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

Cambria, Francesca; Fusconi, Massimo; Candelori, Francesca; Galli, Massimo; Stanganelli, Francesca R. Federici; Venuta, Federico; Valentini, Valentino; Vincentiis, Marco de

doi:10.14639/0392-100x-suppl.1-41-2021-14

Cited by 9 publications

(8 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When antibiotics fail, abscess collection is more than 3 cm and extends to the deep neck spaces, and/or the patient presents complications such as airway impairment, sepsis, or descending infection, DNI surgical incision, and drainage is requested. The purpose of the surgical approach is to remove the triggering cause, drain the purulent collection, and save airway patency [25]. In the patients we described, surgery consisted of an extended unilateral or bilateral cervicotomy based on the degree of spread of the infection.…”

Section: Discussionmentioning

confidence: 99%

Management of Deep Neck Space Infections: A Large Tertiary Center Experience

Loperfido¹,

Stasolla²,

Giorgione³

et al. 2023

Cureus

View full text Add to dashboard Cite

Introduction: Deep neck space infections (DNIs) represent serious bacterial infections affecting the deep cervical space and fascial planes of the neck. This study aims to describe our clinical and surgical experience in the management of DNIs, emphasizing the importance of appropriate imaging in the diagnostic setting and the role of the multidisciplinary approach according to the severity of the infection.Methods: In this retrospective study, we describe 85 patients affected by DNIs coming to the Otolaryngology department observation from the Emergency Room of San Camillo Forlanini Hospital in Rome from January 2006 to December 2021 and treated both by pharmacological and surgical therapy.Results: 54 patients (64%) were male, and 31 (36%) were female, with a mean age of 50.5 years. The most common cause of DNI was odontogenic, accounting for 70% of all collected cases. In 68 patients (80% of all cases), the surgical approach consisted of an extended unilateral cervicotomy, whereas in 17 patients (20% of all cases), a bilateral cervicotomy was performed. Surgical revision was required in 15 cases (18%). A tracheostomy was necessary in seven cases. The overall survival rate was 96.5%.Conclusions: DNI represents a serious and life-threatening condition, remaining a constant challenge for the head and neck surgeon. Contrast-enhanced computed tomography is critical for therapeutic planning, which requires both a surgical approach and antibiotic therapy. Surgical treatment should be performed as soon as possible. In severe cases, the multidisciplinary approach is advisable.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of Deep Neck Space Infections: A Large Tertiary Center Experience

Loperfido¹,

Stasolla²,

Giorgione³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Coexisting medical conditions can also increase the risk of severe infection or sepsis. Most studies recommend the immediate surgical drainage of abscesses combined with the intravenous administration of antibiotics in odontogenic or deep neck infections; however, the optimal timing of surgery is still under debate [ 2 , 7 , 34 , 35 ]. All patients in this cohort were operated on within the first day of admission.…”

Section: Discussionmentioning

confidence: 99%

“…Odontogenic infections are caused by untreated dental caries, periodontal disease, or trauma and are a common reason for seeking medical care in oral and maxillofacial surgery units [ 1 , 2 , 3 ]. Data from developed countries suggest that the rate and severity of odontogenic infections in patients who present to hospital emergency departments are increasing [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, a multidisciplinary approach involving oral and maxillofacial surgeons, anesthesiologists, and emergency medicine physicians is essential for a successful outcome. Although the clinical presentation and treatment outcomes of odontogenic infections have been well reported, the airway management of patients with extended infections originating in the mandible has not been well studied [ 1 , 2 , 4 , 16 ]. Since exploration and advancement in personalized medicine is a rapidly growing domain nowadays, distinguishing the airway management of an individual with mandible-related orofacial infection from others with similar clinical presentations can improve diagnosis, reduce complications, and develop outcomes [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Airway Management of Orofacial Infections Originating in the Mandible

Sakkas

Weiß

Zink

et al. 2023

JPM

View full text Add to dashboard Cite

The primary aim of this study was to assess the incidence of a difficult airway and emergency tracheostomy in patients with orofacial infections originating in the mandible, and a secondary aim was to determine the potential predictors of difficult intubation. This retrospective single-center study included all patients who were referred between 2015 and 2022 with an orofacial infection originating in the mandible and who were surgically drained under intubation anesthesia. The incidence of a difficult airway regarding ventilation, laryngoscopy, and intubation was analyzed descriptively. Associations between potential influencing factors and difficult intubation were examined via multivariable analysis. A total of 361 patients (mean age: 47.7 years) were included in the analysis. A difficult airway was present in 121/361 (33.5%) patients. Difficult intubation was most common in patients with infections of the massetericomandibular space (42.6%), followed by infections of the mouth floor (40%) and pterygomandibular space (23.5%). Dyspnea and stridor were not associated with the localization of infection (p = 0.6486/p = 0.4418). Multivariable analysis revealed increased age, restricted mouth opening, higher Mallampati scores, and higher Cormack–Lehane classification grades as significant predictors of difficult intubation. Higher BMI, dysphagia, dyspnea, stridor and a non-palpable mandibular rim did not influence the airway management. Patients with a difficult airway were more likely to be admitted to the ICU after surgery than patients with regular airway were (p = 0.0001). To conclude, the incidence of a difficult airway was high in patients with orofacial infections originating in the mandible. Older age, limited mouth opening, a higher Mallampati score, and a higher Cormack–Lehane grade were reliable predictors of difficult intubation.

show abstract

“…Odontogenic abscesses often derive from dental plaque, caries and pulp necrosis, and in 90% of cases, the inferior molars are the focus of the infection [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Excision of Unusual Sacked Neck and Mediastinum Abscess of Odontogenic Origin

Colizza

Ciofalo

et al. 2022

Antibiotics

Self Cite

View full text Add to dashboard Cite

The most common cause of neck infections is odontogenic abscesses that can often be life-threatening and require a surgical drain associated with antibiotic therapy. We present a case of the surgical management of an odontogenic sack-shaped and walled abscess arising from elements 3.6, 3.7 and 3.8 that reached the laterocervical spaces and anterior mediastinum in a 28-year-old healthy woman. Typical signs and symptoms of cervical complications of dental origin are fever, a neck mass, lymphadenopathy, trismus and odynophagia. The gold standard treatment in these situations is a multidisciplinary approach involving an oral surgeon, ENT specialist and thoracic surgeon to drain the infected material. To the best of our knowledge, this is the first described case report of a dental abscess enclosed in a sack in the deep space of the neck and in the anterior space of the mediastinum.

show abstract

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

Cited by 9 publications

References 36 publications

Management of Deep Neck Space Infections: A Large Tertiary Center Experience

Management of Deep Neck Space Infections: A Large Tertiary Center Experience

Airway Management of Orofacial Infections Originating in the Mandible

Surgical Excision of Unusual Sacked Neck and Mediastinum Abscess of Odontogenic Origin

Contact Info

Product

Resources

About