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      Infecções cervicais profundas: análise de 80 casos Translated title: Deep neck infection: analysis of 80 cases

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          Abstract

          As infecções cervicais profundas são afecções graves que acometem os diversos espaços do pescoço. A mais temível complicação é a mediastinite necrosante descendente, que necessita de diagnóstico precoce e tratamento, por vezes, agressivo. OBJETIVOS: Analisar os 80 casos tratados de infecção cervical profunda e propor uma diretriz de conduta. MATERIAL E MÉTODO: Os autores realizaram um estudo retrospectivo de 80 casos de infecções cervicais profundas tratados no período de junho de 1997 a junho de 2003. RESULTADOS: As causas odontogênicas e amigdalianas foram as mais comumente encontradas. Os espaços mais acometidos foram o submandibular e parafaríngeo. Os principais microorganismos envolvidos foram o Staphylococcus aureus e o Streptococcus sp. CONCLUSÃO: O manejo da via aérea difícil nas infecções cervicais profundas deve ter cuidado especial, quando da indicação cirúrgica, de preferência com intubação sob visão endoscópica e sem uso de miorrelaxantes. Drenagem cirúrgica ampla permanece o tratamento padrão das infecções cervicais profundas. A tomografia computadorizada é o exame de escolha para o diagnóstico das infecções cervicais profundas. Essas infecções apresentam alta morbimortalidade, quando associada ao choque séptico e à mediastinite. Nossa mortalidade foi de 11,2% e dos cinco doentes com mediastinite apenas um sobreviveu.

          Translated abstract

          Deep neck infections are serious diseases that involve several spaces in the neck. The most dreadful complication is descending necrotizing fasciitis, which needs early diagnosis and aggressive treatment. AIM: To analyze 80 treated cases of deep neck infection and propose a schematic guideline for managing this disease. METHOD: The authors present a retrospective analysis of 80 treated cases of deep neck infection, from June 1997 to June 2003. RESULTS: Odontogenic and tonsilar causes were the more frequent ones. Submandibular and parapharyngeal spaces were the most frequent location of deep neck infection. Staphylococcus aureus and Streptococcus sp were the microorganisms more commonly isolated. CONCLUSIONS: Airway control should be priority in managing deep neck infections and if the patient has to be submitted to surgery special care should be taken at the moment of intubation - when curare must never be used. CT scan is the gold-standard imaging evaluation for the diagnosis of deep neck infection. Morbi-mortality is high when associated with septic shock and mediastinitis. Our mortality rate was 11.2% and only one, in five patients with mediastinitis, survived.

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          Most cited references30

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          Descending necrotizing mediastinitis.

          From January 1975 through July 1981, ten patients with mediastinitis complicating an oropharyngeal infection, that is, a form of mediastinitis best termed as DNM, were encountered at our institution. Based upon rather relatively stringent diagnostic criteria, 21 other instances were found in the literature from 1960 to 1980, a time period well into the antibiotic era. The predominant underlying oropharyngeal infection was of odontogenic origin, specifically, infection involving the mandibular molars. Bacteriologically, DNM is most frequently a polymicrobial process, with anaerobes playing a major role. Although there has been a decline in the over-all incidence of DNM since the introduction of antibiotics, its morbid and lethal nature persists, as evidenced by the present prohibitive mortality of approximately 42 per cent. Delayed diagnosis and inadequate drainage procedures are the primary underlying factors contributing to this high mortality. At present, CT scan is the single most important tool for the early diagnosis of DNM. This noninvasive procedure also helps determine the adequacy of the surgical drainage procedure performed. However, with all the presently available diagnostic tools, it is still the high index of suspicion by physicians toward patients with unrelenting oropharyngeal or deep neck infection that is of utmost importance for making an early diagnosis of DNM. In view of our experience and that of others, we believe that only through aggressive combined medical and surgical management can the highly morbid, if not lethal, course of DNM be reversed. It should be emphasized that, to accomplish successful operative intervention, a thorough knowledge of the complex anatomy of the region is crucial.
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            Deep neck infections in diabetic patients

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              The association between periodontal disease and peritonsillar infection: a prospective study.

              To study the relationship between periodontal status and peritonsillar disease/recurrent tonsillitis.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rboto
                Revista Brasileira de Otorrinolaringologia
                Rev. Bras. Otorrinolaringol.
                ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (São Paulo )
                0034-7299
                April 2008
                : 74
                : 2
                : 253-259
                Affiliations
                [1 ] Santa Casa de Misericórdia de São Paulo Brazil
                [2 ] Santa Casa de Misericórdia de São Paulo Brazil
                [3 ] Santa Casa de Misericórdia de São Paulo Brazil
                [4 ] Santa Casa de Misericórdia de São Paulo Brazil
                [5 ] Santa Casa de Misericórdia de São Paulo Brazil
                Article
                S0034-72992008000200016
                10.1590/S0034-72992008000200016
                45dd36a5-38e8-417e-a88d-3bd9b872fbb1

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0034-7299&lng=en
                Categories
                OTORHINOLARYNGOLOGY

                Otolaryngology
                guideline,complications,diagnosis,infection,neck,treatment,algoritmos,complicações,diagnóstico,infecção,pescoço,tratamento

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