Evaluation of clinical parameters affecting the prognosis in surgically treated patients with descending necrotizing mediastinitis – A retrospective study

Brajković, Denis; Zjalić, Severina; Kiralj, Aleksandar

doi:10.1016/j.jormas.2022.05.017

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…Many authors related the involvement of multiple facial spaces with a higher rate of severity of the infectious process 15,[20][21][22][23] . In the present study, the presence or absence of infection in deeper facial spaces was correlated with the need for hospital admission.…”

Section: Discussionmentioning

confidence: 99%

Maxillofacial infections of dental origin

Fornari,

Souza,

Dallepiane

et al. 2024

Braz.j. of oral sci.

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Aim: to evaluate the occurrence of maxillofacial infection cases, which were treated at local hospital, identifying the main risk factors that determine the need for hospitalization of patients and the factors associated with staying length. Methods: A retrospective review of 191 records of patients with maxillofacial infection of odontogenic origin was performed, statistically evaluated by frequency and percentage of involvement, p values (based on the chi-square test) and odds ratio with a 95% confidence interval. A p-value <0.05 was considered statistically significant. Results: Among all the 191 patients, 31 had some harmful habits, such as smokers (13%) and alcoholics (1%). In addition, 39 patients reported some general health problem, such as systemic arterial hypertension (8.3%), depression (6.8%), diabetes (3.6%) and some immunosuppression (1.57%). Involvement of infection in deep facial spaces was present, with 119 patients presenting a deeper infection (62.3%) and 72 patients a superficial infection (37.7%). The most prevalent clinical signs and symptoms in the initial evaluation were pain (91.1%) and edema (90.1%), followed by erythema/hyperemia (44.5%), trismus (37.7%), abscess (30.9%), cellulitis (27.7%), f istula (16.8%), fever (16.8%), dysphagia (11%), dehydration (9.9%), odynophagia (7.9% ) and dyspnea (3.7%). Pulp necrosis was considered a risk factor for treatment in a hospital environment (0.032) and root canal treatment decreases the risk of hospitalization (p=0.002). Considering the evaluated patients, 146 (76.4%) were admitted and 45 (37.7%) were not admitted for hospitalization after initial clinical evaluation. Conclusion: there is a high occurrence of maxillofacial infection cases of dental origin, considering that involvement of infection in deeper facial spaces, as well as presence of pain, edema, erythema/hyperemia, trismus, abscess, cellulitis and pulp necrosis, represent the main risk factors for hospitalization and staying length.

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Section: Discussionmentioning

confidence: 99%

Maxillofacial infections of dental origin

Fornari,

Souza,

Dallepiane

et al. 2024

Braz.j. of oral sci.

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“…This infectious illness most often occurs in middle-aged males, especially those with damaged immune function as well as nutritional insufficiency. Descending mediastinitis has a serious course, with the possibility of sepsis and septic shock, multiple organ failure, and even a high mortality rate [43]. A head and neck as well as a thoracic CT scan are the standard imaging tools to diagnose the disorder [44].…”

Section: Discussionmentioning

confidence: 99%

“…WBC count and CRP level are indicators of inflammation; patients with higher inflammatory markers have a higher possibility of infection progression. Some authors even found that increased CRP levels were a negative factor for the survival of patients with surgical treatment for descending mediastinitis in the postoperative period [43]. DM is reported to be an essential factor in determining the prognosis of patients with descending mediastinitis [7].…”

Section: Discussionmentioning

confidence: 99%

A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results

Chen,

Chin,

Chan

et al. 2023

Diagnostics

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Background: Deep neck infection (DNI) is a serious infectious disease, and descending mediastinitis is a fatal infection of the mediastinum. However, no study has applied artificial intelligence to assess progression to descending mediastinitis in DNI patients. Thus, we developed a model to assess the possible progression of DNI to descending mediastinitis. Methods: Between August 2017 and December 2022, 380 patients with DNI were enrolled; 75% of patients (n = 285) were assigned to the training group for validation, whereas the remaining 25% (n = 95) were assigned to the test group to determine the accuracy. The patients’ clinical and computed tomography (CT) parameters were analyzed via the k-nearest neighbor method. The predicted and actual progression of DNI patients to descending mediastinitis were compared. Results: In the training and test groups, there was no statistical significance (all p > 0.05) noted at clinical variables (age, gender, chief complaint period, white blood cells, C-reactive protein, diabetes mellitus, and blood sugar), deep neck space (parapharyngeal, submandibular, retropharyngeal, and multiple spaces involved, ≥3), tracheostomy performance, imaging parameters (maximum diameter of abscess and nearest distance from abscess to level of sternum notch), or progression to mediastinitis. The model had a predictive accuracy of 82.11% (78/95 patients), with sensitivity and specificity of 41.67% and 87.95%, respectively. Conclusions: Our model can assess the progression of DNI to descending mediastinitis depending on clinical and imaging parameters. It can be used to identify DNI patients who will benefit from prompt treatment.

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Assessment of the Elderly Adult Patients with Deep Neck Infection: A Retrospective Study

Hsiao

Chan

et al. 2023

Ear Nose Throat J

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Background: Deep neck infection (DNI) is a potentially lethal infectious disease affecting middle-aged adults and can compromise the airway. There are limited data on the prognosis and outcomes of elderly (aged > 65 years) DNI patients, who tend to be immunocompromised. This study analyzed the clinical characteristics of elderly and adult (aged 18-65 years) DNI patients. Methods: Between November 2016 and November 2022, 398 patients with DNIs, including 113 elderly patients, were admitted to our hospital and enrolled in this study. The relevant clinical variables were investigated and compared. Results: The elderly DNI patients had longer hospital stays ( P < .001), higher C-reactive protein levels ( P = .021), higher blood sugar levels ( P = .012), and a higher likelihood of diabetes mellitus ( P = .025) than the adult patients. The higher blood sugar level is an independent risk factor for elderly (odds ratio = 1.005, 95% confidence intervals 1.002-1.008, P < .001). Moreover, the rates of intubation to protect the airway ( P = .005) and surgical incision and drainage (I&D; P = .010) were higher in the elderly group. However, there were no group differences in pathogen distributions. Conclusion: The elderly DNI patients in this study had a more severe disease course, and poorer prognosis than the adult patients, as well as higher rates of intubation and I&D. However, the pathogen distributions did not differ significantly between the groups. Prompt intervention and treatment are important for elderly DNI patients.

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Evaluation of clinical parameters affecting the prognosis in surgically treated patients with descending necrotizing mediastinitis – A retrospective study

Cited by 3 publications

References 25 publications

Maxillofacial infections of dental origin

Maxillofacial infections of dental origin

A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results

Assessment of the Elderly Adult Patients with Deep Neck Infection: A Retrospective Study

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