Objective:To review the clinical findings in deep neck infections and identification predisposing factors of these complications. Methods:In this study, 270 patients with deep neck infections were studied retrospectiv...Objective:To review the clinical findings in deep neck infections and identification predisposing factors of these complications. Methods:In this study, 270 patients with deep neck infections were studied retrospectively, study conducted in the Department of Ear, Nose and Throat, Dr. Shankarrao Chavan Govern-ment Medical College, Nanded, Maharashtra, India, from March 2013 to March 2016. Results:Analysis showed that males are most likely to have deep neck space infections (DNSI). Odontogenic and tonsillar causes were the more frequent ones. Staphylococcus aureus and Streptococcus species were the microorganisms more commonly isolated. Conclusion:DNSI remains a common and challenging disease for otorhinolaryngologists, and should be treated on emergency basis. In developing countries, lack of adequate nutrition, poor oral hygiene, tobacco chewing, smoking and beetle nut chewing has led to an increased prevalence of dental and periodontal diseases. In present study, Odontogenic infections were the most common etiological factor for DNSI.展开更多
Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports avail...Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography(CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.展开更多
Objectives:To compare the effectiveness of vacuum-assisted closure(VAC)against traditional drainage technique,using a retrospective case-control study design,in terms of managing deep neck infections(DNIs).Methods:Pat...Objectives:To compare the effectiveness of vacuum-assisted closure(VAC)against traditional drainage technique,using a retrospective case-control study design,in terms of managing deep neck infections(DNIs).Methods:Patients presenting to Peking Union Medical College Hospital diagnosed with DNIs were recruited in this study.We analyzed the clinical characteristics of DNI patients and divided them into(a)VAC placement group(26 cases)and(b)traditional drainage group(57 cases)according to whether VAC was placed.The differences in length of stay(LOS),wound healing time,and debridement frequency were compared between the two groups.Results:Eighty-three patients had multiple-space infections,i.e.infection at two or more sites.The debridement frequency of the VAC group was significantly lower than that of the traditional drainage group(p=0.001).The wound healing time of the traditional drainage group and VAC group was 38 days(a range of 13-98 days)and 40 days(a range of 11-106 days),respectively;the average LOS was 15 days(a range of 2-68 days)and 16 days(a range of 4-35 days),respectively;and the debridement frequencies were one time(a range of 0-3 times)and zero times(a range of 0-2 times),respectively.The two groups did not differ significantly in wound healing time and hospitalization duration(p=0.319 and 0.937).Conclusions:VAC treatment of DNIs has significant advantages in reducing the frequency of debridement and patient suffering,but it does not show significant advantages in wound healing.Randomized trials are still needed to demonstrate its efficacy.展开更多
BACKGROUND Kawasaki disease(KD),also known as mucocutaneous lymph node syndrome,is an acute,self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious card...BACKGROUND Kawasaki disease(KD),also known as mucocutaneous lymph node syndrome,is an acute,self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications,with a 25%incidence of coronary artery aneurysms.Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.CASE SUMMARY A 5-year-old boy who presented to a community hospital with a 3-d fever,difficulty in opening his mouth,and neck pain and was originally treated for throat infection without improvement.On the basis of laboratory tests,ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck,the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy.On the fifth day of admission,the child developed conjunctival congestion,prune tongue,perianal congestion and desquamation,and slightly stiff and swollen bunions on both feet.A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.CONCLUSION Children with neck pain,lymph node enlargement,or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics.Clinicians should not rush invasive operations such as neck puncture,incision,and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.展开更多
目的分析颈深部间隙感染(deep neck space infections,DNSI)的临床特点,探讨DNSI高危因素。方法回顾性分析2004-01至2017-03广西医科大学第一附属医院耳鼻咽喉头颈外科收治的125例DNSI患者的临床资料,对临床表现、感染间隙、病因、细菌...目的分析颈深部间隙感染(deep neck space infections,DNSI)的临床特点,探讨DNSI高危因素。方法回顾性分析2004-01至2017-03广西医科大学第一附属医院耳鼻咽喉头颈外科收治的125例DNSI患者的临床资料,对临床表现、感染间隙、病因、细菌学、高危并发症、治疗方式等进行分析。并对引发患者高危并发症的气道阻塞、肺炎、纵隔炎/脓肿、败血症等相关危险因素进行统计分析。结果125例中发生高危并发症39例(31.2%);发生高危并发症主要因素为:呼吸困难24例(61.5%),肺炎16例(41.0%),纵隔炎或脓肿11例(28.2%),电解质紊乱5例(12.8%),感染性休克3例(7.6),脓毒血症2例(5.0%)。其余86例无高危并发症。多因素Logistic回归分析显示,伴有糖尿病、累及多间隙感染、全身炎性反应综合征(systemic inflammatory response syndrome,SIRS)是DNSI伴发高危并发症的危险因素。结论合并糖尿病、累及多间隙、伴有SIRS是导致DNSI高危并发症的危险因素。临床医师应高度重视,并预防和积极处理高危并发症,提高治愈率和降低病死率。展开更多
文摘Objective:To review the clinical findings in deep neck infections and identification predisposing factors of these complications. Methods:In this study, 270 patients with deep neck infections were studied retrospectively, study conducted in the Department of Ear, Nose and Throat, Dr. Shankarrao Chavan Govern-ment Medical College, Nanded, Maharashtra, India, from March 2013 to March 2016. Results:Analysis showed that males are most likely to have deep neck space infections (DNSI). Odontogenic and tonsillar causes were the more frequent ones. Staphylococcus aureus and Streptococcus species were the microorganisms more commonly isolated. Conclusion:DNSI remains a common and challenging disease for otorhinolaryngologists, and should be treated on emergency basis. In developing countries, lack of adequate nutrition, poor oral hygiene, tobacco chewing, smoking and beetle nut chewing has led to an increased prevalence of dental and periodontal diseases. In present study, Odontogenic infections were the most common etiological factor for DNSI.
文摘Silver nitrate is sometimes used as a means of chemicalcauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography(CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.
基金Natural Science Foundation of Beijing Municipality(Grant/Award Number:7192171)Peking Union Medical Foundation,Pumch Healthcare Quality and Safety Incubation Program(Grant/Award Number:XHZJ2411)。
文摘Objectives:To compare the effectiveness of vacuum-assisted closure(VAC)against traditional drainage technique,using a retrospective case-control study design,in terms of managing deep neck infections(DNIs).Methods:Patients presenting to Peking Union Medical College Hospital diagnosed with DNIs were recruited in this study.We analyzed the clinical characteristics of DNI patients and divided them into(a)VAC placement group(26 cases)and(b)traditional drainage group(57 cases)according to whether VAC was placed.The differences in length of stay(LOS),wound healing time,and debridement frequency were compared between the two groups.Results:Eighty-three patients had multiple-space infections,i.e.infection at two or more sites.The debridement frequency of the VAC group was significantly lower than that of the traditional drainage group(p=0.001).The wound healing time of the traditional drainage group and VAC group was 38 days(a range of 13-98 days)and 40 days(a range of 11-106 days),respectively;the average LOS was 15 days(a range of 2-68 days)and 16 days(a range of 4-35 days),respectively;and the debridement frequencies were one time(a range of 0-3 times)and zero times(a range of 0-2 times),respectively.The two groups did not differ significantly in wound healing time and hospitalization duration(p=0.319 and 0.937).Conclusions:VAC treatment of DNIs has significant advantages in reducing the frequency of debridement and patient suffering,but it does not show significant advantages in wound healing.Randomized trials are still needed to demonstrate its efficacy.
文摘BACKGROUND Kawasaki disease(KD),also known as mucocutaneous lymph node syndrome,is an acute,self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications,with a 25%incidence of coronary artery aneurysms.Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.CASE SUMMARY A 5-year-old boy who presented to a community hospital with a 3-d fever,difficulty in opening his mouth,and neck pain and was originally treated for throat infection without improvement.On the basis of laboratory tests,ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck,the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy.On the fifth day of admission,the child developed conjunctival congestion,prune tongue,perianal congestion and desquamation,and slightly stiff and swollen bunions on both feet.A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.CONCLUSION Children with neck pain,lymph node enlargement,or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics.Clinicians should not rush invasive operations such as neck puncture,incision,and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.
