Management and maintenance of the airway in cervical necrotising fasciitis: a retrospective analysis of 15 cases

Chen, S.J.; Ji, Nie; Chen, Y.-x.; Zhao, Su-zhen; Xiao, Jianrui; Lin, Xin

doi:10.1016/j.bjoms.2015.04.017

Cited by 13 publications

(10 citation statements)

References 27 publications

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“…A study by Chen et al [21] underlines the difficulty to perform tracheotomy in DNI and the risk of complications related to the procedure. We present a rather high number of compromised airway since 13% of patients were tracheotomized in local anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intubation and tracheotomy in patients with deep neck infection

Tapiovaara

Bäck

Aro

2017

Eur Arch Otorhinolaryngol

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Possible airway compromise further complicates treatment of deep neck infections (DNI). Airway management is crucial, but factors affecting the method of choice are unclear. We retrospectively evaluated adult DNIs in a single tertiary center covering 10 years, with special attention on airway management. Patient data were retrieved from electronic data files from 2007 to 2016, and included adult patients with DNI operated through the neck. Of the 202 patients, 127 (63%) were male, with a median age of 47 years. Odontogenic (n = 74; 35%) infection was the most common etiology. Intubation was the most common method of airway management (n = 165; 82%), and most patients (n = 102; 50%) were extubated immediately after surgery. Tracheotomy was performed primarily for 35 (17%) patients, and secondarily for 25 (15%). Two patients were managed in local anesthesia. Altogether 80 (40%) patients required care in the intensive care unit for a median of 7 days. Median hospital stay was 6 days for intubated patients and 10 days for primarily tracheotomized (p = 0.036). DNI extended to the mediastinal space in 25 (12%) patients, most of whom with odontogenic infection (48%), and necrotizing fasciitis (32%). Odontogenic infection was the most common etiology for DNI with increased risk for mediastinal involvement. Intubation was most common type of airway management with high success in immediate extubation after surgery. The need for tracheotomy seemed to lead to a longer hospital care and was associated with a more severe clinical course.

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Section: Discussionmentioning

confidence: 99%

Comparison of intubation and tracheotomy in patients with deep neck infection

Tapiovaara

Bäck

Aro

2017

Eur Arch Otorhinolaryngol

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“…7 However, primary tracheostomy in this setting may prove especially technically challenging in a compromised airway with distorted anatomy with risk of seeding the infection into the airway and mediastinum. 8 In CNF, endotracheal intubation may also be difficult as trismus may limit mouth opening and abscess mass may restrict neck extension. However, with newer technologies and techniques such as video laryngoscopy and awake fiber optic intubation, the larynx can be visualized without aligning the oral, pharyngeal and laryngeal axes.…”

Section: Airway Managementmentioning

confidence: 99%

“…However, with newer technologies and techniques such as video laryngoscopy and awake fiber optic intubation, the larynx can be visualized without aligning the oral, pharyngeal and laryngeal axes. 8 Awake intubation also offers an additional benefit of cardiovascular stability which is important in cases of septic shock. 9…”

Section: Airway Managementmentioning

confidence: 99%

Odontogenic cervical necrotizing fasciitis with descending mediastinitis: a case report and discussion

Kumaran

Lee

et al. 2020

Int J Otorhinolaryngol Head Neck Surg

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<p class="abstract">Mr KE is a 46 years old gentleman with a background of type 2 diabetes mellitus who was referred to our department for severe polymicrobial cervical necrotising fasciitis with descending mediastinitis after mandibular dental extraction. He was managed with endotracheal intubation, cervicotomy and video assisted thorascopic surgery (VATS), antibiotic and antifungal therapy and myocutaneous flap coverage. This case describes a classical presentation of an uncommon pathology and discusses options for airway management, surgical debridement, antimicrobial therapy and definitive defect coverage. </p>

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“…Despite strong advances in critical care medicine over the past few decades, NF still portends a very high case mortality rate. 1,2 NF most commonly affects the thorax, limbs, perineum, abdomen, and groin. [3][4][5][6] Early and wide surgical debridement is crucial to decrease the mortality rate.…”

mentioning

confidence: 99%