Tonsillitis, descending necrotizing mediastinitis, and a different neck drainage

Mihos, Petros; Gakidis, Ioannis; Potaris, Konstantinos; Stathopoulou, Sotiria

doi:10.1016/j.amjoto.2005.11.012

Cited by 3 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even with the use of CT scanning, aggressive drainage, and modern antibiotic treatment, the mortality rate of DNM remains high. Surgical management, and particularly the optimal form of mediastinal drainage, remains controversial with support ranging from cervical drainage alone, to cervical drainage and routine thoracotomy [3]. We report our experience with four patients affected by DNM, in the period of lockdown in Greece because of the pandemic of coronavirus and stress the importance of early and large surgical mediastinal drainage.…”

Section: Introductionmentioning

confidence: 97%

Descending Necrotizing Mediastinitis in Covid- 19 Time

Thrasyvoulos¹,

Stamatelopoulos²,

Anastasia³

et al. 2020

SCR

View full text Add to dashboard Cite

Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental- odontogenic infections. The aim of this study is to evaluate clinical and surgical feature of the patients with DNM who were managed in our Department during the period of general lockdown in Greece, between March 2020 and June 2020, because of the Covid19. Patients and Methods: During the period of general lockdown in Greece, 4 patients, mean age 46, 25 years (range 39-59), with DNM treated to our Department of General Thoracic Surgery. Primary odontogenic abscess occurred to 2 patients and peritonsillar abscess to other 2 of them. Diagnosis was confirmed by computed tomography (CT) of the neck and chest. All patients underwent surgical drainage of abscesses of the involved cervical region and mediastinum by lateral cervicotomy and left thoracotomy in three of them and cervicotomy, and bilateral thoracotomy in one patient. Results: The delay between the occurrence of thoracic symptoms and mediastinal drainage varied from 1 to 3 days. The side of the thoracotomy depended on the involved mediastinal compartments and side of pleural effusion. The duration of mediastinal drainage varied from 12 to 20 days (mean: 17 days). One patient died of multiorgan failure related to post-op septic shock. Conclusion: Between January 2000 and January 2020, 21 patients with DNM were treated at our Department, whilst during the four - month of lockdown, four patients were treated. We concluded that the patients delay for dentistry recourse because of covid-19, result in the increased number of patients with DNM in the above period. Delayed diagnosis and inadequate drainage are the main causes of the high mortality rate of DNM. If one realistically hopes to avoid the high mortality rate, aggressive surgical drainage and debridement of the neck and drainage of the mediastinum via a posterolateral thoracotomy by a multidisciplinary team of surgeons is a must.

show abstract

Section: Introductionmentioning

confidence: 97%

Descending Necrotizing Mediastinitis in Covid- 19 Time

Thrasyvoulos¹,

Stamatelopoulos²,

Anastasia³

et al. 2020

SCR

View full text Add to dashboard Cite

show abstract

“…Complications of odontogenic infections include descending mediastinitis, septic shock, upper airway obstruction, jugular vein thrombosis, venous septic embolus, carotid artery pseudoaneurysm or rupture, pleural empyema, pericarditis and disseminated intravascular coagulopathy (Paul et al, 2010, Karkos et al, 2007, Flynn et al, 2006a). These conditions are life threatening and increase the mortality rate to about 50% especially in cases of descending mediastinitis (Mihos et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Assessment of predictors of treatment outcome among patients with bacterial odontogenic infection

Adamson

Gbotolorun

Odeniyi

et al. 2018

The Saudi Dental Journal

View full text Add to dashboard Cite

Complications of peritonsillar abscess

Klug

Greve

Hentze

2020

Ann Clin Microbiol Antimicrob

View full text Add to dashboard Cite

Background The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. Methods Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. Results Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). Conclusion Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum , the current findings suggest that viridans group streptococci, S. aureus , Prevotella , and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.

show abstract

Tonsillitis, descending necrotizing mediastinitis, and a different neck drainage

Cited by 3 publications

References 8 publications

Descending Necrotizing Mediastinitis in Covid- 19 Time

Descending Necrotizing Mediastinitis in Covid- 19 Time

Assessment of predictors of treatment outcome among patients with bacterial odontogenic infection

Complications of peritonsillar abscess

Contact Info

Product

Resources

About