Impact of COVID-19 on Management and Outcome of Cervicofacial Infections in a Maxillofacial Centre.

INTRODUCTION: Cervicofacial infections (CFI) are life-threatening and constitute some of the common emergencies seen by the oral and maxillofacial surgeon on a regular basis. The COVID-19 pandemic resulted in reduced human activities for most of 2020 including the first worldwide lockdown. At the height of the pandemic, it was expected that the number of patients presenting with cervicofacial infections would drop as with most health conditions. The purpose of this study was to determine the impact of COVID-19 on the management and outcome of cervicofacial infections in a tertiary maxillofacial institution. PATIENTS AND METHODS: A retrospective analysis of patients who presented at the Maxillofacial clinic with cervicofacial infections and were subsequently admitted into the ward during the lockdown (2020) was compared with those of the previous year (2019) and the year after (2021). RESULTS: The total number of patients seen and admitted with cervicofacial infections in 2020 was 39(31.2%) which was lower than that seen the preceding year 48(38.4%) but higher than 38(30.4%) of the year after. 116 patients were treated while nine patients left hospital without treatment. All patients presented with extensive cervicofacial infections, involving more than three fascial spaces and were treated using parenteral antibiotics with surgical incision and drainage under local anesthesia. There were more deaths in 2020 (n=10) than in the preceding year (n=8) and the year after (n=7). CONCLUSION: A high percentage of CFI was admitted during COVID-19 period compared to the previous and following years. Involvement of multiple fascial spaces was also noted.

INTRODUCTION: Les infections cervico-faciales (ICF) mettent la vie en danger et constituent certaines des urgences les plus courantes que rencontre régulièrement le chirurgien buccal et maxillo-facial. La pandémie de COVID-19 a entraîné une réduction des activités humaines pendant la majeure partie de l'année 2020, y compris le premier verrouillage mondial. Au plus fort de la pandémie, on s'attendait à ce que le nombre de patients présentant des infections cervico-faciales diminue comme pour la plupart des problèmes de santé. Le but de cette étude était de déterminer l'impact de COVID-19 sur la gestion et le résultat des infections cervicofaciales dans une institution tertiaire maxillo-faciale. PATIENTS ET MÉTHODES: Une analyse rétrospective des patients qui se sont présentés à la clinique maxillo-faciale avec des infections cervico-faciales et ont ensuite été admis dans le service pendant le lockdown (2020) a été comparée à celles de l'année précédente (2019) et de l'année suivante (2021). RÉSULTATS: Le nombre total de patients vus et admis pour des infections cervico-faciales en 2020 était de 39 (31,2 %), ce qui était inférieur à celui de l'année précédente (48 (38,4 %)) mais supérieur à celui de l'année suivante (38 (30,4 %)). 116 ont été traités tandis que neuf patients ont quitté l'hôpital sans traitement. Tous les patients présentaient des infections cervico-faciales étendues, impliquant plus de trois espaces fasciaux et ont été traités à l'aide d'antibiotiques parentéraux, avec incision chirurgicale et drainage sous anesthésie locale. Il y a eu plus de décès en 2020 (n=10) que l'année précédente (n=8) et l'année suivante (n=7). CONCLUSION: Bien qu'un pourcentage élevé de FCI ait été admis pendant la période COVI-19 par rapport aux années précédentes et suivantes, l'implication de multiples espaces fasciaux a également été constatée. Mots clés: COVID-19, Infection cervico-faciale, Confinement, Gestion, Impact.

Airway management, intensive care requirement, and corticosteroid use in cervicofacial infection. A Maxillofacial Trainee Research Collaborative (MTReC) study.

Cervicofacial infection (CFI) is a frequently encountered presentation to Oral and Maxillofacial Departments (OMFS). The United Kingdom has recently seen cessation of all routine community dental treatment due to the Coronavirus (COVID-19) pandemic and consequently an initial modification of treatment received in secondary care. Subsequent airway difficulties and the need for level 2 High Dependency Unit (HDU) or level 3 Intensive Care Unit (ICU) is a concern to surgeons and anaesthetists alike. The availability of skilled staff and appropriate facilities can be variable. It is imperative to understand the resource implications of CFI with respect to airway management and critical care utilisation. Adequate provision is fundamental for optimal care. A national, multicentre, trainee-led audit was carried out across 17 hospitals in the UK from May to September 2017. Information recorded included demographic features, presentation, airway management, medical and surgical treatment, and steroid administration. One thousand and two presentations (1002) were recorded. Forty-five percent were female, with a mean (range) age of 37.5 years (0-94). Regarding surgical airway management, 63.4% had a standard intubation (oral 42%, nasal 21.4%). Awake fibreoptic intubation (AFOI) was performed in 28% and surgical airway required in 0.9%. Impending airway compromise at the time of presentation was 1.7%. Following surgical incision and drainage, 96.1% of patients returned to a general ward, 2.7% to Level 3, and 1.1% to Level 2 care. The return to theatre was 2.8%, and 0.7% required reintubation. There was an association between corticosteroid administration and duration of intubation. Those who received steroids were more likely to remain intubated postoperatively (p = 0.006), require a higher level of postoperative care (p < 0.001), and require a return to theatre (p = 0.019). Postoperatively, patients who received steroids were less likely to be extubated at the close of the procedure. Intubated patients who received multiple steroid doses postoperatively were extubated with less frequency those that received a single dose. To our knowledge, this dataset is the largest ever recorded for CFI. Our results showed a high requirement for advanced airway management in this cohort. The requirement for surgical airway was low, but the significance of this situation should not be underestimated. The relatively frequent need for care at levels 2 or 3 within this cohort also placed a significant demand on already overburdened resources. Knowledge of care requirements for these patients will inform resource planning.

Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine.

To present five patients with DNM, who were treated during the first quarantine for Coronavirus disease 2019 (Covid-19). Five patients with DNM were treated in our department during the first lockdown. The mean age of the patients was 42,2 years and four were male. Two patients were immunocompromised. Repeated surgical drainage was performed in all patients, whereas four were also subjected to elective tracheostomy during their first operation. The mean hospitalization duration was 55,4 days and mortality was 40%. During the first lockdown for the Covid-19, a rise in the ratio of DNM cases to the overall incidence of cervicofacial infections was observed in our department. All patients with DNM were operated on an emergency basis and were subsequently admitted to the ICU. We consider the effect of the quarantine as a decisive factor for this escalation, because according to the department archives, there had not been any cases of DNM originating from a dental infection, for the past 5 years. Additionally, past studies from the same department reported no more than 6 cases over a 10 year period.

Impacts of lockdown during the SARS-CoV-2 pandemic on patients presenting with cervicofacial infection of odontogenic origin: a comparative study.

The SARS-CoV-2 pandemic caused unprecedented disruption to primary and secondary healthcare services. Our aim was to explore whether the pandemic had had any impact on patients presenting with cervicofacial infections (CFI) of odontogenic origin to secondary care and management. Comparative analysis was carried out evaluating prospective and retrospective consecutively admitted patients with a diagnosis of CFI of odontogenic origin in the COVID-19 lockdown period from 15 March to 15 June 2020 and pre-COVID-19 during the same period of the previous year. Data included patients' demographics, comorbidities, systemic inflammatory response syndrome (SIRS) status on admission, clinical features, prior treatment in primary care, source of referral, SARS-COV-2 antigen status, treatment received in secondary care, intraoperative findings, and whether escalation of the level of care was required. Across both cohorts there were one hundred and twenty-five (125) patients admitted with CFI of odontogenic origin, with a 33% reduction (n=75 (2019) vs n=50 (2020)) in number of patients admitted during COVID-19 lockdown. There was no difference between the cohorts in terms of age (p=0.192), gender (p=0.609) or major comorbidities (p=0.654). Proportionally more patients in the COVID-19 group presented with SIRS (p=0.004). This group of patients persisted with symptoms for longer before presenting to secondary care (p=0.003), more delay from hospital admission to surgical intervention (p<0.005) and had longer hospital stays (p=0.001). More patients required extraoral surgical drainage during COVID-19 (p=0.056). This study suggests that the COVID-19 lockdown has had adverse effects on the presentation of CFI of odontogenic origin and its management within a Regional Acute Maxillofacial Service. Commissioners and clinicians should endeavour to plan for adequate primary and secondary care provision during any future local lockdowns to ensure that patient care is optimised.