Descending necrotizing mediastinitis: a clinical analysis based on 10 years of published data in China / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.

Cervical Necrotizing Fasciitis: An Uncommon Fulminant Disease Entity

Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.

Fascitis necrotizante cervical: experiencia en el Hospital General Dr. Manuel Gea González, Ciudad de México, / Cervical necrotizing fasciitis: Experience in the Hospital General Dr. Manuel Gea González, Mexico City,

Introducción: la fascitis necrotizante cervical es una entidad poco frecuente en la cabeza y el cuello, pero su importancia está dada por la elevada tasa de mortalidad. La importancia clínica de este estudio se debe al hecho de que no hay muchos reportes de casos de esta patología en América Latina, por lo cual queremos describir la experiencia en nuestro Hospital. Objetivo: describir la experiencia en fascitis necrotizante cervical en el Hospital General Dr. Manuel Gea González. Materiales y métodos: estudio descriptivo, retrospectivo y transversal de historias clínicas del Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital General Dr. Manuel Gea González, de 2011 a 2017. Resultados: se incluyeron 11 historias clínicas con diagnóstico de fascitis necrotizante cervical, de las cuales 8 (72,7 %) eran hombres y 3 (27,2%) mujeres, con una edad promedio de 49,1 años. 5 (45,4 %) pacientes debutaron con diabetes mellitus tipo 2 (DM2). El origen de la infección fue odontogénico en 3 (27,2 %) pacientes. Los microorganismos más frecuentes fueron Klebsiella pneumoniae, Streptococcus anginosus y Staphylococcus epidermidis. Los 11 pacientes (100 %) fueron intervenidos quirúrgicamente e impregnados con antimicrobianos empíricos, que posteriormente fueron modificados o no según los resultados del antibiograma. La hospitalización promedio fue de 18,7 días. 3 (27,2 %) pacientes presentaron mediastinitis como complicación. Hubo 2 muertes (18,1 %). Conclusión: el diagnóstico temprano y el tratamiento antimicrobiano empírico y quirúrgico agresivo pueden reducir significativamente la morbimortalidad.

Introduction: Cervical necrotizing fasciitis is a rare entity in the head and neck, but its importance is given by the high mortality rate. The clinical importance of this study is due to the fact that there are not many case reports of this pathology in Latin America, which is why we want to describe the experience in our hospital. Objective: To describe the experience in cervical necrotizing fasciitis at the Hospital General Dr. Manuel Gea González. Materials and methods: Descriptive, retrospective and cross-sectional study of medical records of the Otorhinolaryngology and Head and Neck Surgery Service of the Hospital General Dr. Manuel Gea González, from 2011 to 2017. Results: 11 medical records with a diagnosis of cervical necrotizing fasciitis were included, of which 8 (72.7%) were men and 3 (27.2%) were women, with a mean age of 49.1 years. 5 (45.4%) patients presented with type 2 diabetes mellitus. The origin of the infection was odontogenic in 3 (27.2%) patients. The most frequent microorganisms were Klebsiella pneumoniae, Streptococcus anginosus and Staphylococcus epidermidis. The 11 patients (100%) underwent surgery and impregnated with empirical antimicrobials, which were later modified or not, according to the results of the antibiogram. The average hospitalization was 18.7 days. 3 (27.2%) patients presented mediastinitis as a complication. There were two deaths (18.1%). Conclusion: Early diagnosis and aggressive empirical and surgical antimicrobial treatment can significantly reduce morbidity and mortality.

Complicaciones infecciosas severas del territorio maxilofacial: presentación de casos clínicos / Severe infectious complications of the maxillofacial territory: clinical cases presentation

RESUMEN: Las infecciones en el territorio maxilofacial, son cuadros frecuentes, de origen polimicrobiano, con manifestaciones clínicas muy variables y que están asociadas a múltiples vías de ingreso de los microorganismos al territorio. Un gran porcentaje de estas infecciones se origina en la cavidad oral, principalmente en lesiones bacterianas que sufren los dientes. La compleja anatomía de la cabeza y el cuello, permiten que muchas de estas infecciones se diseminen por espacios profundos, llegando a comprometer órganos o regiones anatómicas adyacentes, que pueden llevar a cuadros clínicos de alto riesgo vital. Los casos clínicos presentados en este artículo corresponden a pacientes tratados en el hospital San Juan de Dios a causa de procesos infecciosos del territorio maxilofacial, por equipos multidisciplinarios.

ABSTRACT: Infections in the maxillofacial territory are frequent cases of polymicrobial origin, with very variable clinical manifestations and are associated with multiple entering pathways of microorganisms in the territory. A large percentage of these infections originate in the oral cavity, mainly in bacterial lesions that undergo experienced by the teeth. The complex anatomy of the head and neck allows many of these infections to spread through deep spaces, leading to compromising adjacent organs or anatomical regions, which can lead to high-risk clinical conditions. The clinical cases presented in this article correspond to patients treated at the San Juan de Dios hospital because of infectious processes of the maxillofacial territory, by multidisciplinary teams.

Management of Cervical Necrotizing Fasciitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical necrotizing fasciitis (CNF) is a rare but potentially life-threatening soft tissue infection primarily affecting the superficial fascial planes. The purpose of this study was to report various causes, courses of the disease, and outcomes of treatment. SUBJECTS AND METHOD: A retrospective chart review of 12 cases treated between January 2000 and January 2004 was done. All of them were studied with CT scan and treated with intravenous antibiotics. We discussed histories, diagnostic points and treatment of each cases, and analyzed them. RESULTS: There were 9 male and 3 female patients. The age distribution was from 17 to 81 years. Three patients had diabetes mellitus, one patient was a heavy alcoholics, and one patient had Buerger's disease. Two patients were expired due to lung abscess and sepsis, but others were discharged with no complication. Wide debridement was performed in all cases. Wound reconstruction was done in two patients. CONCLUSION: Treatment consists of early diagnosis, aggressive surgical debridement and drainage of the involved necrotic fascia and tissue along with broadspectrum intravenous antibiotics coverage.

Descending Necrotizing Mediastinitis: Report of Three Cases / 대한이비인후과학회지

Cervical necrotizing fasciitis (CNF) is a rare but well-known, rapidly fulminant polymicrobial infection of subcutaneous tissues. It is characterized by progressive destruction of fascia and adipose tissue, with sparing of the overlying skin and muscle in the initial stage. CNF may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay makes this descending necrotizing mediastinitis, the most lethal form of mediastinitis, with a mortality of approximately 40 per cent. So aggressive multidisciplinary therapy with surgical drainage is mandatory. We present three cases of descending necrotizing mediastinitis with literature review.

A Case of Cervical Necrotizing Fasciitis

Necrotizing fasciitis is a relatively rare disease which mainly affects the extremities, inguinal area, and the trunk area, and it is by definition a severe acute bacterial infection which affects the fascia. One can misdiagnose the disease as simple cellulitis, thereby delaying an appropriate treatment, and the disease can rapidly spread through the fascia, causing complication such as sepsis, leaving severe loss of tissue as a sequelae. Necrotizing fasciitis of the cervical area is even a rarer disease. Once a person contracts, the disorder can spread through superficial musculoaponeurotic system and cervical fascia, quickly infecting important vascular systems and mediastinum of the craniocervical and thoracic area, which cause a serious complication from direct spread unto main organs. Therefore, in case of necrotizing fasciitis of the cervical area, active surgical treatment such as wide excision of necrotizing tissue and proper drainage of abscess and early administration of broad range antibiotics are necessary in order to prevent serious complications in main vascular system, mediastinum, or craniocervical system. We have experienced a case of necrotizing fasciitis of the cervical region in 2002, and obtained satisfactory results from wide excision, abscess drainage, local flap with skin graft, and hereby report the case with references.

Three Cases of Cervical Necrotizing Fasciitis / 대한이비인후과학회지

Cervical necrotizing fasciitis (CNF) is an uncommon infection of the subcutaneous soft tissue and fascia. If proper treatment is delayed, the infection may cause extensive necrosis of overlying skin, extend to deeper planes and produce severe systemic toxicity. So an early diagnosis and a radical debridement of the affected tissue is imperative; however, the onset is often insidious in the form of nonspecific regional neck swelling, erythema and fever, rendering clinical distinction from more benign inflammatory conditions of the neck, such as cellulitis, may be impossible at an early stage. We present a series of 3 patients with CNF, each of whom had different clinical courses. One patient, with significant cormobidity at the time of presentation, died of CNF.