Kent S, Hennedige A, McDonald C, Henry A, Dawoud B, Kulkarni R, Logan G, Gilbert K, Exely R, Basyuni S, Kyzas P, Morrison R, McCaul J
Maxillofacial surgery Trainees Research Collaborative, Aberdeen Royal Infirmary, Aberdeen.
Maxillofacial surgery Trainees Research Collaborative, Manchester Foundation Trust, Manchester.
Br J Oral Maxillofac Surg. 2019 Apr;57(3):196-206. doi: 10.1016/j.bjoms.2019.01.010. Epub 2019 Feb 13.
The role of corticosteroids in the management of cervicofacial infections continues to cause controversy. Systemic anti-inflammatory and immunomodulatory effects that reduce swelling and improve symptoms in the head and neck may make these agents an effective addition to the antibiotics used and to surgical management, although this same effect may dull the physiological response to infection, and allow infections to progress. We have systematically reviewed the evidence for the use of corticosteroids in common cervicofacial infections following the PRISMA guidelines. MeSH terms included "head", "neck", "infection", and "glucocorticoid". In total, 31 papers were identified. Eight reported the use of corticosteroids for peritonsillar abscess (PTA), 10 for pharyngitis, four for deep neck space infection (DNSI), four for periorbital cellulitis, and five for supraglottitis. Whilst there is an established evidence base for their use in the treatment of PTA and pharyngitis, other indications need further study, and we highlight the potential pitfalls. The evidence suggests that the use of adjunctive, short-term, high-dose corticosteroids in cervicofacial infections may be safe and effective.
皮质类固醇在颌面部感染治疗中的作用一直存在争议。全身抗炎和免疫调节作用可减轻头颈部肿胀并改善症状，这可能使这些药物成为所用抗生素和手术治疗的有效补充，尽管同样的效果可能会削弱对感染的生理反应，从而使感染进展。我们按照PRISMA指南系统回顾了皮质类固醇用于常见颌面部感染的证据。医学主题词包括“头”“颈”“感染”和“糖皮质激素”。总共识别出31篇论文。8篇报道了皮质类固醇用于扁桃体周脓肿（PTA），10篇用于咽炎，4篇用于颈部深部间隙感染（DNSI），4篇用于眶周蜂窝织炎，5篇用于会厌炎。虽然有既定的证据支持其用于治疗PTA和咽炎，但其他适应证需要进一步研究，我们强调了潜在的陷阱。证据表明，在颌面部感染中使用辅助性、短期、大剂量皮质类固醇可能是安全有效的。
