Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions

Riekert, Maximilian; Kreppel, Matthias; Zöller, Joachim E.; Zirk, Matthias; Annecke, Thorsten; Schick, Volker

doi:10.1007/s10006-019-00770-5

Cited by 16 publications

(13 citation statements)

References 18 publications

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“…The typical signs of OI are pain, restricted mouth opening, and local swelling. In the present study, CRP levels and WBC counts at hospital admission were significantly associated with more severe infection, consistent with previous studies [21,34]. A spreading OI may cause generalised findings such as elevated levels of body temperature and increased heart rate, which also predicted further ICU treatment in the present study.…”

Section: Discussionsupporting

confidence: 92%

“…those with HIV or diabetes) are prone to acquire co-infections and more severe OIs [32,33]. Although greater body mass index (BMI) is also associated with more frequent ICU admission [34], this was not confirmed in the present study. It should be noted that only a fifth of patients in the present study population had a history of diseases that predispose to infections.…”

Section: Discussioncontrasting

confidence: 58%

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Health status in patients hospitalised for severe odontogenic infections

Furuholm

Rautaporras

Uittamo

et al. 2021

Acta Odontologica Scandinavica

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Objective: Previous findings refer to certain predisposing medical conditions that compound the risk of developing severe and potentially lethal acute odontogenic infections (OI). The objective of this study was to clarify this rationale and infection severity in general. Material and methods: Records of patients aged !18 years requiring hospital care for deep OI were retrospectively investigated. The main outcome variable was need for intensive care unit (ICU) treatment. Additional outcome variable was occurrence of infection complications and/or distant infections. Several parameters describing patients' prior health and recent dental treatment were set as independent variables. Results: Of the 303 acute OI patients included, 71 patients (23%) required treatment in the ICU, with no significant difference between previously healthy and patients with disease history. OIs originating from teeth in the mandible compared with maxilla had 7.8-fold risk (p ¼ .007) for ICU treatment in binary logistic regression analyses. Elevated levels of infection parameters at hospital admission predicted further ICU stay. Infection complications and/or distant infections occurred in 7.6% of patients, of which septicaemia and pneumonia were the most common. The mortality rate was 0.3%. Infection complications and/or distant infections occurred significantly more often in smokers (p ¼ .001) and in patients with excessive consumption of alcohol or drugs (p ¼ .025), however smoking showed 3.5folded independent risk for infection complications and/or distant infections (p ¼ .008) in logistic regression. Conclusions: Severe OIs often occur in previously healthy patients. Smokers in particular are prone to the most serious OIs.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 58%

Health status in patients hospitalised for severe odontogenic infections

Furuholm

Rautaporras

Uittamo

et al. 2021

Acta Odontologica Scandinavica

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“…A mass may be not readily visible or palpable externally, because the dense structure of the cervical fascia may hide the mass, or the location of the DNI is hidden by the neighboring organs, such as the trachea, esophagus, and vertebrae [16,39,40]. Palpation of the oral cavity, leukocytosis, C-reactive protein levels, arterial blood gas analysis, direct laryngoscopy, neck computed tomography, and neck magnetic resonance imaging are recommended in identifying the mass [24][25][26][39][40][41]. To find the collection of deep pus due to DNI, a pitting appearance, focal tenderness, or a doughy feeling are the characteristic signs by firm deep palpation.…”

Section: Discussionmentioning

confidence: 99%

“…Securing the airway in patients undergoing surgical intervention for the management of DNI is still challenging because they usually have limited mouth opening, airway distortion, tissue edema, or cervical immobility [29,52,53]. It is critical to assess the risk of a potentially difficult airway and prepare the most appropriate airway management method [41]. Video laryngoscopy and fiberoptic bronchoscopy provide a good real-time visualization of the remaining airway, thus helping in the intubation of the distorted airway of patients with DNI [54,55].…”

Section: Discussionmentioning

confidence: 99%

A dangerous cause of airway obstruction: deep neck infection

2020

Signa Vitae

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Deep neck infection (DNI) is an infection in the fascial spaces of the neck. Complications of DNI, including mediastinitis, internal jugular vein thrombosis, and upper airway obstruction, are severe and potentially life threatening. Therefore, early identification and accurate management of DNI are essential. We review the anatomy of the deep spaces of the neck to determine the route of DNI spread so that emergency doctors, physicians, and otorhinolaryngologists can quickly recognize the development of lethal complications of DNI, such as asphyxia from airway obstruction.

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“…A admissão na UTI foi significativamente associada a níveis mais elevados de proteína C reativa, contagem de leucócitos, dispneia, e maior índice de massa corporal. O manejo difícil das vias aéreas depende principalmente da limitação da abertura da boca e da PCR elevada (Riekert et al, 2019). Devido à grande frequência de infecções graves nos serviços hospitalares e o risco de complicações que podem surgir durante o manejo clínico e cirúrgico desta enfermidade (Alotaibi et al, 2015), buscou-se através deste orientar melhor os profissionais envolvidos no atendimento multidisciplinar, de forma a diminuir os riscos de complicações graves, o aumento do tempo de permanência hospitalar e a consequente diminuição dos custos do tratamento hospitalar (Kim et al, 2012a).…”

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Indicadores clínicos e laboratoriais como determinantes de um padrão na evolução das infecções orais graves - Estudo retrospectivo de 3 anos

Saizaki

Raldi

Moraes

et al. 2022

RSD

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Objetivo: Avaliar possíveis indicadores clínicos e laboratoriais que podiam determinar um padrão na evolução das infecções e orientar os profissionais a tomarem uma melhor conduta, evitando maiores complicações e maus resultados. Material e Métodos: Foram colhidos os dados de 440 pacientes, durante 3 anos no Hospital Alípio Corrêa Netto. O período de coleta de dados foi de julho 2018 a julho 2021. Foram analisados se a presença de doenças de base, o trismo, os espaços bucais e se as alterações de exames laboratoriais podiam ou não determinar um padrão no curso do tratamento das infecções. Resultados: Idade média foi 26,5 anos. Os principais sinais e sintomas foram: dor, prostração, trismo, febre, odinofagia e a dispneia. Em 65% dos casos, múltiplos espaços estavam envolvidos na infecção. A doença de base apresentou maior significância estatística. Os pacientes com doença de base precisaram ser tratados com anestesia geral devido ao maior grau de gravidade. A média de dias de internação foi de 8,1 dias para pacientes sistemicamente comprometidos contra 4,2 dos pacientes hígidos. O valor da PCR foi fortemente influenciado pela doença de base, apresentando média de 45 mg/L para pacientes comprometidos contra menos de 20 mg/L dos pacientes hígidos. Conclusão: Pacientes sistêmicos devem ser tratados com uma atenção maior, porque tendem a apresentar maiores trismo, valores da PCR, necessidade de tratamento em centro cirúrgico e tempo de internação principalmente na UTI, o que demonstra uma maior gravidade dos casos.

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Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions

Cited by 16 publications

References 18 publications

Health status in patients hospitalised for severe odontogenic infections

Health status in patients hospitalised for severe odontogenic infections

A dangerous cause of airway obstruction: deep neck infection

Indicadores clínicos e laboratoriais como determinantes de um padrão na evolução das infecções orais graves - Estudo retrospectivo de 3 anos

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