How to avoid life-threatening complications following head and neck space infections: an algorithm-based approach to apply during times of emergency. When and why to hospitalise a neck infection patient

Gallo, Oreste; Mannelli, Giuditta; Lazio, Maria Silvia; Santoro, Roberto

doi:10.1017/s0022215117002201

Cited by 12 publications

(5 citation statements)

References 26 publications

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“…In the case of severe facial infections, patients often have a prolonged course in hospital, requiring intravenous therapy with the potential for significant surgical interventions. 11 The gravity of SSI sequelae may be responsible for increased prophylaxis durations. When we compared concordance between contaminated and noncontaminated CFHN procedures, there was a statistically significant difference in concordance with EBG (P ¼ .002).…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence

et al. 2021

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Background: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis. Methods: A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use. Results: Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use. Conclusion: Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.

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Section: Discussionmentioning

confidence: 99%

Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence

et al. 2021

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“…Huang et al[5] reported that older age and underlying systemic disease can increase the risk of multi-space infections. Gallo et al[9] reported that algorithm-based management of head and neck space infections was successful in avoiding the onset LTCs. To identify the deep neck infection factors related to LTCs, Mejzlik et al[10] conducted a multi-institutional study involving 586 patients.…”

Section: Discussionmentioning

confidence: 99%

Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report

Dai¹,

Ran²,

Qiu³

et al. 2019

WJCC

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BACKGROUNDOdontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions. Clinically, if early odontogenic infections such as acute periapical periodontitis, alveolar abscess, and pericoronitis of wisdom teeth are not treated timely, effectively and correctly, the infected tissue may spread up to the skull and brain, down to the thoracic cavity, abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck. Severe multi-space infections are formed and can eventually lead to life-threatening complications (LTCs), such as intracranial infection, pleural effusion, empyema, sepsis and even death.CASE SUMMARYWe report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions. One week before admission, due to pain in the right lower posterior teeth, the patient placed a cigarette butt dipped in the pesticide "Miehailin" into the "dental cavity" to relieve the pain. Within a week, the infection gradually spread bilaterally to the floor of the mouth, submandibular space, neck, chest, waist, back, temporal and other areas. The patient had difficulty breathing, swallowing and eating, and was transferred to our hospital as an emergency admission. Following admission, oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology, thoracic surgery, general surgery, hematology, anesthesia and the intensive care unit to assist with treatment. The patient was treated with the highest level of antibiotics (vancomycin) and extensive abscess incision and drainage in the oral, maxillofacial, head and neck, chest and back regions. Unfortunately, the patient died of septic shock and multiple organ failure on the third day after admission.CONCLUSIONOdontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions, which can result in multiple LTCs. The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.

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“…The carotid sleeve is mobilized medially, so it is possible to reach the deep cervical fascia and if necessary, the prevertebral fascia. In selected cases, with single-chamber and circumscribed abscess cavities, endopharyngeal access to the abscess is possible [26][27][28][29][30][31] . After the abscess has been drained, the drains are placed 32,33 .…”

Section: Multidisciplinary Management Of Deep Neck Infectionsmentioning

confidence: 99%

Surgical multidisciplinary approach in the management of odontogenic or non-odontogenic neck infections

Cambria

Fusconi

Candelori

et al. 2021

Acta Otorhinolaryngol Ital

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In recent years, in our university hospital, the number of odontogenic and non-odontogenic abscesses has been rapidly increasing. We included 70 patients from January 4 th 2018 to February 19 th 2020 affected by the odontogenic ones. Deep neck infection can spread to the chest and is associated with high morbidity and mortality. The purpose of this mini-review is to demonstrate that, in case of complications, a multidisciplinary approach is needed to treat these infections, so that all practitioners should work together to achieve the patient's rapid recovery.

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How to avoid life-threatening complications following head and neck space infections: an algorithm-based approach to apply during times of emergency. When and why to hospitalise a neck infection patient

Cited by 12 publications

References 26 publications

Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence

Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence

Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report

Surgical multidisciplinary approach in the management of odontogenic or non-odontogenic neck infections

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