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Thoracic complications of deeply situated serous neck infections
C Colmenero Ruiz1, A D Labajo, I Yañez Vilas
1Department of Maxillofacial Surgery, La Paz General Hospital Madrid, Spain.
Abstract:
Nine cases of complicated deep neck infections, occurring during a period of twelve years are presented. Complications observed were cervico-thoracic necrotizing fasciitis in 3 cases, purulent pleural effusion in 6 cases, pericardial effusion in 2, mediastinitis in 8 cases, jugular vein thrombosis and rupture of the innominate artery in one case each. Although 2 cases were managed initially with blind endotracheal intubation, all cases finally required tracheostomy. A cervico-mediastinal approach was useful for the early mediastinal involvement. Two patients died because of inadequacy of the multiple surgical procedures resulting in persistent infection and multi-organ failure and one because of uncontrollable bleeding after innominate artery rupture.
Insights
Deep neck infections can lead to severe complications like necrotizing fasciitis and mediastinitis. Early surgical intervention and tracheostomy are crucial for managing these complex cases.
Area of Science:
- Medicine
- Surgery
- Infectious Diseases
Background:
- Deep neck infections are serious conditions with potentially life-threatening complications.
- Managing these infections requires prompt and aggressive treatment strategies.
Purpose of the Study:
- To present a series of complicated deep neck infection cases.
- To analyze the observed complications and treatment outcomes.
Main Methods:
- Retrospective review of nine cases of complicated deep neck infections over twelve years.
- Documentation of complications including necrotizing fasciitis, pleural effusion, mediastinitis, and vascular injuries.
- Analysis of airway management (endotracheal intubation, tracheostomy) and surgical approaches.
Main Results:
- Common complications included mediastinitis (8 cases) and purulent pleural effusion (6 cases).
- Cervico-thoracic necrotizing fasciitis occurred in 3 cases.
- All patients ultimately required tracheostomy for airway management.
- A cervico-mediastinal approach was beneficial for early mediastinal involvement.
- Mortality occurred in 3 cases due to persistent infection, multi-organ failure, or arterial rupture complications.
Conclusions:
- Complicated deep neck infections present with a high rate of severe thoracic complications.
- Aggressive surgical management, including tracheostomy and appropriate surgical approaches, is essential.
- Vascular complications, such as innominate artery rupture, carry a high risk of mortality.