Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Sokolska 581, Hradec Kralove, 50005, Czech Republic.
Eur Arch Otorhinolaryngol. 2014 Jun;271(6):1679-83. doi: 10.1007/s00405-013-2651-5. Epub 2013 Aug 8.
The goal of the study was to find out the risk factors for the development of mediastinitis in patients with deep neck infections (DNI) and describe the differences in symptoms and clinical image between uncomplicated DNI and infections with mediastinal spread. Our study represents the retrospective analysis of 634 patients with DNI. The file was divided into two groups. There were 619 patients (97.6%) in the first group who had an uncomplicated course of DNI without spread of infection into mediastinum (DNI group). The second group included 15 patients (2.4%) with descending mediastinitis as a complication of DNI (mediastinitis group). The most frequent comorbidities were cardiac and pulmonary diseases, which were more frequent in the mediastinitis group comparing to DNI group. Dental origin of the infection was more frequent in DNI group than in the mediastinitis group. On the other hand, tonsillar origin of the infection was more frequent in the mediastinitis group than in DNI group. In both mediastinitis and DNI groups, the typical presenting symptoms were pain, oedema and dysphagia. Furthermore, dysphagia, dyspnoea, dysphonia and restriction of neck movements were more significant in the mediastinitis group than in DNI group. The incidence of airway obstruction, sepsis, pneumonia and death was significantly higher in the mediastinitis group than in DNI group. Due to our results, the predisposing factors for mediastinal extension of DNI are cardiovascular and pulmonary diseases. Mediastinitis is associated with higher morbidity and mortality than DNI. The most common complications are airway obstruction, pneumonia and sepsis.
本研究旨在探讨深部颈感染（DNI）患者发生纵隔炎的危险因素，并描述单纯 DNI 与伴有纵隔播散感染的 DNI 之间症状和临床影像的差异。我们的研究代表了对 634 例 DNI 患者的回顾性分析。该文件分为两组。第一组 619 例（97.6%）患者为单纯 DNI，无感染向纵隔播散（DNI 组）。第二组包括 15 例（2.4%）因 DNI 并发下行性纵隔炎的患者（纵隔炎组）。最常见的合并症是心脏和肺部疾病，在纵隔炎组中比 DNI 组更常见。DNI 组的感染来源以牙科为主，而纵隔炎组则以扁桃体为主。在 DNI 和纵隔炎两组中，典型的表现症状都是疼痛、水肿和吞咽困难。此外，纵隔炎组的吞咽困难、呼吸困难、声音嘶哑和颈部活动受限比 DNI 组更为明显。纵隔炎组的气道阻塞、败血症、肺炎和死亡率显著高于 DNI 组。由于我们的结果，DNI 向纵隔扩展的易患因素是心血管和肺部疾病。与 DNI 相比，纵隔炎的发病率和死亡率更高。最常见的并发症是气道阻塞、肺炎和败血症。
