Severe complications of multi-space infections in head and neck region: A clinical study of 549 cases

Abstract

Abstract: PURPOSE : To assess the incidence and treatment outcomes of life-threatening complications of multi-space infections (LCMI) in head and neck. METHODS : We reviewed the medical records of a tertiary teaching hospital in Shanghai from February 2006 to July 2014. Patients with multi-space infections of head and neck were included in this study. Their demography, causes of infections, comorbidity, bacteriological studies, imaging studies, treatment regimens, life-threatening complications and outcomes were reviewed. Statistical analysis performed using SPSS 19.0 software package. RESULTS : A total of 549 cases were included. LCMI was found in 66 patients (12.20%). Descending mediastinitis was the most frequent LCMI (n=37, 56.06%), followed by airway obstruction (n=27, 40.91%), pneumonia (n=12, 18.18%), pericarditis (n=6, 9.09%), intraorbital infection (n=2, 3.03%), multiple organ failure (n=2, 3.03%), intracranial infection (n=2, 3.03%), and sudden cardiac death (n=1, 1.52%). All LCMI patients underwent antibiotic therapy and facial and cervical incision and drainage. In addition, mediastinal drainage was performed for 33 patients with descending mediastinitis, and 27 patients with airway obstruction underwent tracheotomy or tracheal intubation. Twelve patients died during the treatment. Elder patients and patients with comorbidity were more likely to be accompanied with LCMI. CONCLUSIONS : Multi-space infections continue to cause life-threatening complications and significant morbidity in China. Descending mediastinitis is the most common LCMI. Airway obstruction is the most frequent cause of death. It is recommended that a prompt and aggressive surgical incision and drainage with antibiotic therapy managed by a multidisciplinary team are appropriate for multi-space infections, especially for LCMI.

Key words: Head and neck, Multi-space infections, Complications, Descending mediastinitis, Airway obstruction

CLC Number:

R782.3

CAI Xie-yi, HUANG Lin-jian, JIANG Bin, ZHANG Wei-jie, Qian Wen-tao, LI Jie-yan, ZHANG Zhi-yuan, GUAN Xin, LIANG Xiang, ZHOU Long-nv, ZHU Jian.. Severe complications of multi-space infections in head and neck region: A clinical study of 549 cases[J]. China Journal of Oral and Maxillofacial Surgery, 2015, 13(6): 539-544.

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