Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine

Abstract

To present five patients with DNM, who were treated during the first quarantine for Coronavirus disease 2019 (Covid-19). Five patients with DNM were treated in our department during the first lockdown. The mean age of the patients was 42,2 years and four were male. Two patients were immunocompromised. Repeated surgical drainage was performed in all patients, whereas four were also subjected to elective tracheostomy during their first operation. The mean hospitalization duration was 55,4 days and mortality was 40%. During the first lockdown for the Covid-19, a rise in the ratio of DNM cases to the overall incidence of cervicofacial infections was observed in our department. All patients with DNM were operated on an emergency basis and were subsequently admitted to the ICU. We consider the effect of the quarantine as a decisive factor for this escalation, because according to the department archives, there had not been any cases of DNM originating from a dental infection, for the past 5 years. Additionally, past studies from the same department reported no more than 6 cases over a 10 year period.

The Effect of the COVID-19 Pandemic on Odontogenic Cervicofacial Infections in a Single Center in Greece

“…This may cause a serious complication if the pus finds its way through the thoracic cavity via the prevertebral or "danger space", the large neck vessels (internal jugular vein-IJV, carotid artery), or the subdermal. This constitutes an urgent situation requiring immediate thoracotomy and drainage [8]. Other major complications are cardiopulmonary ones, as well as Lemierre's syndrome describing the thrombophlebitis of the IJV which can also cause metastatic emboli to other organs and the lungs [2,3,[7][8][9][10]15,[18][19][20].…”

“…This constitutes an urgent situation requiring immediate thoracotomy and drainage [8]. Other major complications are cardiopulmonary ones, as well as Lemierre's syndrome describing the thrombophlebitis of the IJV which can also cause metastatic emboli to other organs and the lungs [2,3,[7][8][9][10]15,[18][19][20].…”

The COVID-19 pandemic and its possible impact on the treatment of odontogenic and intraoral abscesses

“…A similar trend was observed by Parara et al in Athens, who reported a significant increase in descending necrotizing mediastinitis. The focus of the healthcare system on COVID-19 was also mentioned as a possible reason, with patients staying away from hospitals for fear of COVID-19 [ 19 ]. Yakubov et al argued that the limited dental service available and the focus on emergencies only in the early period of COVID-19 might have discouraged patients from coming to the clinic, resulting in more severe cases requiring treatment [ 32 ].…”

Recommendations for a safe restart of elective aerosol-generating oral surgery procedures following the COVID-19 pandemic outbreak: An Italian multicenter study

“…In Europe, although studies focusing on the reduction of surgical activities and on triage protocols have been published ( Allevi et al, 2020 ; Salzano et al, 2020 ; Barca et al, 2020 ; Zimmermann and Nkenke, 2020 ; Parara et al, 2021 ; Robiony et al, 2020 ), no study has had the objective of identifying guidelines that affect all aspects of maxillofacial surgical practice. This is reflected in the fact that, to date, no Italian maxillofacial or odontoiatric organization has issued official guidelines, with the decision on which practices should be implemented being left to the individual centers.…”