Risk factors for delayed oral dietary intake in patients with deep neck infections including descending necrotizing mediastinitis

Abstract

Although clinical outcomes of descending necrotizing mediastinitis (DNM) and/or deep neck infection (DNI) have been extensively reported, no study has addressed delay in recovering oral ingestion after surgical interventions other than sporadic case reports. We herein compared clinical features of DNM and DNI cases over the same period, and clarified precipitating factors of delay in recovering oral ingestion by logistic regression analysis. We reviewed records of patients with DNI and DNM at our institution from August 2005 to July 2015. We extracted data on patient age, sex, complication with diabetes mellitus, gas gangrene, extension of infections, operative procedure, tracheotomy, bacterial results, and duration of empirical antibiotic therapy. Patients were categorized into three groups according to vertical spread of infection: 60 DNI patients without extension below the hyoid bone (group-A), 48 DNI patients with extension below the hyoid bone without DNM (group-B), and 10 DNM patients (group-C). Age, diabetes mellitus, and gas gangrene were significantly different among the groups. Concerning surgical intervention, tracheotomy was significantly less frequently performed in group-A (25%) than the other groups (74%) (p < 0.001). Logistic regression analyses revealed that extension of infections below the hyoid bone and tracheotomy were significantly associated with delayed oral dietary intake [odds ratios (95% confidence intervals) 2.96 (1.06-8.28) and 10.69 (3.59-31.88), respectively]. Along with DNM patients, patients who undergo tracheotomy for infections that extend below the hyoid bone should receive postoperative care with careful attention to avoid delay in recovering oral ingestion.

Identification of risk factors for mortality and delayed oral dietary intake in patients with open drainage due to deep neck infections: Nationwide study using a Japanese inpatient database

“…The primary outcome was survival at discharge. Regarding the subgroup analysis focusing on patients who were alive at discharge, the secondary outcome was the interval between admission and presumed full recovery of oral intake without nutrition from tube feeding or intravenous hydration, according to our previous retrospective, cohort study (11).…”

“…Although the aetiology and clinical outcomes of treating DNI and/or DNM have been extensively reported, no study, other than a few sporadic case reports published in the Japanese language, has addressed dysphagia after surgical treatment (8)(9)(10). We thus recently reported a logistic regression analysis addressing risk factors related to swallowing recovery after surgical intervention for DNI in a retrospective cohort of 123 patients (11). However, these studies have several limitations attributed to their relatively small sample size from a single medical centre.…”

Necrotizing Mediastinitis Following Rabbit Bone Ingestion: A Case Report

“…Based on previous studies, a large number of patients with DNM are at high risk due to underlying diseases such as diabetes, malnutrition, aging, kidney failure, liver cirrhosis, and underlying malignancies (16). Gender variables are also involved, with DNM mortality being higher in men than in women (2).…”

Successful Treatment with the Chin-down Maneuver of Dysphagia Secondary to Descending Necrotizing Mediastinitis: A Case Study

“…Such dysphagia is thought to be caused by movement disorder of the hypopharyngeal muscle and hyoid/thyroid cartilage that develops as a result of fibrosis and scarring caused by the inflammatory changes in the fascial space. 3 , 4 ) However, the mechanism remains a matter of speculation. There are very few reports on rehabilitation for this condition, 5 ) probably because of the absence of detailed swallowing evaluations.…”