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      Mediastinitis Necrotizante Descendente de Origen Dental Translated title: Descending Necrotizing Mediastinitis of Dental Origin


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          Resumen El tratamiento inoportuno de las infecciones odontogénicas se acompaña de una complicación mortal, la mediastinitis necrotizante descendente aguda (MNDA), definida como una inflamación de los tejidos conectivos y las estructuras dentro del mediastino. La mortalidad es de aproximadamente del 11% al 41%, por sepsis e insuficiencia orgánica. Las decisiones médicas son decisivas porque el diagnóstico y el retraso del tratamiento son los cofactores primordiales relacionados con la mortalidad. El tratamiento quirúrgico precoz es el aspecto más importante en su manejo, necesitando en muchos casos, tratamiento en la unidad de cuidados intensivos (UTI). Se expone el caso clínico de un paciente masculino de 39 años, diabético, que ingresó a urgencias por un absceso odontógeno de 4 días de evolución. Tras los exámenes complementarios se constata un proceso inflamatorio que se extendía desde el piso de la boca hasta el mediastino, compatible con un MNDA; requirió varias intervenciones quirúrgicas y manejo en UTI más de 30 días con evolución favorable y posterior alta.

          Translated abstract

          Abstract The untimely treatment of odontogenic infections is accompanied by a life-threatening complication, acute descending necrotizing mediastinitis (ADNDM), defined as an inflammation of the connective tissues and structures within the mediastinum. The mortality is approximately 11% to 41%, caused by sepsis and organ failure. Medical decisions are critical because diagnosis and treatment delay are the primary cofactors associated with mortality. Early surgical treatment is the most important aspect in the management, requiring, in most cases, treatment in the intensive care unit (ICU). We present the clinical case of a 39-year-old male patient, diabetic, who was admitted to the emergency room for a dental abscess with 4 days of evolution. After the complementary examinations, an inflammatory process was confirmed that extended from the floor of the mouth to the mediastinum, compatible with an MNDA; the patient required several surgical interventions and management in ICU for more than 30 days with favorable evolution and subsequent discharge.

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          Risk factors for mediastinitis after cardiac surgery.

          Postoperative mediastinitis is one of the most feared complications in patients who undergo cardiac surgery because in addition to a high mortality rate (10% to 47%), there are increases in the length of hospital stay and in hospital costs. The purpose of the present study is to assess the risk factors for mediastinitis after cardiac surgery, the mediastinitis rate, and the mortality rate in our institution. To determine the risk factors, a matched case-control study was carried out, with 39 cases and 78 controls, among the patients who underwent cardiac surgery at the Dante Pazzanese Cardiology Institute, São Paulo, Brazil. In the period of the study, 9,136 cardiac surgeries were performed and the mediastinitis rate was 0.5%. In the multivariate analysis, the independent risk factors found were obesity (odds ratio, 6.49; 95% confidence interval, 2.24 to 18.78), smoking (odds ratio, 3.27; 95% confidence interval, 1.04 to 10.20), intensive care unit stay more than 2 days (odds ratio, 4.50; 95% confidence interval, 1.57 to 12.90), and infection at another site (odds ratio, 8.86; 95% confidence interval, 1.86 to 42.27). The mortality rate was 23% among the patients with mediastinitis. We observed two independent risk factors related to patients' antecedents (obesity and smoking) and two risk factors related to problems in the postoperative period (length of intensive care unit stay and infection at another site). Efforts should be concentrated so that patients lose weight and stop smoking before elective surgeries. There should also be a prevention program against hospital infection directed to, and intensified for, at-risk patients.
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            Deep neck infections: a constant challenge.

            Although the advent of antibiotics and improved dental care decreased the incidence and mortality, deep neck infections (DNIs) are not uncommon and present a challenging problem due to the complex anatomy and potentially lethal complications that may arise.
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                Author and article information

                Gaceta Médica Boliviana
                Gac Med Bol
                Facultad de Medicina de la Universidad Mayor de San Simón (Cochabamba, , Bolivia )
                : 45
                : 1
                : 69-74
                [2] orgnameCaja Nacional de Salud orgdiv1Hospital Obrero Nro. 2
                [1] orgnameC.N.S. orgdiv1Hospital Obrero N°6 orgdiv2Medicina Interna
                S1012-29662022000100069 S1012-2966(22)04500100069

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                : 15 March 2022
                : 02 May 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 6

                SciELO Bolivia

                CASOS CLÍNICOS

                dental focal infection,mediastino,mediastinitis,infección focal dental,mediastinum


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