Iwata Eiji, Inokuchi Go, Kawakami Masakazu, Matsui Taiki, Kusumoto Junya, Tachibana Akira, Akashi Masaya
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan.
Odontology. 2024 Dec 14. doi: 10.1007/s10266-024-01041-w.
In this study, we aimed to identify risk factors that predict the postoperative need for advanced or prolonged airway management in patients with severe odontogenic deep neck infections (DNIs). This retrospective case-control study included patients of both sexes aged ≥ 18 years who had undergone surgical drainage including debridement of necrotic tissues of odontogenic deep neck abscesses and necrotizing soft tissue infection under general anesthesia between April 2016 and September 2023 at a single center. The patients' characteristics, laboratory tests, and computed tomography (CT) findings were analyzed and compared between the difficult postoperative airway group, which required prolonged intubation or tracheostomy, and the short-term intubation group. Statistical significance was set at P < 0.05. Sixty-four patients required surgical drainage including debridement under general anesthesia. Of them, 7 (10.9%) patients were included in the difficult postoperative airway group. In addition to increased inflammatory markers, the presence of arytenoid edema among laryngeal edema and retro- and parapharyngeal space abscesses on preoperative CT images were identified as risk factors. The presence of pharyngeal space abscesses was significantly associated with laryngeal edema, and the intubation period was longer in patients with more elements relevant to these two factors. Thus, the presence of pharyngeal space abscesses and degree of laryngeal edema on preoperative CT images can be used to predict the complexity of postoperative airway management. Our results suggest that tracheostomy is preferable for patients with retropharyngeal space abscesses, and that patients with parapharyngeal space abscesses and laryngeal edema are desirable to undergo prolonged intubation.
在本研究中，我们旨在确定预测严重牙源性深部颈部感染（DNIs）患者术后是否需要高级或延长气道管理的风险因素。这项回顾性病例对照研究纳入了2016年4月至2023年9月期间在单一中心接受全身麻醉下手术引流（包括清创牙源性深部颈部脓肿的坏死组织和坏死性软组织感染）的年龄≥18岁的男女患者。分析并比较了需要延长插管或气管切开的术后气道困难组和短期插管组患者的特征、实验室检查及计算机断层扫描（CT）结果。统计学显著性设定为P<0.05。64例患者需要在全身麻醉下进行包括清创在内的手术引流。其中，7例（10.9%）患者被纳入术后气道困难组。除炎症标志物升高外，术前CT图像上喉水肿中的杓状软骨水肿以及咽后和咽旁间隙脓肿的存在被确定为风险因素。咽间隙脓肿的存在与喉水肿显著相关，与这两个因素相关的要素越多，患者的插管时间越长。因此，术前CT图像上咽间隙脓肿的存在和喉水肿程度可用于预测术后气道管理的复杂性。我们的结果表明，对于有咽后间隙脓肿的患者，气管切开术更为可取，对于有咽旁间隙脓肿和喉水肿的患者，宜进行延长插管。
