Hyperbaric Oxygen Treatment in Three Cases of Necrotizing Infection of the Neck

Abstract

Necrotizing infections of the head and neck are rare conditions in our hospital. Clinical and microbiological characteristics of three consecutive cases treated in Haukeland University Hospital in western Norway in the year 2010 are described. Two cases of Lemierre's syndrome and one case with a descending necrotizing mediastinitis (DNM) were diagnosed. All three cases were treated with broad spectrum antibiotics and in two cases surgery was possible. Hyperbaric oxygen treatment (HBOT) with intensive care facilities became recently available at our hospital, and this treatment was used in all these patients regardless of surgery. In one case we describe the use of HBOT on the basis of strong clinical suspicion of anaerobic infection only. Bacterial identification by partial sequencing of the 16SrDNA gene proved to be a useful supplement to conventional culture techniques. All the cases all demonstrated a significant clinical improvement after introduction of HBOT. When HBOT is available, it should be considered as adjunctive treatment in extensive infections with anaerobes.

Efficacity of hyperbaric oxygen therapy for necrotizing fasciitis in the maxillofacial region: The review of the literature

“…In 2012, Nedrebø et al 11 presented three case reports (a 67-year old man, a 53-year man and a woman aged 22) with NF that were treated by a broad spectrum of antibiotics and surgery, followed by HBO therapy at 3 ATM for 90 min sequences. Mixed anaerobes bacteria were identified from the wound.…”

“…Microbiological cultures typically revealed aerobic microbes, although some studies identified both aerobic and anaerobic organisms. [3][4][5][6][10][11][12] Common comorbidities included diabetes, alcohol abuse, cardiovascular disorders, malignancies and obesity. Treatment approaches generally involved a combination of antibiotic therapy, surgical debridement, and, in select cases, adjunctive HBO therapy and immunoglobulin administration.…”

“…Among the reviewed articles, 6 were retrospective studies 1–6 and 10 were case reports 7–16 . The primary objective of retrospective studies was to evaluate the efficacy of HBO therapy in managing NF in the maxillofacial region.…”

“…• Among the reviewed articles, 6 were retrospective studies [1][2][3][4][5][6] and 10 were case reports. [7][8][9][10][11][12][13][14][15][16] The adjunctive use of HBO therapy is widely recommended for patients with NF, yet the absence of randomized controlled trials hampers the assessment of its benefits, specifically in the management of cervical NF. • Certain studies have suggested a detrimental effect on survival, leading to ambiguity regarding its impact.…”

A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities

“…An early and combined HBOT therapy plus current practices may be crucial as a lifesaving and cost-efficacy therapy, particularly in the most critical patients [ 73 ]. Clinical practice agrees on the necessity of HBOT in the event of an anaerobic infection, as anaerobic bacteria are killed by a much higher amount of pressurized O 2 [ 74 , 75 ]. For instance, the use of HBOT in the anaerobic Clostridium perfringens bacteria is specially recommended [ 76 ].…”