颈性下行性纵隔脓肿15例分析

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Descending cervical mediastinitis: the multidisciplinary surgical approach

European Archives of Oto-Rhino-Laryngology - Descending cervical mediastinitis (DCM) is defined as spread of oropharyngeal or odontogenic infection into the mediastinum. It occurs uncommonly and...     

Descending necrotizing mediastinitis following acute epiglottitis: a case report

Descending necrotizing mediastinitis occurs secondary to deep neck infection, and the primary focus of infection is mostly located in the tonsil, pharynx and carious tooth. DNM following acute epiglottitis is quite rare, with only one case reported. We treated an 84-year old female with an acute epiglottitis followed by DNM. She was successfully treated by drainages with cervical surgery combined with thoracotomy and cervical surgery.     

Descending necrotizing mediastinitis: report of a case following steroid neck injection

Cervical necrotizing fasciitis is a rare, rapidly progressive, severe bacterial infection of the soft tissues of the neck. Uncommonly, it may descend into the mediastinum. We describe a case of descending necrotizing mediastinitis in a young man, where there was diagnostic confusion and delay, with an eventual fatal outcome. A steroid injection for neck pain is thought to be the source of infection. In this case, the signs of mediastinitis were initially masked, and the diagnosis delayed until cardiopulmonary arrest occurred. Early recognition with a low threshold for computed tomography (CT) scanning is essential. Aggressive multidisciplinary therapy with mediastinal drainage is mandatory.     

Descending necrotizing mediastinitis: ten years' experience

Descending necrotizing mediastinitis is a rare disease that is usually caused by a spreading, diffuse inflammatory reaction (phlegmon) to an odontogenic infection or peritonsillar abscess. Reported mortality rates range from 25 to 40%. The use of antibiotics and advances in resuscitation procedures and critical care techniques have not essentially improved survival, and an effective treatment has not been clearly established. We report the findings of our 10-year study of 21 patients affected by phlegmon and/or fasciitis of the neck. The aim of our contribution is to help define the clinical criteria and diagnostic procedures that will improve the early diagnosis of mediastinal sepsis secondary to neck fasciitis and to suggest optimal treatment approaches. Our experience indicates that (1) cervical drainage alone is sufficient for cases of cervical phlegmon or mediastinal involvement that are limited to a single superior mediastinal space and (2) thoracotomy and drainage of mediastinal collections is necessary when mediastinal sepsis is more extensive.     

Descending necrotising mediastinitis: a safe treatment algorithm

Descending necrotising mediastinitis can complicate oropharyngeal infection and has a high associated mortality. We present three cases treated in our department and propose a treatment algorithm based on our experience and literature review. The primary oropharyngeal infection was peritonsillar abscess in two cases and odontogenic abscess in one. Two patients underwent cervicotomy and later thoracotomy. The third underwent cervicotomy with transcervical mediastinal drainage and later required pericardial drainage via a subxiphoid incision. All recovered fully and were discharged within 6 weeks. To enable successful treatment, diagnosis needs to be prompt and surgical drainage adequate. Thoracic management of the chest is essential.     

Descending necrotizing mediastinitis: trends in a developing country

Descending necrotizing mediastinitis is believed to be a rare and serious complication of odontogenic and oropharyngeal infections. It is associated with a high (up to 40%) mortality rate, which can be attributed to delays in diagnosis and inadequate surgical drainage. Between May 1999 and September 2002, we treated 7 cases at our institution in New Delhi, indicating that such fulminating infections are not so rare in developing countries. In our 7 cases, a high index of suspicion and early computed tomography helped us make a rapid diagnosis and initiate prompt treatment, which resulted in a favorable outcome in 6 cases (mortality rate: 14.3%).     

Descending necrotizing mediastinitis caused by odontogenic infections

Intrathoracic dissemination of an odontogenic infection is very infrequent. The resulting clinical manifestation, known as descending necrotizing mediastinitis, causes high mortality. Due to the absence of early clinical or radiological signs, diagnosis is usually made only when the process is completely established. Treatment is a combination of intravenous antibiotics and mediastinal drainage, via either a cervical or a transthoracic approach. We report the clinical and microbiological characteristics of 4 patients with descending necrotizing mediastinitis, and their clinical course over a period of 10 years.     

Descending necrotizing mediastinitis from deep neck infection

This study aims to identify predisposing characteristics of descending necrotizing mediastinitis (DNM) arising from deep neck infection (DNI) and to determine appropriate therapeutic intervention strategies. We retrospectively reviewed 54 patients (male, n = 34; female, n = 20; mean age, 64.5 years) who had been treated at Mie University Hospital for DNI between April 2001 and October 2011. Eight of nine patients who developed DNM confirmed by computed tomography of the neck and chest, underwent mediastinal drainage (video-assisted thoracic surgical drainage, n = 6; mediastinoscopy-assisted drainage, n = 2). A patient developed uncontrolled acute respiratory distress syndrome after aggressive surgery, resulting in a mortality rate of 12 %. High blood CRP values, and the pharynx and tonsils as origins of infection were factors involved in the development of DNM arising from DNI. In conclusion, DNM remains a destructive and fatal disease that requires aggressive treatment including mediastinal exploration.     

A report of two cases of cervical necrotizing soft-tissue infection]

Two recent cases of cervical necrotizing soft-tissue infection are herein presented. Case 1. A 52-year-old man with uncontrolled diabetes was hospitalized because of an erythematous swelling of the left side of his neck and high grade fever. Fetid yellowish pus exuded from the left parotid area. The swelling extended from the left temporal area to the left supraclavicular fossa, with necrosis of the parotid gland, sternocleidomastoid, masseter and a portion of the strap muscles. Wound cultures revealed Staphylococcus aureus and alpha-hemolytic streptococcus. No anaerobic bacteria were detected. Treatment consisted of intravenous administration of antibiotics, control of diabetes with insulin, and debridement of the necrotic tissue, which left an epidermal defect in the initially swollen area. Transfer of a forearm free flap was done after the growth of healthy granulation tissue over the affected area. Case 2. A 55-year-old woman with rheumatoid arthritis was transferred to our hospital after tracheotomy performed in another hospital because of dyspnea due to severe crepitant swelling of her cheeks and submandibular areas bilaterally, and her left temporal area. A copious amount of fetid pus exuded from the incisions made in the left temporal area, left cheek, and right submandibular area. There were bilateral diffuse rales. Culturing the pus revealed alpha-hemolytic streptococci, while MRSA and Pseudomonas aeruginosa were detected from cultures of sputum. No anaerobic bacteria were found. After intravenous administration of antibiotics, infected wounds and pneumonia were ameliorated, and necrotic subcutaneous tissue and fascia were debrided. The patient was discharged with a residual depression in her left cheek and a scar on her left temporal area.     

Laryngeal tuberculosis: a report of 15 cases

Laryngeal tuberculosis is usually a complication of pulmonary tuberculosis. Recent studies have described a change in the clinical features of laryngeal tuberculosis. We present 15 cases of laryngeal tuberculosis treated at the Osaka Prefectural Habikino Hospital between 1993 and 2000. The results showed a mean age of 51 years, a male predominance by 2.75 to 1, and a 20% incidence (n = 3) of negative chest radiographic findings. The prominent presenting symptom was hoarseness (73.3%), and systemic symptoms were relatively rare. Seven patients showed ulcerative lesions, 5 showed granulomatous lesions, and the remaining 3 showed nonspecific inflammatory lesions in the larynx. Laryngeal lesions did not show any predilection for specific laryngeal sites in our series. In contrast to earlier studies, our study shows variations in clinical features of laryngeal tuberculosis. Physicians should consider tuberculosis in the differential diagnosis of laryngeal disease.     

Neonatal cervical teratoma: case report]

Cervical teratomas are extremely rare tumours. Surgery of these mostly benign malformations is very challenging for a multidisciplinary team. A single case of a newborn, who was imminently prenatally diagnosed with a neck mass, is presented. After delivery the patient was transferred to neonatal intensive care unit and intubation was performed. A rapid growth of the mass required early surgery and removal of the neck mass was performed on the third day post delivery. Histological investigation showed an immature teratoma. The postoperative period was complicated by hypothyroidism. Due to severe laryngo-tracheomalacia tracheostomy was required when the baby was 2 weeks old. Further development has been without any sign of recurrence (12 months). On the basis of this case differential diagnosis, therapy and outcome is discussed.     

Laryngeal tuberculosis: apropos of 15 cases]

Based on a retrospective study over a six year period, we report 15 cases of tuberculosis of the larynx, confirmed histologically. Dysphonia was the main symptom. The diagnosis rests on direct laryngoscopy and biopsy, with histology. Medical treatment achieves a good outcome.     

Retrospective study of descending cervical mediastinitis

Objective Descending cervical mediastinitis can occur as a complication of oropharyhgeal and cervical space that spread to the mediastinum vis cervical space. Descending mediastinitis represent a virulent form of mediastinal infection requiring prompt diagnosis and treatment to reduce high morality associated with the disease. Surgical management and a particularly optimal form of mediastinal drainage remain controversial. Method From 1998–2004, eighteen patients were treated in our institution. Surgical treatment consisted more than 2 times. Cervical drainage associated with drainage of the mediastinum through a thoracic approach in 11 patients with pleural drainage in 8 patients. Result The outcome was favorable in eleven patients who had mediastinum drained through thoracotomy. One patient who was not drained died with tracheo-oesophageal fistula. Main culprit neck space is pre and para tracheal space which lead to anterior, superior and posterior mediastinal collection in our series. The tracheostomy is of immense help not only in opening cervical space collections and also to secure a partially compromised airway.     

Midline cervical cleft: A report of two cases

Congenital midline cervical cleft is a rare congenital anomaly. The cardinal diagnostic features are-(1). Fistula's opening are located caudally (2) Internuittent serous fluid discharge in the early neonatal period (3). Nipple like appearance of the cleft in the superior aspect (4). Widened scar and mininual neck contracture in later life. Two such cases are reported herewith with briefreview of literature and it's surgical management.     

Spontaneous cervical hematoma: a report of two cases

Cervical hematomas are generally associated with trauma, surgery, and tumors. Although they are rare, they can be life-threatening because they put the patient at risk for great-vessel compression and upper airway obstruction. We describe two cases of spontaneous cervical hematoma--one in an 81-year-old man and the other in a 30-year-old woman. The man reported dysphonia, dysphagia, and neck swelling of 5 hours' duration. He had been taking 100 mg/day of aspirin for a cardiovascular condition. Examination revealed that the man had polycythemia vera. The woman was found to have neck ache, odynophagia, and cervical ecchymosis; portal hypertension, schistosomiasis, and blood dyscrasia were also found. Both patients denied trauma. A suspected diagnosis of cervical hematoma was confirmed by computed tomography, and treatment was instituted. The hematomas resolved in about 2 weeks. The treatment of cervical hematoma is controversial, although it is agreed that the evaluation of upper airway obstruction and its permeability is mandatory. Surgical treatment is generally reserved for complicated cases because of the risk of infection or bleeding.     

Congenital midline cervical cleft: a report of two cases

Congenital midline cervical cleft is an uncommon malformation of the anterior neck. We report the cases of two patients with such an anomaly who had been born within 10 days of each other at a regional hospital in upstate New York. Fewer than 100 cases of congenital midline cervical cleft have been reported in the literature, and to the best of our knowledge, none of the other reported cases occurred so close to each other in terms of time and location. Diagnoses in both cases were established by clinical observation soon after birth. No likely epidemiologic commonalities between the two patients were found. Head and neck surgeons should be familiar with these malformations because early surgical excision is critical. Both of our patients were surgically treated at an early age, one with a Z-plasty and one with a straight closure. In both cases, the patients exhibited good functional and cosmetic results at 5 years of age.     

Congenital midline cervical cleft: a report of 3 cases

Congenital midline cervical cleft is a rare anomaly of the anterior neck. The diagnosis is typically made on the basis of the lesion's characteristic clinical presentation at birth. It appears to occur as a result of a failure of fusion of the paired second branchial arches in the midline during embryogenesis. Surgical intervention is necessary to avoid potential long-term complications, such as contractures and limitation of neck mobility. We present 3 cases of congenital midline cervical cleft, and we discuss the embryology, presentation, and surgical management of this unusual condition.     

多原发癌15例分析

目的对重复癌的发病情况进行回顾性调查。方法对1990～2000年10年间治疗的重复癌患者15例进行回顾性分析研究。结果15例中同时性重复癌1例,异时性重复癌14例。第1原发癌为喉癌,第2原发癌以肺癌最多。第1原发癌为下咽癌,第2原发癌多为上消化道癌。结论喉癌、下咽癌的重复癌发病率有增高趋势,其重复癌多发生于肺及上消化道,喉癌、下咽癌患者应重点检查肺部和上消化道,必要时行气管镜、食道镜、胃内窥镜检查以免漏诊。     

Tuberculosis of the cervical lymph nodes: report of 193 cases

193 patients suffering from tuberculosis of the cervical lymph nodes are analysed. All cases were examined with respect to sex, age, nationality and typical findings of blood parameters. The diagnostic and therapeutic proceedings are elucidated. Histological diagnosis should be done, but micro-biology is only significant in a few cases. Tuberculosis of lymph nodes of neck should be considered in obscure swellings of the neck.