most commonly involved in both the diabetic (33.9%) and nondiabetic groups (40.3%). Odontogenic infections and upper airway infections were the 2 leading causes of deep neck infection in diabetic and nondiabetic groups. Streptococcus viridans is the most commonly isolated organism in the nondiabetic group (43.7%). However, the most common organism in the diabetic group was Klebsiella pneumoniae (56.1%). There were 89.3% of diabetic patients, versus 71.3% of nondiabetic patients, with abscess formation ( P = 0.0136). Surgical drainage was performed more frequently in the diabetic group than in the nondiabetic group (86.0% versus 65.2%, P = 0.0142). In comparison with the nondiabetic group, the diabetic group tended to have older mean age (57.2 y versus 46.2 y, P = 0.0007), longer duration of hospital stay (19.7 days versus 10.2 days, P < 0.0001), more frequent complications (33.9% versus 8.5%, P < 0.0001), and more frequent tracheostomy or intubation (19.6% versus 6.2%, P = 0.0123). CONCLUSIONS:Patients with diabetes mellitus are susceptible to deep neck infection. We should pay more attention when dealing with deep neck infections in patients with diabetes mellitus because those patients tend to have complications more frequently and a longer duration of hospital stay. Empirical antibiotics should cover K. pneumoniae in patients with deep neck infection who have diabetes mellitus.
10.1016/j.otohns.2005.01.035
Comparison of multi-space infections of the head and neck in the elderly and non-elderly: part I the descriptive data.
Zheng Lingyan,Yang Chi,Zhang Weijie,Cai Xieyi,Jiang Bin,Wang Baoli,Pu Yiping,Jin Jiamin,Kim Eric,Wang Jin,Zhang Zhiyuan,Zhou Longnv,Zhou Jian,Guan Xin
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery
PURPOSE:This study aims to analyze the difference between the aged patients and non-elderly with multi-space infections of the head and neck. MATERIALS AND METHODS:A retrospective study was conducted on 242 patients receiving treatment for severe multi-space infections of the head and neck region. Demographics, clinical parameters (the coexisting conditions, the etiology, the length between first symptomatic onset and admission, the number of spaces affected, and the distribution of involved spaces), laboratory values (bacteriology, admission blood glucose level, admission white blood cell count, and percent of neutrophil on admission) and treatment parameters (the number of incisions, complications and length of hospital stay) were collected and analyzed for clinical significance. Statistical analyses of the results between groups were performed using the Student t test, Fisher's exact test, and chi-square. RESULTS:Compared with the non-elderly, the elderly had more system diseases (P = 0.0002), had longer hospital stays (P = 0.02), and developed more frequent complications (P = 0.04). CONCLUSION:This study has determined the differences in clinical features of patients with multi-space infections of the head and neck by comparing the aged patients to non-elder patients.
10.1016/j.jcms.2013.01.020
The clinical features of severe multi-space infections of the head and neck in patients with diabetes mellitus compared to non-diabetic patients.
Zheng Lingyan,Yang Chi,Kim Eric,Zhang Weijie,Cai Xieyi,Jiang Bin,Wang Baoli,Pu Yiping,Jin Jiamin,Wang Jin,Zhang Zhiyuan,Zhou Longnv,Zhou Jian,Guan Xin
The British journal of oral & maxillofacial surgery
We have recorded the clinical features of diabetic patients with multispace infections of the head and neck and compared them with those of non-diabetic patients. We retrospectively studied 191 patients who were treated for severe multispace infections of the head and neck, and compared the patients' background, the aetiology of the infection, clinical variables, laboratory values (microbiology, and blood glucose concentration, white cell count (WCC), and percentage of neutrophils on admission) and treatment (the number of incisions, complications and duration of hospital stay). Statistical analyses of the differences between groups were made with Student's t test, the chi square test, and analysis of variance, as appropriate. Diabetic patients had more spaces involved concurrently (P=0.02), required more incisions for drainage (P=0.002), had longer hospital stays (P<0.0001), and developed more complications (P=0.02). Two diabetic patients died. We conclude that diabetic patients are more likely to develop complications and the complications are more likely to be severe than those in non-diabetic patients.
10.1016/j.bjoms.2012.01.019
Is there association between severe multispace infections of the oral maxillofacial region and diabetes mellitus?
Zheng Lingyan,Yang Chi,Zhang Weijie,Cai Xieyi,Kim Eric,Jiang Bin,Wang Baoli,Pu Yiping,Wang Jin,Zhang Zhiyuan,Zhou Longnv,Zhou Jian,Guan Xin
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
PURPOSE:This study aims to identify the impact of diabetes on the final outcome (length of hospital stay and development of complications) in patients with severe multispace infections in the head and neck. Furthermore, it intends to characterize significant clinical features of these patients compared with nondiabetics. MATERIALS AND METHODS:A retrospective study was conducted in 117 patients who received treatment for multispace infections of the head and neck region from 2007 through 2010 at the Department of Oral and Maxillofacial Surgery, Shanghai Ninth Hospital. The study identified diabetic patients and compared them with nondiabetic patients. Demographics, etiology of infection, clinical parameters (time from first onset of symptoms to hospital admission, number of spaces affected, and distribution of involved spaces), and laboratory values (bacteriology, admission blood glucose level, admission white blood cell count, and percentage of neutrophils on admission) were analyzed for clinical significance. Statistical analyses of the results between groups were performed using the Student t test, χ(2) test, variance analysis, logistic regression analysis, and linear regression analysis. RESULTS:Admission blood glucose level was the only factor influencing the complications in multispace infections in the oral-maxillofacial region. Compared with nondiabetic patients, diabetics had infections that involved more spaces, longer hospital stays, and more frequent complications. Some diabetic patients died. The disease status (with or without diabetes) was associated with clinical outcomes (length of hospital stay and complications) in the therapy procedures. CONCLUSIONS:This study identifies uncontrolled diabetes mellitus as an important indicator of clinical features and outcomes in treating multispace infections of the oral-maxillofacial region.
10.1016/j.joms.2011.07.010
[Retrospective analysis of the effectiveness of treating multi-space infection combined with descending necrotizing mediastinitis at oral maxillofacial and cervical region via multidisciplinary team collaboration].
Zheng H Y,Li Z X,Niu Z X,Su L,Zhao J F,Sun M L,Han X G,Sun Q
Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese journal of stomatology
To explore the strategy and experience for treating maxillofacial and cervical multi-space infection combined with descending necrotizing mediastinitis (DNM) via multidisciplinary team (MDT) collaboration. A total of 36 patients with maxillofacial and cervical multi-space infection complicated with DNM admitted to the First Affiliated Hospital of Zhengzhou University from July 2011 to July 2019 were included in the study. The clinical data of the patients were retrospectively analyzed, including gender, age, symptoms at admission, source of infection, preoperative and postoperative evaluation indicators, MDT strategy and prognosis. There were 26 males and 10 females with an average age of (51.6±17.6) years (8-80 years). The course of disease before admission was (8.9±8.4) days (2-30 days). All patients were admitted with maxillofacial and neck swelling and pain as the main complaints. Odontogenic infection accounted for 39% (14/36), throat floor swelling and pain accounted for 25% (9/36) and unknown maxillofacial swelling accounted for 36% (13/36). There were 28 cases receiving surgical treatment, 26 cases were cured and discharged (72%), 10 cases died (28%). In the patients treated with multidisciplinary therapy (mainly by surgery), the white blood cell count, neutrophil percentage, C-reactive protein and procalcitonin levels were significantly improved compared with those at admission at each observation time point after operation (<0.05). The length of stay was positively correlated with the levels of C-reactive protein (=0.545, <0.05) and procalcitonin (=0.504, <0.05). The prognosis of patients treated with surgery (26/28) was better than that of patients without surgery (0/8) (<0.01). The patients with maxillofacial and cervical multi-space infection combined with DNM might be in critical condition. The surgical based MDT strategy has an important impact on the prognosis of patients. White blood cell count and other inflammatory indicators monitoring can effectively observe the changes of the patient's condition.
10.3760/cma.j.cn112144-20200217-00062
[Clinical analysis of 27 cases with descending necrotizing mediastinitis].
Zhang J L,Chen W X,Li J J,He F Y,Tang S C
Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
To explore the clinical manifestation and treatment strategy for descending necrotizing mediastinitis (DNM). A total of 27 cases diagnosed as DNM from January 2010 to August 2018 in the First People's Hospital of Foshan were reviewed. There were 16 males and 11 females, age ranged from 16 to 84 years. The clinical data were collected. SPSS 16.0 software and chi square test were used for statistical analysis. ALL 27 cases were diagnosed as DNM by contrast-enhanced CT scan of the neck and chest. Among the 27 cases, 13 cases resulted from peritonsillar abscess, 8 cases from esophageal foreign body perforation, 5 cases from parapharyngeal and retropharyngeal space abscess, and one case from infection of oral cavity. These 27 cases were divided into three subtypes according to the sites of mediastinitis, including 11 cases for typeⅠ, 5 cases for type ⅡA and 11 cases for type ⅡB. Of 27 cases, 20 cases underwent transcervical drainage for DNM, of which 5 cases with tracheotomy and 6 cases with thoracic drainage, and finally 19 of the 20 patients were cured, and one patient died of bacteremia; 7 cases refused to received surgery and were routinely treated with antibiotics, of which, one case was cured and 6 cases died. The curative rate in patients underwent surgery was significantly higher than that in patients treated with medication (χ(2)=13.638, <0.001). Among the 20 cured cases, 4 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis, while in the 7 died cases, 5 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis. The comorbidity rates of diabetes mellitus (χ(2)=4.074, =0.044) and necrotizing fasciitis (χ(2)=4.457, =0.035) in died cases were significantly higher than those in cured cases. DNM is a serious infection, with high mortality especially in patients with diabetes and necrotizing fasciitis. Timely cervical and chest enhanced CT scan play vital role in its diagnosis. DNM can be treated effectively with transcervical drainage.
10.3760/cma.j.issn.1673-0860.2019.12.007
Descending necrotizing mediastinitis: contemporary trends in etiology, diagnosis, management, and outcome.
Ridder Gerd J,Maier Wolfgang,Kinzer Susanne,Teszler Christian B,Boedeker Carsten C,Pfeiffer Jens
Annals of surgery
OBJECTIVE:To evaluate contemporary trends in etiology, diagnosis, management, and outcome of descending necrotizing mediastinitis (DNM) and to draw the clinician's attention on this probably underappreciated disease. SUMMARY OF BACKGROUND DATA:An uncommon but one of the most serious forms of mediastinitis is DNM which is caused by downward spread of deep neck infections and arises as a major complication of "banal" odontogenic, pharyngeal, or cervicofacial foci. As most studies are based on small patient populations, current data on risk factors, etiology, and outcome vary significantly. Also, the optimal form of treatment remains controversial. METHODS:This retrospective study, which is the largest single-center study since 1960, is based on the management of 45 patients with DNM treated over a period of 12 years. Additionally, a meta-analysis of 26 studies on DNM published between 1999 and 2008 was performed and compared with own data and 2 previous meta-analyses covering the interval from 1960 to 1998. RESULTS AND CONCLUSIONS:Today DNM most commonly arises from pharyngeal foci and mixed polymicrobial aerobic and anaerobic infections. Reduced tissue oxygenation and impaired immune function promotes its development. Most cases of DNM are limited to the upper mediastinum and can be adequately drained by a transcervical approach. Formal thoracotomy should be reserved for cases extending below the plane of the tracheal bifurcation. Although DNM remains an aggressive infection with high morbidity, a favorable outcome can now be obtained in 85% of patients, even with this selective approach. Early diagnosis and surgical intervention are crucial.
10.1097/SLA.0b013e3181c1b0d1
Descending necrotizing mediastinitis below the tracheal carina.
Dajer-Fadel Walid L,Ibarra-Pérez Carlos,Sánchez-Velázquez Luis D,Borrego-Borrego Rafael,Navarro-Reynoso Francisco P,Argüero-Sánchez Rubén
Asian cardiovascular & thoracic annals
BACKGROUND:Descending necrotizing mediastinitis is a dreadful disease with a high mortality rate, particularly when below the tracheal carina. This study describes the epidemiologic, clinical, and paraclinical features of patients treated for this condition. METHODS:We performed a single-center retrospective descriptive review of 60 patients with descending necrotizing mediastinitis below the tracheal carina, who were treated during a 7-year period, the largest study in the last 50 years. Demographic, clinical, paraclinical, and therapeutic variables were analyzed. RESULTS:43 (71.7%) patients were male. The mean age was 41.2 ± 14.7 years. Mean hospital length of stay was 25.0 ± 19.8 days. Comorbidities were present in 46.7% of patients, diabetes mellitus being the most common. Odontogenic infections (45%) were the most frequent source of descending necrotizing mediastinitis. Cultures showed Gram-negative bacilli in 68.3%, Gram-positive cocci in 38.3%, and fungi in 6.7%. Mortality was 35% (21 patients); risk factors for mortality were age (>35 years), diabetes mellitus among other comorbidities, and associated complications. CONCLUSIONS:In this low socioeconomic status patient population, descending necrotizing mediastinitis below the carina causes high morbidity and mortality, the latter particularly associated with age, complications, diabetes mellitus and other comorbidities.
10.1177/0218492313485589
[Mortality risk factors in descending necrotizing mediastinitis].
Deu-Martín María,Saez-Barba Manel,López Sanz Iker,Alcaraz Peñarrocha Rosa,Romero Vielva Laura,Solé Montserrat Joan
Archivos de bronconeumologia
INTRODUCTION:The term descending necrotizing mediastinitis (MND) refers to an infection that begins in the oropharyngeal region and spreads through the fascial planes into the mediastinum. This study aims to estimate the incidence of MND in our centre, the epidemiology and clinical features of the disease and to evaluate prognostic factors influencing mortality. PATIENTS AND METHODS:We performed a retrospective study on 43 consecutive patients diagnosed at the Hospital Universitari Vall d'Hebron in Barcelona from January 1996 to December 2006. We performed a descriptive study and a bivariate and a multivariate analysis of variables collected. RESULTS:Overall mortality was 21%, but when we subdivided the study into two periods (1996-2000 and 2001-2006) it shows a significant decrease (40% versus 4.3%). Risk factors identified in the bivariate analysis were: diagnosis period 1996-2000, diabetes mellitus, comorbidity, number of surgeries, left lateral surgery, postoperative morbidity and septic shock. In multivariate analysis, only the presence of septic shock proved to be an independent predictor of mortality. CONCLUSIONS:MND is a disease of low incidence and should be suspected clinically and confirmed immediately with a computed tomography (CT). Multidisciplinary and early treatment has allowed us to reduce mortality by 40% in the first initial period to 4.3% today.
10.1016/j.arbres.2010.01.008
Clinical predictors of descending necrotizing mediastinitis after deep neck infections.
Kimura Akari,Miyamoto Shunsuke,Yamashita Taku
The Laryngoscope
OBJECTIVES/HYPOTHESIS:To identify the clinical predictors of descending necrotizing mediastinitis (DNM) secondary to deep neck infections (DNIs) before treatment. STUDY DESIGN:Retrospective case series. METHODS:We reviewed 73 patients with DNIs who had been treated with external drainage at our institute between April 2009 and March 2019. We divided these patients into either a DNI group without mediastinitis (n = 55) or a DNM group secondary to DNI (n = 18). We collected clinical data and compared them between the groups, conducting univariate and multiple logistic regression analysis to identify the predictors of DNM. RESULTS:We identified age, C-reactive protein (CRP), neutrophil percentage, lymphocyte percentage, neutrophil to lymphocyte ratio (NLR), presence of comorbidities, presence of gas, and abscess extension below the hyoid bone as statistically significant by univariate analysis. Moreover, multiple logistic regression analysis showed that age ≥55 years, NLR ≥13, and CRP ≥30 mg/dL were statistically significant. CONCLUSIONS:We identified age ≥55, NLR ≥13, and CRP ≥30 before DNI treatment as clinical predictors of a DNM complication. LEVEL OF EVIDENCE:4 Laryngoscope, 130:E567-E572, 2020.
10.1002/lary.28406
Risk factors for delayed oral dietary intake in patients with deep neck infections including descending necrotizing mediastinitis.
Hidaka Hiroshi,Ozawa Daiki,Kuriyama Shinichi,Obara Taku,Nakano Toru,Kakuta Risako,Nomura Kazuhiro,Watanabe Kenichi,Katori Yukio
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
Although clinical outcomes of descending necrotizing mediastinitis (DNM) and/or deep neck infection (DNI) have been extensively reported, no study has addressed delay in recovering oral ingestion after surgical interventions other than sporadic case reports. We herein compared clinical features of DNM and DNI cases over the same period, and clarified precipitating factors of delay in recovering oral ingestion by logistic regression analysis. We reviewed records of patients with DNI and DNM at our institution from August 2005 to July 2015. We extracted data on patient age, sex, complication with diabetes mellitus, gas gangrene, extension of infections, operative procedure, tracheotomy, bacterial results, and duration of empirical antibiotic therapy. Patients were categorized into three groups according to vertical spread of infection: 60 DNI patients without extension below the hyoid bone (group-A), 48 DNI patients with extension below the hyoid bone without DNM (group-B), and 10 DNM patients (group-C). Age, diabetes mellitus, and gas gangrene were significantly different among the groups. Concerning surgical intervention, tracheotomy was significantly less frequently performed in group-A (25%) than the other groups (74%) (p < 0.001). Logistic regression analyses revealed that extension of infections below the hyoid bone and tracheotomy were significantly associated with delayed oral dietary intake [odds ratios (95% confidence intervals) 2.96 (1.06-8.28) and 10.69 (3.59-31.88), respectively]. Along with DNM patients, patients who undergo tracheotomy for infections that extend below the hyoid bone should receive postoperative care with careful attention to avoid delay in recovering oral ingestion.
10.1007/s00405-017-4716-3
Risk Factors Affecting the Prognosis of Descending Necrotizing Mediastinitis From Odontogenic Infection.
Qu Luyao,Liang Xiang,Jiang Bin,Qian Wentao,Zhang Weijie,Cai Xieyi
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
PURPOSE:Descending necrotizing mediastinitis (DNM) is a serious complication of head and neck infections and has an excessively high mortality rate owing to the lack of understanding of DNM. We assessed the clinical characteristics, diagnosis, treatment, and outcomes of odontogenic DNM and evaluated the risk factors affecting the prognosis of DNM to provide an up-to-date overview for clinical practice. MATERIALS AND METHODS:We performed a retrospective cohort study, enrolling a sample of patients with DNM due to odontogenic infection who had been referred from January 2013 to December 2016. The patients were classified into surviving and deceased groups. The primary predictors in the present study were the presence of multiple comorbidities, complications, demographic data (age, gender), laboratory tests (white blood cell count, percentage of neutrophils), and time (duration before diagnosis, length of hospital stay). The primary outcome variable was the patient outcome (dead or alive). The continuous variables were evaluated using Student's t test or the t test, and the categorical and binary variables were compared using the χ test or Fisher exact test. RESULTS:A total of 81 patients (68 men, 13 women; median age of 57.2 ± 12.2 years) were included. The mortality was 4.9%. The most frequent cause of DNM was periapical periodontitis (66.7%). The lower posterior molars were involved in 39.5% of the cases. Treatment consisted of antibiotic therapy, aggressive transcervical mediastinal drainage (n = 74), and thoracotomy (n = 7). The associated risk factors for mortality were complications (P < .005) and severe sepsis or septic shock (P < .001) on bivariate analysis. CONCLUSIONS:Septic shock and complications were the risk factors that correlated with a poor prognosis. A timely diagnosis and use of aggressive mediastinal drainage are fundamental to reducing the incidence of complications and the development of septic shock in odontogenic DNM patients.
10.1016/j.joms.2017.12.007
A Retrospective Cohort Study of Risk Factors for Descending Necrotizing Mediastinitis Caused by Multispace Infection in the Maxillofacial Region.
Qu Luyao,Xu Hongyuan,Liang Xiang,Cai Xieyi,Zhang Weijie,Qian Wentao
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
PURPOSE:Descending necrotizing mediastinitis (DNM) has been the most common life-threatening complication of multispace infection (MSI) in the maxillofacial region owing to the lack of a timely diagnosis and treatment. We assessed the clinical characteristics and diagnosis of odontogenic MSI and evaluated the risk factors for DNM caused by MSI. PATIENTS AND METHODS:We performed a retrospective cohort study of inpatients with MSI in the maxillofacial region from January 2012 to October 2016. The patients were classified into a non-DNM group and a secondary DNM group. The information collected included gender, age, systemic comorbidities, source of maxillofacial infection, computed tomography imaging data, and laboratory test results. Univariate analysis (t test and χ test, or the Fisher exact test) and logistic regression analysis were applied. RESULTS:A total of 296 patients were included. The mortality was 6.3%. On univariate analysis, the following factors were statistically significant: gender (P = .001); age (P = .003); source of infection (P = .004); number of affected spaces (P < .001); involvement of the parotid space (P < .001), submandibular space (P < .001), subgingival space (P < .001), pterygomandibular space (P < .001), parapharyngeal space (P < .001), and retropharyngeal space (P < .001); and percentage of neutrophils (P < .001). On multivariate analysis, the parapharyngeal space (P = .008), source of infection (P = .037), and number of affected spaces (P < .001) were statistically significant. CONCLUSIONS:Glandular infection, parapharyngeal space involvement, and the presence of multiple affected spaces were risk factors for DNM. Clinicians should vigilantly watch for these factors during clinical treatment and effective measures taken to prevent the occurrence of DNM as soon as possible.
10.1016/j.joms.2019.11.017