Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment |
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Authors: | Paolo Boscolo-Rizzo Marco Stellin Enrico Muzzi Monica Mantovani Roberto Fuson Valentina Lupato Franco Trabalzini and Maria Cristina Da Mosto |
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Institution: | (1) Department of Medical and Surgical Specialities, University of Padua, School of Medicine, Padua, Italy;(2) Regional Center for Head and Neck Cancer, University of Padua, School of Medicine, Treviso Regional Hospital, Treviso, Italy;(3) Otorhinolaryngology Unit, University Hospital S. Maria della Misericordia, Udine, Italy;(4) Department of Sense Organs, Otology and Skull Base Surgery Unit, Siena University Hospital, Siena, Italy;(5) Viale Umbria 6, 30019 Chioggia, Italy |
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Abstract: | The aims of this investigation were to review the clinical behavior of deep neck infections (DNIs) treated in our institution
in order to identify the predisposing factors of life-threatening complications and propose valuable recommendations for management
and treatment. A total of 365 adult patients with DNIs were retrospectively identified. One-hundred and thirty-nine patients
(38.1%) underwent surgical drainage. Overall, 226 patients (61.9%) responded effectively to intravenous antimicrobial therapy
only. There were 67 patients (18.4%) developing life-threatening complications. Diabetes mellitus (odd ratio 5.43; P < 0.001) and multiple deep neck spaces involvement (odd ratio 4.92; P < 0.001) were the strongest independent predictors of complications. The mortality rate was 0.3%. Airway obstruction and
descending mediastinitis are the most troublesome complications of DNIs. In selected patients, a trial of intravenous antibiotic
therapy associated with an intensive computed tomography-based wait-and-watch policy may avoid an unnecessary surgical procedure.
However, about one-fourth of patients present significant comorbidities, which may negatively affect the course of the infection.
In these cases and in patients with large or multiple spaces infections, a more aggressive surgical strategy is mandatory. |
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