scholarly journals Paciente acometido por Angina de Ludwig com grave progressão reabilitado com próteses dentárias: relato de caso

2019 ◽  
Vol 8 (3) ◽  
Author(s):  
Adriana Caroline Leite ◽  
Daniele Maria dos Santos Goes ◽  
Ricardo Shibayama ◽  
Glaykon Alex Vitti Stabile ◽  
Marcelo Medeiros Battistetti ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Diabetic Patients ◽  
Deep Neck Infection ◽  
Odontogenic Infections ◽  
Neck Infection ◽  
Retrospective Audit ◽  
Ludwig’S Angina ◽  
Deep Neck Infections ◽  
Head Neck ◽  
Ludwig's Angina

O objetivo deste trabalho é relatar e discutir um caso clínico de um paciente acometido por Angina de Ludwig que evoluiu gravemente para mediastinite. O paciente compareceu inicialmente ao Pronto Socorro do Hospital Universitário da Universidade Estadual de Londrina e após diagnóstico de Angina de Ludwig foi internado e tratado de forma emergencial. O tratamento foi multiprofisssional e constituiu-se em abordagem cirúrgica para descompressão dos tecidos, administração de antimicrobianos e remoção da causa da infecção. Mesmo após a primeira abordagem cirúrgica, o paciente evoluiu gravemente e houve a necessidade de reabordagem da região cervical e torácica. O paciente necessitou de um mês de internação hospitalar até que o quadro infeccioso fosse estabilizado. Após o incidente, o paciente se apresentava com baixa autoestima e com sua relação interpessoal afetada. Desta forma, foi encaminhado para a Clínica Odontológica Universitária da Universidade Estadual de Londrina onde foi reabilitado com prótese total superior e prótese parcial removível inferior a fim de devolver grande parte da função mastigatória, estética e, consequentemente, qualidade de vida.Descritores: Angina de Ludwig; Infecção; Prótese Dentária; Saúde Bucal.ReferênciasJiménez Y, Bagán JV, Murillo J, Poveda R. Odontogenic infections. Complications. Systemic manifestations. Med Oral Patol Oral Cir Bucal. 2004;9(Suppl):139-43.Lugo AFG, Ravago MGC, Martinez RAG, Peltrini RJZ. Ludwig’s angina: A report of two cases. Rev Esp Cir Oral Maxilofac. 2014;36(4):177-81.Umeda M, Minamikawa T, Komatsubara H, Shibuya Y, Yokoo S, Komori T. Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(3):283-90.Bakir S, Tanriverdi MH, Gün R, Yorgancilar AE, Yildirim M, Tekbas G et al. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol. 2012;33(1):56-63.Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg. 2004;62(12):1545-50.Caccamese JF Jr, Coletti DP. Deep neck infections: Clinical considerations in aggressive disease. Oral Maxillofac Surg Clin North Am. 2008;20(3):367–80.Chen MK, Wen YS, Chang CC, Lee HS, Huang MT, Hsiao HC. Deep neck infections in diabetic patients. Am J Otolaryngol. 2000;21(3):169-73Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am. 2008;41(3):459-83.Zarb GA, Bolender CL. Tratamento protético para os pacientes edêntulos – Próteses totais convencionais e implantossuportadas. 13. ed. Santos: São Paulo; 2013.Rodrigues JC. Tabu do corpo. Rio de Janeiro: Fiocruz; 2006.Narby B, Kronström M, Söderfeldt B, Palmqvist S. Changes in attitudes toward desire for implant treatment: a longitudinal study of a middle-aged and older Swedish population. Int J Prosthodont. 2008;21(6):481-85.Walton JN, MacEntee MI. Choosing or refusing oral implants: a prospective study of edentulous volunteers for a clinical trial. Int J Prosthodont. 2005;18(6):483-8.Sakarya EU, Kulduk E, Gündoğan O, Soy FK, Dündar R, Kılavuz AE, Özbay C, Eren E, İmre A. Clinical features of deep neck infection: analysis of 77 patients. Kulak Burun Bogaz Ihtis Derg. 2015;25(2):102-8.Botha A, Jacobs F, Postma C. Retrospective analysis of etiology and comorbid diseases associated with Ludwig’s Angina. Ann Maxillofac Surg. 2015;5(2):168-73.Suehara AB, Goncalves AJ, Alcadipani FAMC, Kawabata NK, Menezes MB. Deep neck infection: analysis of 80 cases. Braz J Otorhinolaryngol. 2008;74(2):253-59.Lee JK, Kim HD, Lim SC. Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J. 2007;48(1):55-62.Igoumenakis D, Gkinis G, Kostakis G, Mezitis M, Rallis G. Severe odontogenic infections: causes of spread and their management. Surg Infect (Larchmt). 2014;15(1):64-8.Rao DD, Desai A, Kulkarni RD, Gopalkrishnan K, Rao CB. Comparison of maxillofacial space infection in diabetic and nondiabetic patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(4):e7-12.Akinbami BO, Akadiri O, Gbujie DC. Spread of odontogenic ifnfections in Port Harcourt, Nigeria. J Oral Maxillofac Surg. 2010;68(1):2472-77.Flynn TR, Shanti RM, Hayes C. Severe odontogenic infections, Part 2: Prospective outcomes study. J Oral Maxillofac Surg. 2006;64(7):1104-13.Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck. 2004;26(10):854-60.Hsu RF, Wu PY, Ho CK. Transcervical drainage for descending necrotizing mediastinitis may be sufficient. Otolaryngol Head Neck Surg. 2011;145(5):742-47.Varghese L, Mathews SS, Antony Jude Prakash J, Rupa V. Deep head and neck infections: outcome following empirical therapy with early generation antibiotics. Trop Doct. 2018;48(3):179-82.Liau I, Han J, Bayetto K, May B, Goss A, Sambrook P et al. Antibiotic resistance in severe odontogenic infections of the South Australian population – a 9- year retrospective audit. Aust Dent J. 2018;63(2):187-92.

Deep neck infection in diabetic patients: Comparison of clinical picture and outcomes with nondiabetic patients

2005 ◽  
Vol 132 (6) ◽  
pp. 943-947 ◽  
Author(s):  
Tung-Tsun Huang ◽  
Fen-Yu Tseng ◽  
Tien-Chen Liu ◽  
Chuan-Jen Hsu ◽  
Yuh-Shyang Chen
Keyword(s):  
Diabetes Mellitus ◽  
Hospital Stay ◽  
Clinical Picture ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Deep Neck Infection ◽  
Neck Infection ◽  
Duration Of Hospital Stay ◽  
Patients With Diabetes ◽  
Deep Neck Infections

OBJECTIVE: To compare the difference in the clinical picture and outcomes between diabetic and nondiabetic patients with deep neck infections. STUDY DESIGN AND SETTING: We retrospectively reviewed the records of patients who were diagnosed with deep neck infections and who received treatment at the Department of Otolaryngology of National Taiwan University Hospital between 1997 and 2002. One hundred eighty-five patients were included in our study. Fifty-six patients with diabetes mellitus were enrolled for further analysis (diabetic group) and compared with the other 129 patients without diabetes mellitus (nondiabetic group) in demography, etiology, bacteriology, treatment, duration of hospital stay, complications, and outcome. RESULTS: The parapharyngeal space was the space most commonly involved in both the diabetic (33.9%) and nondiabetic groups (40.3%). Odontogenic infections and upper airway infections were the 2 leading causes of deep neck infection in diabetic and nondiabetic groups. Streptococcus viridans is the most commonly isolated organism in the nondiabetic group (43.7%). However, the most common organism in the diabetic group was Klebsiella pneumoniae (56.1%). There were 89.3% of diabetic patients, versus 71.3% of nondiabetic patients, with abscess formation ( P = 0.0136). Surgical drainage was performed more frequently in the diabetic group than in the nondiabetic group (86.0% versus 65.2%, P = 0.0142). In comparison with the nondiabetic group, the diabetic group tended to have older mean age (57.2 y versus 46.2 y, P = 0.0007), longer duration of hospital stay (19.7 days versus 10.2 days, P >0.0001), more frequent complications (33.9% versus 8.5%, P >0.0001), and more frequent tracheostomy or intubation (19.6% versus 6.2%, P = 0.0123). CONCLUSIONS: Patients with diabetes mellitus are susceptible to deep neck infection. We should pay more attention when dealing with deep neck infections in patients with diabetes mellitus because those patients tend to have complications more frequently and a longer duration of hospital stay. Empirical antibiotics should cover K. pneumoniae in patients with deep neck infection who have diabetes mellitus.

scholarly journals “Air” on the side of caution: The importance of early recognition and intervention in Ludwig’s angina

2018 ◽  
Vol 5 (3) ◽  
pp. 40
Author(s):  
Sallie M. Long ◽  
Talha Demirci ◽  
Stacy R. Kruse
Keyword(s):  
Surgical Intervention ◽  
Early Recognition ◽  
Morbidity And Mortality ◽  
Deep Neck Infection ◽  
Airway Compromise ◽  
Significant Morbidity ◽  
Neck Infection ◽  
Ludwig’S Angina ◽  
Basic Treatment ◽  
Ludwig's Angina

Ludwig’s angina is a deep neck infection of the supramylohyoid and inframylohyoid spaces. Without prompt recognition and intervention, it can progress to airway compromise with significant morbidity and mortality. Although otolaryngologists and oral surgeons are well-versed in this condition, it is vital that physicians across all specialties are knowledgeable about the presentation and basic treatment of this potentially fatal condition. Here we report a case of Ludwig’s angina in a 29-year-old male that was successfully managed with both medical and surgical intervention. We also aim to describe the presentation and treatment of Ludwig’s angina in order to increase awareness in non-surgical fields.

scholarly journals Multidisciplinary treatment of deep neck infection associated with descending necrotizing mediastinitis: a single-centre experience

2019 ◽  
Vol 47 (12) ◽  
pp. 6027-6040 ◽  
Author(s):  
Chao Ma ◽  
Lian Zhou ◽  
Ji-Zhi Zhao ◽  
Run-Tai Lin ◽  
Tao Zhang ◽  
...  
Keyword(s):  
Thoracoscopic Surgery ◽  
Multidisciplinary Treatment ◽  
Multiple Organ ◽  
Deep Neck Infection ◽  
Descending Necrotizing Mediastinitis ◽  
College Hospital ◽  
Odontogenic Infections ◽  
Neck Infection ◽  
Medical College ◽  
Mediastinal Drainage

Objective Deep neck infection (DNI) associated with descending necrotizing mediastinitis (DNM) is a highly lethal condition. This retrospective review was performed to share our experience performing multidisciplinary management of DNI associated with DNM during a 7-year period. Methods We reviewed 16 patients who had been surgically treated for DNM at Peking Union Medical College Hospital from April 2010 to July 2017. The clinical outcomes were analysed to determine the most appropriate therapeutic strategy. Results Five women and 11 men were included in this study. Their mean age was 54.9 ± 14.3 years. DNM-associated infections most commonly occurred secondary to odontogenic infections (n = 10). Thirteen patients required tracheotomy because of tracheal compression. All patients underwent unilateral or bilateral cervicotomy. Six patients with DNM localized in the upper mediastinal space underwent transcervical mediastinal drainage, while 10 patients with DNM extending to the lower mediastinum were treated by cervicotomy and video-assisted thoracoscopic surgery. Three patients died of multiple organ failure. Conclusion Multidisciplinary treatment can achieve favourable outcomes in >80% of patients with DNM. Early diagnosis, proper airway management, and adequate surgical drainage are crucial for reducing mortality in patients with DNM, and minimally invasive procedures also play an important role.

scholarly journals Deep Neck Infection and Descending Mediastinitis as a Complication ofPropionibacterium acnesOdontogenic Infection

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Evgeni Brotfain ◽  
Leonid Koyfman ◽  
Lisa Saidel-Odes ◽  
Abraham Borer ◽  
Yael Refaely ◽  
...  
Keyword(s):  
Propionibacterium Acnes ◽  
Interesting Case ◽  
Deep Neck Infection ◽  
Positive Bacterium ◽  
Gram Positive ◽  
Neck Infection ◽  
Deep Neck Infections ◽  
Descending Mediastinitis

Propionibacterium acnesis an anaerobic, Gram-positive bacterium which causes numerous types of infections. IsolatedPropionibacterium acnesdeep neck infections are very rare. We present an interesting case of deep neck infection complicated by descending mediastinitis of isolatedPropionibacterium acnesinfection.

Airway Management in a Patient with Ludwig's Angina

2020 ◽  
Author(s):  
Sara B. Robertson
Keyword(s):  
Airway Management ◽  
Pediatric Patients ◽  
Signs And Symptoms ◽  
Thoracic Pain ◽  
Neck Infection ◽  
Airway Collapse ◽  
Life Threatening ◽  
Neck Anatomy ◽  
Ludwig’S Angina ◽  
Ludwig's Angina

Ludwig’s angina (LA) is a rare but life-threatening deep space neck infection that affects several combined potential spaces in the neck, namely the submental and submandibular spaces. Patients often present with signs and symptoms such as dysphonia, odynophagia, neck and thoracic pain, otalgia, sialorrhea, and cough. In later stages, the patient may present with dysphagia, trismus, cyanosis, dyspnea, and stridor which all may signal an impending airway collapse. This comprehensive review will set out to describe the definition, anatomy, and epidemiology of Ludwig’s angina, how it manifests, and how to diagnose and treat the infection that can be often difficult to recognize. Clinical features of the disease are discussed as well as different strategies for anesthesia and airway management. Two special situations in which Ludwig’s angina can occur—pregnancy and pediatric patients—are also covered. This review contains 5 tables, and 30 references. Keywords: Ludwig’s angina, management of the airway in Ludwig’s angina, conservative treatment in Ludwig’s angina, surgical management in Ludwig’s angina, antibiotic treatment for Ludwig’s angina, Ludwig’s angina in pediatrics, Ludwig’s angina in pregnancy, neck anatomy in Ludwig’s angina

scholarly journals Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection

2004 ◽  
Vol 122 (6) ◽  
pp. 259-263 ◽  
Author(s):  
Agricio Nubiato Crespo ◽  
Carlos Takahiro Chone ◽  
Adriano Santana Fonseca ◽  
Maria Carolina Montenegro ◽  
Rodrigo Pereira ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Evaluation ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Clinical Findings ◽  
Deep Neck Infection ◽  
Disease Extent ◽  
Neck Infection ◽  
Increased Temperature ◽  
Deep Neck Infections

CONTEXT: Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. OBJECTIVE: To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. TYPE OF STUDY: Non-randomized retrospective study. SETTING: Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. METHODS: Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. RESULTS: The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the submandibular triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. DISCUSSION: The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. CONCLUSIONS: The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.

Deep neck cellulitis: a challenging diagnosis

2020 ◽  
Vol 13 (12) ◽  
pp. e236415
Author(s):  
Ana Isabel Gonçalves ◽  
Ditza Vilhena ◽  
Delfim Duarte ◽  
Nuno Trigueiros
Keyword(s):  
Soft Tissues ◽  
Deep Neck Infection ◽  
Central Nervous System Infections ◽  
C Reactive Protein ◽  
Intense Pain ◽  
Neck Infection ◽  
Reactive Protein ◽  
Deep Neck Infections ◽  
T2 Hyperintensity ◽  
High Degree

A 38-year-old woman with Crohn’s disease, under immunosuppressive therapy, was referred to the emergency department for severe progressive neck pain and fever, with 1 week of evolution. She was unable to perform neck mobilisation due to the intense pain aroused. She referred dysphagia. Oral cavity, oropharynx, hypopharynx and larynx showed no alterations. She had an increased C reactive protein. Central nervous system infections were excluded by lumbar puncture. CT was normal. Only MRI showed T2 hyperintensity of the retropharyngeal and prevertebral soft tissues of the neck without signs of abscess. The patient was treated with broad spectrum antibiotics. Complications of deep neck infection include abscess formation, venous thrombosis and mediastinitis. In this case, no complications occurred. A high degree of clinical suspicion is essential as deep neck infections need to be promptly diagnosed and treated given their rapidly progressive character, especially in immunocompromised patients.

Univariate and multivariate models for the prediction of life-threatening complications in 586 cases of deep neck space infections: retrospective multi-institutional study

2017 ◽  
Vol 131 (9) ◽  
pp. 779-784 ◽  
Author(s):  
J Mejzlik ◽  
P Celakovsky ◽  
L Tucek ◽  
M Kotulek ◽  
A Vrbacky ◽  
...  
Keyword(s):  
Bacterial Culture ◽  
Infection Type ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Retropharyngeal Space ◽  
Deep Neck Infection ◽  
Neck Movement ◽  
Neck Infection ◽  
Life Threatening ◽  
Deep Neck Infections

AbstractObjective:To identify deep neck infection factors related to life-threatening complications.Methods:This retrospective multi-institutional study comprised 586 patients treated for deep neck infections between 2002 and 2012. The statistical significance of variables associated with life-threatening complications of deep neck infections was assessed.Results:During treatment, life-threatening complications occurred in 60 out of 586 cases. On univariate analysis, life-threatening complications were linked to: dyspnoea, neck movement disturbance and dysphonia (all p < 0.001); and parapharyngeal, anterior visceral or pretracheal deep neck involvement (all p < 0.002). Aetiology was significantly linked to tonsils (p < 0.001). Regarding infection type, fasciitis was a significant factor (p < 0.001). Candida albicans was a significant bacterial culture (p < 0.001). A multivariate step-wise model disclosed fewer significant variables: retropharyngeal space (p = 0.005) and major blood vessels area (p = 0.006) involvement, and bacterial culture C albicans (p < 0.001).Conclusion:It can be predicted that patients with deep neck infections, with neck movement disturbances, dysphonia, dyspnoea and swelling of the external neck, accompanied by severe pain, and inflammatory changes in the retropharyngeal space and large vessel areas, with culture-confirmed infection of C albicans, are likely to develop life-threatening complications.

scholarly journals Surgical Management of Parapharyngeal Abscess

2012 ◽  
Vol 4 (3) ◽  
pp. 122-124 ◽  
Author(s):  
Jagadish Tubachi ◽  
Arsheed Hakeem ◽  
DC Pradeep ◽  
Puneeth Nayak
Keyword(s):  
Surgical Management ◽  
Deep Neck Infection ◽  
Surgical Drainage ◽  
Space Management ◽  
Neck Infection ◽  
Parapharyngeal Abscess ◽  
Life Threatening ◽  
Deep Neck Infections ◽  
Spread Of Infection ◽  
Extent Of Disease

ABSTRACT Parapharyngeal abscess is a life-threatening infection. It occurs due to spread of infection form anatomical locations in the vicinity of the space. Management of the deep neck infection is governed by the general condition of the patient, the extent of disease and patency of airway. In treatment of deep neck infections intensive antibiotic therapy and surgical drainage are complementary to each other. How to cite this article Tubachi J, Hakeem A, Pradeep DC, Nayak P. Surgical Management of Parapharyngeal Abscess. Int J Otorhinolaryngol Clin 2012;4(3):122-124.

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