Infección de los espacios profundos del cuello de origen dentario / Odontogenic deep neck infections

RESUMEN Antecedentes: los pacientes con infecciones cervicales pueden presentar cuadros de extrema gravedad que ponen en riesgo su vida. Parece increíble que en pleno siglo XXI alguien muera por la infección de una muela, pero es real. Objetivo: describir los resultados con el diagnóstico y tratamiento de una serie de pacientes con infecciones de los espacios profundos del cuello de origen dentario, y establecer criterios para su manejo. Material y métodos: se realizó un estudio descriptivo y retrospectivo a partir de los registros en nuestra base datos entre septiembre de 2006 y junio de 2022. Se incluyeron sólo pacientes con infecciones cervicales de origen dentario. Se evaluaron las variables demográficas, las relacionadas al origen de la complicación, el tratamiento realizado y la evolución de los pacientes. Resultados: la muestra quedó conformada por 499 pacientes, con promedio de edad de 29 años (12- 70); 288 (57.7%) eran hombres. Consultaron en forma tardía 269 (53,9%) y se automedicaron en forma inicial 271 pacientes (54.3%). La mayoría no había recibido tratamiento de la pieza dentaria en el centro de atención primaria. Se realizó tratamiento quirúrgico 267 casos (53.5%), y el resto pudo tratarse de forma conservadora. La evolución fue favorable en 497 pacientes (99.6 %), y dos fallecieron por mediastinitis. Conclusión: las infecciones odontógenas deben ser diagnosticadas y tratadas apropiadamente en forma precoz a fin de evitar cuadros de extrema gravedad. Las campañas de educación poblacional y la instrucción de los médicos/odontólogos de centros de atención primaria y servicios de guardia podría mejorar esta problemática.

ABSTRACT Background: Patients with deep infections may present with extremely serious and life-threatening conditions. It is unbelievable that someone could die from a molar infection in the 21st century, but it is real. Objective: The aim of the present study is to describe the diagnosis and treatment results of a series of patients with odontogenic deep neck infections, and to establish criteria for the management of these infections. Material and methods: We conducted a retrospective and descriptive study based on records from a database from September 2006 to June 2022. Only patients with odontogenic deep neck infections were included. The demographic variables, those related to the origin of the complication, the treatment performed, and the patients' progress were evaluated. Results: The sample was made up of 499 patients; mean age was 29 years (12-70) and 288 (57.7%) were men. Late visits and self-medication were recorded in 269 patients (53.9%) and 271 patients (54.3%), respectively. Most of them had not received treatment for the affected tooth at the primary healthcare center. Surgical treatment was performed in 267 cases (53.5%), and the rest were managed with conservative approach. The disease had a favorable course in 497 patients (99.6%) and two patients died of mediastinitis. Conclusion: Odontogenic infections should be adequately diagnosed and treated correctly and early to avoid extremely serious complications. Population-based educational campaigns and training for physicians and dentists working in primary care centers and emergency departments could improve this issue.

Diagnostic and therapeutic approaches in deep neck infections: an analysis of 74 consecutive patients / Abordagens diagnósticas e terapêuticas em infecções cervicais profundas: uma análise de 74 pacientes consecutivos

Abstract Introductıon: Deep neck infections are a group of diseases with serious complications and mortality, which can occur as a result of common diseases in the community and which have surgical and medical treatment options. Objectives: Patients ages, genders, complaints, physical examination findings, hospitalization complaints, history of antibiotic use before the application, additional diseases, radiological tests and analysis of examinations, type of treatment method, antibiotic agents selected in treatment, bacterial culture results, duration of hospitalization, complications, mortality rates were systematically recorded. In the study, anaerobic bacterial factors, which are difficult to produce in routine, were produced by considering special transport conditions and culture media. Methods: A total of 74 patients who were hospitalized in the Department of Otorhinolaryngology, University of Mersin, between 01.07.2016 and 01.07.2017 for deep neck infection were evaluated prospectively. The study included 37 female and 37 male patients. The ages of the patients ranged from 1 to 69 and the mean age was 31 years. Results: According to the analysis of the obtained data, there was a statistically significant relationship between the patients with additional diseases and the treatment modalities of the patients (p = 0.017). The surgical treatment rate was increased in this group of patients. In patients with a history of antibiotic use, it was found that patients in the pediatric group were in hospital longer in terms of length of stay compared to adults (p = 0.036). In adult patients who underwent surgery, the absorptive long axis was found to be longer in mm than in patients receiving isolated medical treatment (p = 0.008). Conclusions: Deep neck infections is a disease group that seriously concerns public health, with significant mortality and morbidity. Ensuring airway safety of patients should be the first intervention. Abscesses located lateral to the tonsil capsule may not drain adequately without concomitant tonsillectomy.

Resumo Introdução: As infecções cervicais profundas constituem um grupo de doenças com graves complicações e mortalidade, que podem ocorrer como resultado de doenças comuns na comunidade e que têm opções de tratamento médico e cirúrgico. Objetivo: Detectar bactérias anaeróbias e comparar a eficácia do tratamento médico-cirúrgico em diferentes faixas etárias. Método: Foram sistematicamente registrados idade dos pacientes, sexo, queixas, achados do exame físico, queixas na hospitalização, histórico de uso de antibióticos, doenças adicionais, exames radiológicos e análise dos exames, tipo de tratamento, agentes antibióticos selecionados no tratamento, resultados de cultura bacteriana, duração da hospitalização, complicações e taxas de mortalidade. No estudo, culturas bacterianas anaeróbias, difíceis de obter rotineiramente, mesmo considerando-se condições especiais de transporte e meios, foram obtidas. Foram avaliados prospectivamente 74 pacientes internados no Departamento de Otorrinolaringologia da Universidade de Mersin, entre 01.07.2016 e 07.07.2017, devido a infecção cervical profunda. O estudo incluiu 37 pacientes do sexo feminino e 37 do masculino. A idade dos pacientes variou de 1 a 69 anos e a média foi de 31. Resultados: De acordo com a análise dos dados obtidos, houve uma relação estatisticamente significante entre os pacientes com doenças adicionais e as modalidades de tratamento dos pacientes (p = 0,017). A taxa de tratamento cirúrgico foi maior nesse grupo de pacientes. Em pacientes com histórico de uso de antibióticos, verificou-se que aqueles do grupo pediátrico permaneceram mais tempo hospitalizados em comparação aos adultos (p = 0,036). Nos pacientes adultos submetidos à cirurgia, verificou-se que o eixo longo absortivo era mais longo em mm do que nos pacientes que receberam tratamento médico isolado (p = 0,008). Conclusão: As infecções cervicais profundas constituem um grupo de doenças que são preocupantes na saúde pública, com sua mortalidade e morbidade. Garantir a segurança das vias aéreas dos pacientes deve ser a primeira intervenção. Os abscessos localizados lateralmente à cápsula tonsilar podem não apresentar drenagem sem a tonsilectomia.

Estreptococos del grupo Streptococcus anginosus Parte IIIa. Epidemiología e infecciones de cabeza y cuello / Streptococcus anginosus group. Part IIIa. Epidemiology and head and neck infections

Resumen Los estreptococos del grupo Streptococcus anginosus (EGA) son colonizantes habituales de las mucosas orofaríngea, intestinal y genitourinaria, pero, cada vez más frecuentemente, son reconocidos como patógenos humanos. En esta parte IIIa se describen la epidemiología de las infecciones por EGA y las características de las localizadas en cabeza y cuello. Es ampliamente conocida su capacidad de formar abscesos; en particular en la zona de cabeza y cuello se destacan los abscesos odontogénicos, los periorbitales y los cerebrales. También producen sinusitis, infecciones oculares, abscesos epidurales, síndrome de Lemierre, empiemas subdurales y colecciones en piel y tejidos blandos y huesos del cráneo. Su rol en la faringitis es controvertido aunque algunas de las subespecies podrían estar involucradas en ese tipo de infecciones. También se postula su potencial cancerígeno dada su asociación con carcinomas orofaríngeos, gástricos o esofágicos.

Abstract Streptococcus anginosus group (SAG) organisms are common colonizers of the oropharyngeal, intestinal, and genitourinary mucosa, but are increasingly recognized as human pathogens. This part IIIa describes the epidemiology of SAG infections and the characteristics of those located in the head and neck. Its ability to form abscesses is widely known, particularly, in the head and neck area; odontogenic, periorbital and brain abscesses stand out. They also cause sinusitis, eye infections, epidural abscesses, Lemierre's syndrome, subdural empyemas, and collections in the skin and soft tissues and bones of the skull. Its role in pharyngitis is controversial, although some of the subspecies could be involved in such infections. Its carcinogenic potential is also postulated given its association with oropharyngeal, gastric or esophageal carcinomas..

Resumo Os estreptococos do grupo Streptococcus anginosus (EGA) são colonizadores comuns da mucosa orofaríngea, intestinal e geniturinária, mas são cada vez mais frequentemente reconhecidos como patógenos humanos. Esta parte IIIa descreve a epidemiologia das infecções por EGA e as características daquelas localizadas na cabeça e no pescoço. Sua capacidade de formar abscessos é amplamente conhecida, principalmente, na região da cabeça e pescoço, destacando-se os abscessos odontogênicos, os periorbitais e os cerebrais. Eles também causam sinusite, infecções oculares, abscessos epidurais, síndrome de Lemierre, empiemas subdurais e coleções em pele e tecidos moles, e ossos do crânio. Seu papel na faringite é controverso, embora algumas das subespécies possam estar envolvidas em tais infecções. Seu potencial carcinogênico também é postulado pela associação com carcinomas orofaríngeos, gástricos ou esofágicos.

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.

Factors influencing paediatric neck abscess and treatment at Hospital Tuanku Jaafar, Seremban

@#Background: This is a descriptive study of in-patient paediatric population with the diagnosis of neck abscess. The objective of this study was to calculate the number of children who require conservative (antibiotic) management compared to surgery for neck abscess. A second objective was to identify the factors influencing the choice of the treatments selected. Methods: A retrospective review was performed on a group of paediatric population aged 0 till 12 years of age, with a history of admission to paediatric ENT ward from the year 2010 till 2015 in HTJS. Initially, 69 children with the diagnoses of various neck infections were identified. Then, the sample amount was narrowed to 30 patients with neck abscesses only. Results: The data analysis was performed using descriptive statistics, Chi-squared test and Fisher’s exact test. Twentyfive out of the 30 patients required operative drainage of abscess (83.3%). In this group, children aged ≤2 years old were the largest group to have undergone surgical drainage. Only five patients were successfully treated with antibiotic therapy alone. Nineteen children came only after developing neck swelling for more than a week, in which 18 of them required surgery. Conclusion: Younger group of children are more likely to undergo surgical drainage than older children for neck abscess. Also, children who came in after two weeks of symptoms have a higher probablity of requiring surgery than antbiotic alone. Nonetheless, every child who comes in with neck abscess should be evaluated and treated early to avoid any sinister complications.

Peritonsillar and deep neck infections: a review of 330 cases / Infecções peritonsilares e cervicais profundas: revisão de 330 casos

Abstract Introduction: Deep neck infections are defined as suppurative infectious processes of deep visceral spaces of the neck. Objective: The aim of this study is to review different factors that may influence peritonsillar and deep neck infections and may play a role as bad prognosis predictors. Methods: We present a retrospective study of 330 patients with deep neck infections and peritonsillar infections who were admitted between January 2005 and December 2015 in a tertiary referral hospital. Statistical analysis of comorbidities, diagnostic and therapeutic aspects was performed with Excel and SPSS. Results: There has been an increase in incidence of peritonsilar and deep neck infections. Systemic comorbidities such as diabetes or hepatopathy are bad prognosis factors. The most common pathogen was S. viridans (32.1% of positive cultures). 100% of the patients received antibiotics and corticosteroids, 74.24% needed surgical treatment. The most common complications were mediastinitis (1.2%) and airway obstruction (0.9%). Conclusion: Systemic comorbidities are bad prognosis predictors. Nowadays mortality has decreased thanks to multidisciplinary attention and improvements in diagnosis and treatment.

Resumo Introdução: Infecções cervicais profundas são definidas como processos infecciosos supurativos dos espaços viscerais profundos do pescoço. Objetivo: Analisar diferentes fatores que podem influenciar as infecções peritonsilares e cervicais profundas que podem desempenhar um papel como preditores de mau prognóstico. Método: Apresentamos um estudo retrospectivo de 330 pacientes portadores de infecções cervicais profundas e de infecções peritonsilares admitidos entre janeiro de 2005 e dezembro de 2015 em um hospital terciário de referência. A análise estatística de comorbidades, aspectos diagnósticos e terapêuticos foi realizada utilizando-se os programas Excel e o SPSS. Resultados: Houve um aumento na incidência de infecções peritonsilares e infecções cervicais profundas. Comorbidades sistêmicas como diabetes ou doença hepática são fatores de mau prognóstico. O patógeno mais comum foi S. viridans (32,1% das culturas positivas). 100% dos pacientes receberam antibióticos e corticosteroides, e 74,24% necessitaram de tratamento cirúrgico. As complicações mais comuns foram mediastinite (1,2%) e obstrução das vias aéreas (0,9%). Conclusão: Comorbidades sistêmicas são preditores de mau prognóstico. Atualmente, a mortalidade diminuiu graças ao cuidado multidisciplinar e melhorias no diagnóstico e tratamento.

Infecciones por Streptococcus anginosusen otorrinolaringología: revisión de 9 casos clínicos / Infections caused by Streptococcus anginosusin otolaryngology: review of 9 clinical cases

Introducción: El Streptococcus anginosus (SA) es un habitante común de la cavidad oral y tracto gastrointestinal, y puede ser un patógeno agresivo causante de abscesos en varios sitios del cuerpo. Aparentemente, su rol en infecciones de cabeza y cuello está adquiriendo cierta notoriedad y no está claramente reportado en la literatura. Objetivo: El objetivo del presente estudio fue evaluar las implicancias clínicas de estas infecciones en otorrinolaringología. Material y método: Estudio retrospectivo de todos los pacientes diagnosticados microbiológicamente con infecciones causadas por Streptococcus anginosus, tratados en el Servicio de Otorrinolaringología del Hospital Barros Luco-Trudeau entre los años 2007 a 2012. Se describen las características clínicas, microbiológicas y el manejo de los pacientes. Resultados: La muestra estuvo constituida por 9 casos, 3 hombres y 6 mujeres, con una mediana de edad de 52 años (rango 6-70). Los sitios de infección fueron: absceso periamigdalino (2 casos), un absceso peritraqueostoma, un absceso submandibular, un absceso submentoniano, un absceso parafaríngeo con extensión retrofaríngea y mediastino, un caso de absceso cerebral frontal secundario a sinusitis frontal complicada, un caso de otitis media crónica activa, y un caso de sinusitis maxilar crónica. Discusión: El SA ha sido reportado como un agente causal de infecciones potencialmente graves en cabeza y cuello. Su identificación requiere de consideraciones especiales para el cultivo, y al ser un microorganismo común puede ser confundido e informado como S viridans o Streptococcus anaeróbico. Es importante reconocer al SA como un patógeno a considerar en infecciones de cabeza y cuello.

Introduction: Streptococcus anginosus (SA) is a common inhabitant of the oral cavity and gastrointestinal tract, and can be an aggressive pathogen causing abscesses in various body sites. Apparently, its role in head and neck infections is gaining some notoriety that it is not clearly reported in the literature. Aim: The aim of this study was to evaluate the clinical implications of this infections in otolaryngology. Material and method: A retrospective case series study of all patients diagnosed microbiologically with Streptococcus anginosus infections treated at the Department of Otolaryngology, HospitalBarros Luco-Trudeau from 2007 to 2012. We describe the clinical and microbiological features, and treatment of each patient. Results: The sample consisted of 9 patients, 3 men and 6 women, with a median age of 52 years (range 6-70). The sites of infection were: peritonsillar abscess (2 cases), peritracheostomy abscess, submandibular abscess, submental abscess, parapharyngeal abscess with retropharyngeal and mediastinal extension, a case of frontal brain abscess secondary to frontal sinusitis, a case of otitis chronic active half, and one case of chronic maxillary sinusitis. Discussion: SA has been reported as a causative agent ofpotentially serious infections in the head and neck region. Their identification requires special considerations for growing, and because of being a common microorganism may be confused and informed as Streptococcus viridans or anaerobic streptococcus. It is important to recognize SA as a relevant pathogen in head and neck infections.

Retrospective Clinical Review of Deep Neck Infections (abscesses)

PURPOSE: This study was performed to review our experience with deep neck infections (DNI) in an emergency center. METHODS: Over a 60-month period, 32 consecutive patients with DNI were included in the study. Variables included in the data analysis were age, sex, clinical symptoms and signs, and laboratory findings on initial presentation. Both DNI and NDNI (Non-deep neck infections; acute tonsillitis, acute oropharyngitis) groups were examined clinically, and blood samples were taken and studied for several parameters associated with infection, including C-reactive protein levels; the findings were analyzed statistically for differences between the groups. RESULTS: A retrospective review was conducted of 32 patients with deep neck infections. Based on clinical and radiologic findings, these patients were categorized as retropharyngeal space, parapharyngeal space, sublingual space, submandibular space, or multiple space. The most common symptoms were fever (78%) and sore throat (53%), followed by dysphagia (47%), trismus (38%), and neck swelling (31%). No particular background variables were associated with DNI; however, a particularly high CRP level on admission was found to be associated with DNI (p<0.05). CONCLUSION: We should distinguish deep neck infections from non deep neck infections in the emergency department. This study showed that determination of the CRP level may be useful in making a clinical diagnosis of deep neck infections.