The Value of Early Intervention and a Multidisciplinary Approach in the Management of Necrotizing Fasciitis of the Neck and Anterior Mediastinum of Odontogenic Origin

Muhammad, Joseph Kamal; Almadani, Hana; Hashemi, Bader A. Al; Liaqat, Muneezeh

doi:10.1016/j.joms.2014.12.021

Cited by 20 publications

(26 citation statements)

References 24 publications

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“…Thus, this condition must be considered as a challenging race against time, since only early diagnosis allows welltimed and adequate medical and surgical treatment. In fact, delayed diagnosis is considered to be one of the main pre-dictors of mortality and morbidity for DNSIs 8 , particularly in case of CNF. CNF represent only 3.5% 15 of total DNSIs, but they dramatically affect the prognosis of these patients, with a mortality rate of 7-22%, increasing to 41% in case of thoracic involvement and up to 64% if associated with DNM and septic complications 17 .…”

Section: Discussionmentioning

confidence: 99%

“…The presence of Gram-germs (Pseudomonas aeruginosa 4.07%, Klebsiella pneumonia 1.48%) 6 is more frequently related to diabetic comorbidity 2 . Anaerobic bacteria (Prevotella 4%, Fusobacterium 5%) 7 have been demonstrated to play an important role in the development of cervical necrotising fasciitis (CNF) 7,8 due to the production of specific enzymes involved in the necrotising process 8 . Bacterial cultures can be polymicrobial in 20.8% 5 of cases and negative in 10.74% 6 of patients, probably due to the wide use of prehospitalisation antibiotic therapy or to technical difficulty in isolating anaerobic pathogens 9,10 .…”

Section: Introductionmentioning

confidence: 99%

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New laboratory predictive tools in deep neck space infections

Fiorella

Greco

Madami

et al. 2020

Acta Otorhinolaryngol Ital

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SUMMARY Introduction Deep neck space infections (DNSIs) are a group of infective suppurative diseases involving deep neck spaces and cervical fascia. Necrotising and septic evolutions are rare, but severe complications can dramatically affect the prognosis and should be promptly managed. Clinical examination often has low sensitivity, although instrumental diagnosis may delay te treatment. We investigated two laboratory tools, LRINEC (Laboratory Risk Indicator for the Necrotizing fasciitis) and NLR (neutrophil to lymphocyte ratio), in the expectation to find a rapidly available predictive indicator that may help in distinguishing necrotising complications and/or systemic septic involvement. Methods A retrospective observational cohort study was performed on 118 patients who had underwent surgical treatment for DNSIs at our Surgical Unit. LRINEC, NLR and the product LRINEC x NLR were calculated. Results Statistical analysis showed that these scores may have utility in rapidly predicting the risk of necrotising fasciitis and systemic involvement at an early diagnostic stage. Conclusions Further studies with a larger cohort may be necessary in order to increase the sensitivity and specificity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

New laboratory predictive tools in deep neck space infections

Fiorella

Greco

Madami

et al. 2020

Acta Otorhinolaryngol Ital

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“…In addition, the potential whole body presentation causes many different medical specialties to be confronted with necrotizing fasciitis, resulting in more scattered experience. This stretches the need for a universal treatment algorithm [ 34 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Triple diagnostics for early detection of ambivalent necrotizing fasciitis

et al. 2016

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BackgroundNecrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct.MethodsRetrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented.ResultsIn total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitisConclusionIn the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis.

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“…viridans, Klebsiella pneumonia, Pseudomonas aeruginosa, gram negative bacilli and anaerobes [9]. In literature, odontogenic causes have been shown to be the most common source [10][11][12]. Necrotising fasciitis morbidity and mortality are high in comorbidities [13].…”

Section: Discussionmentioning

confidence: 99%

An adjuvant therapy in cervical necrotising fasciitis: hyperbaric oxygen treatment

Ensari¹,

Gür²,

Öztürk³

et al. 2016

Med-Science

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Kearn sayre syndrome (KSS) is a rare disease with a typical onset before 20 years and characterized by triad of chronic progressive external ophthalmoplegia, retinitis pigmentosa and progressive cardiac conduction abnormalities. The most important prognostic factor in KSS patients is the involvement of heart characterized by progressive degeneration of the conduction system. In patients with KSS, early diagnosis of cardiac involvement is very important because complete atrioventricular (AV) block may develop and it can be cause of sudden cardiac death. Herein we report a patient with KSS who presented with syncope due to complete AV block.

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The Value of Early Intervention and a Multidisciplinary Approach in the Management of Necrotizing Fasciitis of the Neck and Anterior Mediastinum of Odontogenic Origin

Cited by 20 publications

References 24 publications

New laboratory predictive tools in deep neck space infections

New laboratory predictive tools in deep neck space infections

Triple diagnostics for early detection of ambivalent necrotizing fasciitis

An adjuvant therapy in cervical necrotising fasciitis: hyperbaric oxygen treatment

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