Prevalence of diabetes mellitus and clinicodemographic profiles of patients with head and neck infections in a Philippine tertiary government hospital

@#Objective: To determine the prevalence of diabetes mellitus among patients admitted for head and neck infections and describe their clinicodemographic features. Methods: Design: Retrospective Case Series Setting: Tertiary Government Training Hospital Participants: Forty-two (42) patients Results: Out of 211 adult patients admitted for head and neck infections during the study period, 42 (20%) were diagnosed to have concomitant diabetes mellitus (DM). Only 6 (14%) were known to have DM before admission while 28 (67%) were found to have DM only after admission. The most common site of infection was the neck (11; 26%). More than half of the patients (24; 57.1%) had infections in the head only, 17 (40.5%) had infections in the neck only, and 1 (2.4%) had infections in both the head and neck regions. Among these, 26 (61.9%) had infection in one site only, 15 (35.7%) had infections in two sites and one (2.4%) had infections in three sites. The majority (28; 66.7%) had an unknown etiology of infection with spontaneous appearance of redness and swelling in the involved area. Six (14.3%) were odontogenic, five (11.9%) were due to skin trauma, and three (7.1%) were due to nasal mucosal trauma. Available cultures in 14 patients revealed 12 (86%) with aerobic microorganisms and two (14%) with anaerobic growths. Half of the aerobic cultures grew K. pneumoniae. All patients were started on empiric intravenous antibiotics and over half of them (52.4%) needed surgical management. More than half (27; 64.3%) suffered from diabetic head and neck-associated complications, categorized into orbital (56%), organ/systemic (26%), local (11%), and neural (7%). Despite these complications, the majority (37, 86%) went home improved while five (12%) expired. Conclusion: This study found that 20% of patients admitted for head and neck infections during the study period had concurrent DM. Guided by known clinicodemographic haracteristics, patients admitted with suspicious head and neck infections must be promptly screened for concomitant DM and properly managed before substantial morbidity and death ensue. Otolaryngologists - head and neck surgeons, endocrinologists, general practitioners and patients alike must be cognizant of diabetic head and neck infections so that they can be prevented or managed early before complications set in.

Tuberculosis of the temporomandibular region

Objective:@#To describe a unique case of extrapulmonary tuberculosis (TB) of the temporomandibular area focusing on its insidious and destructive course over a 2-year period with insights into the diagnostic and therapeutic pitfalls encountered throughout its clinical development. @*Methods:@#Study Design: Case Report. Setting: Tertiary Government Hospital. Patient: One. @*Results@#A 33-year old man initially presented with right pre-auricular swelling and trismus that were unresponsive to antibiotic therapy. On subsequent follow-ups, initial symptoms were accompanied by a non-healing right pre-auricular wound, right ear discharge, trismus, and right facial paralysis (House-Brackmann III). Cranial and temporal bone computed tomography scans revealed osteolytic destruction of the right temporomandibular region extending to the auditory canal and of the right mastoid bone extending to the right mandibular condyle and parotid. Infected malignancy of the parotid, mandible and temporal bone were considered, but definitive diagnosis from an incision biopsy revealed caseating granulomatous inflammation consistent with tuberculosis. He was started on anti-tuberculosis medications with significant resolution of pre-auricular swelling, non-healing pre-auricular wound, facial paralysis and ear discharge but minimal improvement in mouth opening.@*Conclusion@#Tuberculosis of temporomandibular region is rare and is associated with nonspecific manifestations. Delay in diagnosing and initiating appropriate treatment can lead to morbidity and serious complications involving destruction of the temporal bone, middle ear, mandible and parotid gland over its progression. A high index of suspicion by the physician and awareness of the patient’s health seeking behaviors could have aided in the early diagnosis and treatment of this extrapulmonary TB.