Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina; Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina; Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
Acta Otorrinolaringol Esp (Engl Ed). 2022 Jan-Feb;73(1):4-10. doi: 10.1016/j.otoeng.2020.08.008.
The most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial.
A randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0.
128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The P-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results.
Surgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient's airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed.
Ultrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.
深部颈部感染最常见的原因是牙源性感染。通过体格检查、影像学研究、超声或计算机断层扫描来诊断。根据具体情况，应尽早通过经典或经皮方式进行脓肿的外科引流。本研究的目的是在一项对照和随机试验中比较超声引导下经皮引流技术与手术引流治疗牙源性来源的深部颈脓肿。
进行了一项随机对照临床试验，时间为 2015 年 1 月至 2019 年 12 月。将住院时间作为效率变量进行评估。分析了流行病学和次要变量数据（肿瘤、牙关紧闭、发热、疼痛）、白细胞增多、比较两种技术的美容效果。统计分析采用 STATA v 14.0 进行。
共分析了 128 例患者，其中女性 51 例，男性 77 例。平均年龄 27.3（SD=10.13）岁。经皮组的平均住院时间为 3.03（SD=2.86）天，手术组为 5.46（SD=2.96）天。P 值<.001。美容效果显示经皮引流组有优势。其他变量均无统计学差异。
对于深部间隙有广泛脓肿形成的证据，应尽早进行手术治疗（颈切开术和清创术）。微创影像引导下的手术是一种替代方法。对于位置良好、单房性的脓肿，可以在不影响患者气道的情况下进行。必要时可进行经皮引流和抽吸技术，或进行多次引流放置。
超声引导下和经皮连续引导引流是治疗轻度和/或中度牙源性感染患者的最佳治疗选择。
