Comparison of intubation and tracheotomy in patients with deep neck infection

Tapiovaara, Laura; Bäck, Leif; Aro, Katri

doi:10.1007/s00405-017-4694-5

Cited by 38 publications

(30 citation statements)

References 24 publications

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“…The rate for necrotising fasciitis was 0.7% in this study. Previously, Tapiovaara et al [7] observed that OI is the most common aetiology for deep neck infections with increased risk for mediastinal involvement. In their study, 12 of 25 patients (48%) who developed mediastinitis as a result of deep neck infections were assessed to be of dental origin.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of clinical research, it is interesting that severe OIs have become more frequent in recent decades [1][2][3][4][5]. Deep neck infections are often caused by odontogenic foci [2,6,7], which may, in the most severe cases, be fatal [8]. Besides the need for treatment in intensive care, OIs may lead to infection complications and distant infections [2,7,[9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Deep neck infections are often caused by odontogenic foci [2,6,7], which may, in the most severe cases, be fatal [8]. Besides the need for treatment in intensive care, OIs may lead to infection complications and distant infections [2,7,[9][10][11]. Like deep neck infections from other origins, severe OIs may spread into deep fascial spaces and even beyond these barriers, resulting in distant infection complications such as cavernous sinus thrombosis, brain abscesses, airway obstruction, mediastinitis, or endocarditis [12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Health status in patients hospitalised for severe odontogenic infections

Furuholm

Rautaporras

Uittamo

et al. 2021

Acta Odontologica Scandinavica

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“…For patients with DNI and limited mouth opening, transnasal intubation with the guidance of a flexible fiberoptic bronchoscope may be attempted [55,56]. Tracheostomy is life-saving and early tracheostomy is recommended when massive upper airway edema potentially leading to a compromised airway, or a complicated clinical course without response to the initial treatment [57,58].…”

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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“…Only one of the 92 patients had tracheostomy performed at the primary stage of OI treatment; this patient did not develop nosocomial pneumonia during the ICU period. Tracheostomy has been thought to decrease complications related to longer intubation times in patients with deep neck infection according to the study of Tapiovaara et al [24]. In that study, patients were treated mostly for otolaryngological infections.…”

Section: Discussionmentioning

confidence: 99%

Deep odontogenic infections—identifying risk factors for nosocomial pneumonia

et al. 2020

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Objectives To evaluate occurrence and risk factors for pneumonia in patients with deep odontogenic infection (OI). Materials and methods All patients treated for deep OIs and requiring intensive care and mechanical ventilation were included. The outcome variable was diagnosis of nosocomial pneumonia. Primary predictor variables were re-intubation and duration of mechanical ventilation. The secondary predictor variable was length of hospital stay (LOHS). The explanatory variables were gender, age, current smoking, current heavy alcohol and/or drug use, diabetes, and chronic pulmonary disease. Results Ninety-two patients were included in the analyses. Pneumonia was detected in 14 patients (15%). It was diagnosed on postoperative day 2 to 6 (median 3 days, mean 3 days) after primary infection care. Duration of mechanical ventilation (p = 0.028) and LOHS (p = 0.002) correlated significantly with occurrence of pneumonia. In addition, re-intubation (p = 0.004) was found to be significantly associated with pneumonia; however, pneumonia was detected in 75% of these patients prior to re-intubation. Two patients (2%) died during intensive care unit stay, and both had diagnosed nosocomial pneumonia. Smoking correlated significantly with pneumonia (p = 0.011). Conclusion Secondary pneumonia due to deep OI is associated with prolonged hospital care and can predict the risk of death. Duration of mechanical ventilation should be reduced with prompt and adequate OI treatment, whenever possible. Smokers with deep OI have a significantly higher risk than non-smokers of developing pneumonia. Clinical relevance Nosocomial pneumonia is a considerable problem in OI patients with lengthy mechanical ventilation. Prompt and comprehensive OI care is required to reduce these risk factors.

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Comparison of intubation and tracheotomy in patients with deep neck infection

Cited by 38 publications

References 24 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

Deep odontogenic infections—identifying risk factors for nosocomial pneumonia

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