Treviño-Gonzalez José Luis, Maldonado-Chapa Félix, González-Larios Amalia, Morales-Del Angel Josefina Alejandra, Soto-Galindo Germán Armando, Zafiro García-Villanueva Jennifer Mística
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico,
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Monterrey, Mexico.
ORL J Otorhinolaryngol Relat Spec. 2022;84(2):130-138. doi: 10.1159/000517026. Epub 2021 Jul 8.
Deep neck infections (DNIs) are abscesses located in the profound spaces of the neck and constitute one of the most common otolaryngological life-threatening emergencies. The aim of this study is to review the clinical and demographic data of patients with DNI and identify factors associated with prolonged hospitalization, reoperation, and mortality.
Retrospective review and analysis of 75 patients with DNI admitted from January 2015 to December 2019 in a tertiary referral hospital.
Of 75 patients, 50 (66.6%) were males and 25 (33.3%) females. Age ranged from 18 to 91 years with a mean of 41.79 (±15.48). DNIs were odontogenic in 49 patients (65.3%). History of diabetes mellitus (DM) was positive in 26 patients (34.6%). The submandibular space was involved in 57 patients (76%). Streptococcus spp. were isolated in 35 patients (46%). Intubation for airway preservation was needed in 21 patients (28%) and tracheostomy in 6 (8%). Mediastinitis presented in 8 patients (10.67%), with a mortality rate of 62.5% (n = 5). Mean hospital stay was 9.13 days (±7.2). DM (p = 0.016), age (p = 0.001), BMI classification 3, 4, and 6 (p = 0.041), and intensive care unit (ICU) admission (p = 0.009) were associated with a longer stay. Surgical drainage was performed after 1.71 days (±1.65). Surgical reintervention was needed in 6 cases (8%) and was associated with temporal (p = 0.001) and masticator (p = 0.002) space involvement and DM (p = 0.009). Overall mortality was 8% and decreased to 1.5% when mediastinitis was excluded. Mediastinitis (p = 0.001), ICU admission (p < 0.0001), Streptococcus spp. (p = 0.019), and low hemoglobin levels (p = 0.004) were associated with mortality.
DISCUSSION/CONCLUSION: DNIs are entities associated with high morbimortality. Mediastinitis and airway obstruction are life-threatening possible complications and should be promptly evaluated. Low HB could be used as a predicting factor for mortality.
深部颈部感染（DNIs）是位于颈部深部间隙的脓肿，是耳鼻喉科最常见的危及生命的紧急情况之一。本研究的目的是回顾DNI患者的临床和人口统计学数据，并确定与住院时间延长、再次手术和死亡率相关的因素。
对2015年1月至2019年12月在一家三级转诊医院收治的75例DNI患者进行回顾性分析。
75例患者中，男性50例（66.6%），女性25例（33.3%）。年龄范围为18至91岁，平均年龄为41.79岁（±15.48）。49例患者（65.3%）的DNIs为牙源性。26例患者（34.6%）糖尿病（DM）病史呈阳性。57例患者（76%）累及下颌下间隙。35例患者（46%）分离出链球菌属。21例患者（28%）需要插管以保护气道，6例患者（8%）需要气管切开术。8例患者（10.67%）出现纵隔炎，死亡率为62.5%（n = 5）。平均住院时间为9.13天（±7.2）。DM（p = 0.016）、年龄（p = 0.001）、BMI分类3、4和6（p = 0.041）以及入住重症监护病房（ICU）（p = 0.009）与住院时间延长相关。手术引流在1.71天（±1.65）后进行。6例患者（8%）需要再次手术干预，这与颞部（p = 0.001）和咀嚼肌（p = 0.002）间隙受累以及DM（p = 0.009）相关。总体死亡率为8%，排除纵隔炎后降至1.5%。纵隔炎（p = 0.001）、入住ICU（p < 0.0001）、链球菌属（p = 0.019）和低血红蛋白水平（p = 0.004）与死亡率相关。
讨论/结论：DNIs是与高发病率和死亡率相关的疾病。纵隔炎和气道阻塞是可能危及生命的并发症，应及时评估。低血红蛋白可作为死亡率的预测因素。
