ABSTRACT
INTRODUCTION: The most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial. METHODS: A randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0. RESULTS: 128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The P-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results. DISCUSSION: Surgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient's airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed. CONCLUSIONS: Ultrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.
Subject(s)
Abscess , Drainage , Abscess/diagnostic imaging , Abscess/surgery , Adult , Female , Humans , Male , Neck/surgery , Ultrasonography , Ultrasonography, Interventional/methodsABSTRACT
Oral diseases are limiting to health, welfare, and conservation practices, especially in the case of endangered animals. In this retrospective study, a survey on oral health-related conditions noted in the clinical records for 261 deer comprised in an ex situ population of the Marsh Deer Conservation Center (CCCP) over 30 years (1990-2020) was carried out. Of these, 49 (18.77%) marsh deer (31 females - 63.27% and 18 males - 36.73%) had clinical oral affections; the affected deer's mean age was 8.9 years. Logistic regression analysis was performed, and the variable age was significantly associated with the presence of dental affections. Thus, with a change in the age category, a deer had eight times the chance of manifesting oral affections; therefore, age can be considered a risk factor for the manifestation of oral affections in the species. Increased facial volume (65.3%), accumulation of food in the mouth (36.7%), tooth loss (22.4%), fistulas (22.4%), mucosal or palatal lesions (22.4%), tooth wear (20.4%), and tooth root exposure (18.3%) were the most frequently recorded lesions. The relatively high occurrence of oral affections in Blastocerus dichotomus reiterates the importance of oral health care when deer are kept in human care.
As doenças bucais são limitantes para as práticas de saúde, bem-estar e conservação, especialmente no caso de animais ameaçados de extinção. Neste estudo retrospectivo, realizou-se um levantamento sobre condições relacionadas à saúde bucal observadas nos registros clínicos de 261 cervídeos que compunham uma população ex situ do Centro de Conservação do Cervo-do-Pantanal durante um período de 30 anos (1990-2020). Destes, 49 (18,77%) cervos-do-pantanal (31 fêmeas (63,27%) e 18 machos (36,73%)) apresentavam afecções clínicas bucais; e a idade média dos cervídeos afetados foi de 8,9 anos. Realizou-se a análise de regressão logística e a variável idade mostrou associação significativa com a presença de afecções dentárias. Assim, com a mudança de categoria de idade, um cervídeo teve oito vezes mais chances de manifestar afecções bucais; portanto, a idade pode ser considerada como fator de risco para manifestação de afecções bucais na espécie. Aumento de volume facial (65,3%), acúmulo de alimentos na boca (36,7%), perda dentária (22,4%), fístulas (22,4%), lesões nas mucosas ou palatinas (22,4%), desgaste dentário (20,4%) e exposição de raiz (18,3%) foram as lesões mais registradas. A ocorrência relativamente alta de afecções bucais em Blastocerus dichotomus reitera a importância dos cuidados com a saúde bucal quando os cervídeos são mantidos sob cuidados humanos.
Subject(s)
Animals , Periodontal Diseases/veterinary , Tooth Diseases/veterinary , Deer , Brazil , Endangered SpeciesABSTRACT
INTRODUCTION: The most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial. METHODS: A randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0. RESULTS: 128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The p-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results. DISCUSSION: Surgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient's airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed. CONCLUSIONS: Ultrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.
ABSTRACT
BACKGROUND: Cervical fasciitis is a group of severe infections with high morbimortality. Reports in the literature of patients with cases evolving with mediastinal dissemination of deep cervical abscess are common. However, cases of abdominal dissemination by contiguity are much rarer. CASE PRESENTATION: A 34-year-old Caucasian man presented to the emergency department with a 15-day history of left neck edema, local pain, and fever. Seventeen days prior to presentation, he had undergone odontogenic surgical treatment in a dental clinic. Laboratory examinations did not show meaningful changes. He underwent computed tomography of the neck, thorax, and abdomen, which showed evidence of left collection affecting the retromandibular, submandibular, parapharyngeal, vascular, and mediastinal spaces, bilateral pleural effusion, right subphrenic collection and a small amount of liquids between intestinal loops. A cervical, thoracic, and abdominal surgical approach at the same surgery was indicated for odontogenic cervical abscess, descending necrotizing mediastinitis, and subphrenic abscess. The patient remained in the intensive care unit for three days, and he was discharged on the 22nd day after surgery with no drains and no tracheostomy. His outpatient discharge occurred after 6 months with no sequelae. CONCLUSIONS: Aggressive surgical treatment associated with antibiotic therapy has been shown to be effective for improving the clinical course of cervical fasciitis. Despite the extension of the infection in our patient, a surgical approach of all infectious focus associated with a broad-spectrum antibiotic therapy led to a good clinical evolution and has significant implications for aggressive treatment.
Subject(s)
Abscess/diagnosis , Fasciitis, Necrotizing/diagnosis , Mediastinitis/diagnosis , Neck , Abdomen/diagnostic imaging , Abscess/therapy , Acute Disease , Adult , Anti-Bacterial Agents/therapeutic use , Drainage , Fasciitis, Necrotizing/therapy , Humans , Laparotomy , Male , Mediastinitis/therapy , Neck/diagnostic imaging , Neck/pathology , Neck/surgery , Thoracotomy , Thorax/diagnostic imagingABSTRACT
Antecedentes: La mediastinitis necrotizante descendente es una entidad poco frecuente de alta mortalidad que se origina en procesos sépticos orofaríngeos o cervicales mal drenados. El pasaje de material infectado se realiza a través del espacio parafaríngeo, y de allí por el espacio retrovisceral hacia el mediastino posterior. Objetivos: Definir los parámetros para diagnosticar en forma temprana esta afección y lograr así instaurar rápidamente la conducta quirúrgica agresiva que nos permita disminuir la elevada tasa de mortalidad de esta severa complicación. Lugar de aplicación: Hospital nacional universitario. Diseño: Retrospectivo y descriptivo. Población: Práctica hospitalaria. Material y método: Entre 1995 y 2011 fueron tratados 12 pacientes con mediastinitis necrotizante (7 hombres y 5 mujeres). El foco fue absceso dentario en 9 y absceso amidgalino, absceso pos-fractura de maxilar y mastoiditis, en 1 caso respectivamente. Todos presentaron edema cervical, fiebre y dolor y fueron estudiados con radiología convencional y TAC cervicotorácica de inicio. El tiempo de demora entre la primera consulta y la atención en nuestro hospital fue de más de 72 hs en el 75% de los pacientes. Todos fueron operados por un doble abordaje, cervical y torácico. A 4 pacientes se les realizó abordaje torácico bilateral. Resultados: Las complicaciones fueron: distres respiratorio en 7, bronconeumonía en 3, hemorragia cervical e infección urinaria en 1. Fueron reoperados 4 paciente. La mortalidad fue del 33% (4 de 12 pacientes). Conclusión: Si bien la mediastinitis necrotizante descendente es una entidad rara, su gravedad obliga a considerarla como complicación ante todo absceso cervical no drenado. La TAC cervicotorácica en estos pacientes, sumada a una conducta terapéutica quirúrgica agresiva son las claves para un diagnostico precoz y un tratamiento efectivo.(AU)
Background: The descending necrotizing mediastinitis is a slightly frequent entity of high mortality that originates itself in septic oropharyngeal processes or poorly drained cervicals. The passage of infected material is realized across the parapharyngeal area and hence for the retrovisceral area towards the back mediastinum. Objective: To define the diagnostic parameters to recognize prematurely this affection and to select rapidly the effective surgical treatment which help us diminish the high rate of mortality of this severe complication. Setting: University Nacional Hospital. Design: Retrospective and descriptive. Population: Hospital practice. Material and method: Between 1995 and 2011, 12 patients, including seven men and five women were treated with necrotizing mediastinitis. The critical area was an abscess toothwort for 9 and tonsil abscess for 2, abscess post-fractures of maxillary and mastoiditis in 1 respectively. They all presented cervical edema, fever and pain and they were studied by conventional radiology and cervicothoracic TAC in the beginning. The time of delay between the first consult and the visit in our hospital was over 72 h. in 75% of the cases. They all were treated with double medical approach, both cervical and thoracic. On the other hand, 4 patients faced only thoracic bilateral medical approach. Results: The medical complications arised were: respiratory distress in 7, bronchopneumonia in 3, cervical hemorrhage and urinary infection in 1. 4 were re-operated. The mortality was 33% (4 out of 12 patients). Conclusion: Though the descending necrotizing mediastinitis is a rare entity, its seriuosness forces us to consider it as a critical medical issue while tackling any cervical abscess not drained. Under these circumstances the cervicothoracic TAC, along with an aggressive therapeutic surgery, is the key factor to obtain a precocious diagnosis and an effective treatment.(AU)
ABSTRACT
Antecedentes: La mediastinitis necrotizante descendente es una entidad poco frecuente de alta mortalidad que se origina en procesos sépticos orofaríngeos o cervicales mal drenados. El pasaje de material infectado se realiza a través del espacio parafaríngeo, y de allí por el espacio retrovisceral hacia el mediastino posterior.Objetivos: Definir los parámetros para diagnosticar en forma temprana esta afección y lograr así instaurar rápidamente la conducta quirúrgica agresiva que nos permita disminuir la elevada tasa de mortalidad de esta severa complicación. Lugar de aplicación: Hospital nacional universitario. Diseño: Retrospectivo y descriptivo. Población: Práctica hospitalaria. Material y método: Entre 1995 y 2011 fueron tratados 12 pacientes con mediastinitis necrotizante (7 hombres y 5 mujeres). El foco fue absceso dentario en 9 y absceso amidgalino, absceso pos-fractura de maxilar y mastoiditis, en 1 caso respectivamente. Todos presentaron edema cervical, fiebre y dolor y fueron estudiados con radiología convencional y TAC cervicotorácica de inicio. El tiempo de demora entrela primera consulta y la atención en nuestro hospital fue de más de 72 hs en el 75% de los pacientes. Todos fueron operados por un doble abordaje, cervical y torácico. A 4 pacientes se les realizó abordaje torácico bilateral.Resultados: Las complicaciones fueron: distres respiratorio en 7, bronconeumonía en 3, hemorragia cervical e infección urinaria en1. Fueron reoperados 4 paciente. La mortalidad fue del 33% (4 de 12 pacientes).Conclusión: Si bien la mediastinitis necrotizante descendente es una entidad rara, su gravedad obliga a considerarla como complicaciónante todo absceso cervical no drenado. La TAC cervicotorácica en estos pacientes, sumada a una conducta terapéutica quirúrgica agresivason las claves para un diagnostico precoz y un tratamiento efectivo.