• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.1
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• pp.62-67
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• 2010

The spreading pathways which is the cause of infection on head and neck area are submandibular space, masticatory space, parapharyngeal space, retropharyngeal space, carotid sheath and mediastinum, etc. If spread to parapharyngeal area involving airway, such infection can be life-threatening by airway obstruction, or can cause vascular injury followed by hemorrhage, nerve injuries. Also, if spread to superficially, necrotizing fasciitis and many complications may occur including gangrene of skin. The key to successful treatment of infection on head and neck area is recognition of spreading pathways, early diagnosis and following therapeutic management. Our department present two cases, one is infection progressed superficially to suprasternal space, another is spreading deep according to parapharyngeal space, subclavian space and carotid sheath followed by airway obstruction, and obtained significant results with surgical incision and drainage, administration of selected antibiotics, continuous post-operative treatment. We report these 2 cases with literatures review.

• Journal of Korean Dental Science
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• v.8 no.2
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• pp.89-94
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• 2015

As popularity of dental implantation is increasing, the number of cases associated with complications also increase. Evaluation on diabetes mellitus is often neglected due to the disease's irrelevance to implantability. However, patients with diabetes mellitus are susceptible to infection due to impaired bactericidal ability of neutrophils, cellular immunity and activity of complements. Due to this established connection between diabetes mellitus and infection, a couple of cases were selected to present patients with diabetes mellitus with glycemic incontrollability, suffering from post-implantation dentigerous inter-fascial space abscess.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.16 no.1
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• pp.85-87
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• 2005

The pyriform sinus fistula can cause a recurrent abscess in the neck and the current treatment of choice involves complete excision of the sinus tract. But, because of excisional difficult, chemical cautery has been intermittently used as a successful substitute. Recently we experienced a case of pyriform sinus fistula of 9 year-old female who was successfully treated with chemocauterization with trichloroacetic acid(TCA) and ligation of the internal opening of the fistula tract on suspension laryngoscopy. So we report this rate case with review of literatures.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.234-237
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• 2001

Pyriform sinus fistula is a rare anomaly arising from 3rd or 4th branchial apparatus and has been recognized as one cause of acute suppurative thyroiditis or acute deep neck infection. Pyriform sinus fistula must be considered when a clinician is encountered recurrent left lower neck abscess and a history of repeated incision and drainage. The confirmation of the diagnosis is made when the fistula tract is identified on a barium swallow study and when the internal orifice of the fistula is found at the apex of pyriform sinus on laryngoscopic examination. A complete excision of the fistula tract has been proposed as a treatment of choice. However, in some cases it is very difficult to resect the tract completely because of severe inflammation and repeated drainage procedure. We present three cases of pyriform sinus fistula which are successfully treated by laryngomicroscopic chemocauterization using synthetic fibrin and $AgNO_3$.

• Clinical and Experimental Otorhinolaryngology
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• v.11 no.4
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• pp.293-300
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• 2018

Objectives. The current study aims to determine the correlation between nutritional status upon presentation and disease severity, as well as treatment and survival outcomes. Methods. Patients who were diagnosed with deep neck infection, underwent at least one surgical drainage/debridement, and had more than 1 week of hospitalization at a tertiary medical center from 2007 to 2015 were retrospectively included. Thereafter, initial serum albumin, C-reactive protein (CRP), and body mass index (BMI) were reviewed. Results. A total of 135 patients were included in the final analysis. Accordingly, the proportion of patients with simultaneous mediastinitis (21.0%), necrotizing fasciitis (12.9%), disease extent >1 cervical level (72.6%), mean CRP (22.4 mg/dL), mean length of hospitalization (25.0 days), and mean 1-week follow-up CRP (7.2 mg/dL) was significantly higher in the hypoalbuminemia group (initial serum albumin <3.0 g/dL) than in the normoalbuminemia group (all P<0.05). No significant correlations had been observed according to BMI status. After adjusting for age and Charlson comorbidity index, odds ratios for the following outcomes were calculated in patients initially presenting with hypoalbuminemia: simultaneous mediastinitis (3.07), necrotizing fasciitis (7.89), disease extent >1 cervical level (2.12), initial serum CRP over 20 mg/dL (3.79), hospitalization of more than 14 days (4.10), 1-week follow-up CRP over 5 mg/dL (3.78), and increased duration for an over 50% decrease in initial CRP (2.70) (all P<0.05). Although intravascular albumin replenishment decreased the proportion of patients with hypoalbuminemia after 2 weeks (P<0.05), it did not significantly predict better treatment outcomes. Conclusion. Among the markers reflecting an individual's nutritional state, an initial serum albumin of less than 3.0 g/dL was an independent serologic marker predicting increased disease severity and complications in patients with deep neck infection.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.1
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• pp.63-71
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• 2014

Extension of advanced odontogenic infection from deep neck fascial spaces into the mediastinum is heralded by chest pain, dyspnea, fever, and radiographic demonstration of mediastinal widening. The critical care should be done in a team approach by multiple medical and dental departments, such as, oral & maxillofacial surgery, otolaryngology, anesthesiology, chest surgery, and infection medicine. Especially, fluid & drug therapy, adequate incision & drainage and systemic supportive psychosedation care are important. But, acute hyperventilation can be produced by several distinct causes: severe anxiety, respiratory alkalosis, increased blood catecholamine levels, and a decrease in the level of the ionized calcium in the blood. The orofacial fears about acute pain, trismus, dysphagia, swelling and oral surgical treatment lead to the severe anxiety and increased blood catecholamine level by stress. Therefore, the most dental patient should be cared gently as the stress reduction protocol. In spite of the care, hyperventilation was occurred during psychosedation and local anesthesia for incision and drainage of the masticatory fascial space abscess with deep neck infection & mediastinitis. We suggest that the dental patient with advanced odontogenic infection must be attention for the manifestation of hyperventilation, especially in the medically compromised conditions.

• Archives of Plastic Surgery
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• v.36 no.3
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• pp.351-355
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• 2009

Purpose: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. Methods: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient : signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum - assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. Conclusion: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.3
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• pp.197-208
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• 2021

Objectives: The purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea. Materials and Methods: A retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses. Results: Average LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis. Conclusion: For successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.401-409
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• 2006

Infections of the oral and maxillofacial region are one of the most common conditions for which a patient presents to a maxillofacial surgeons. Although these infections can arise from a variety of source, dental disease is the most common etiology. So, odontogenic infection are frequently encountered in the practice of oral and maxillofacial surgery. These infections often respond to antimicrobial chemotherapy or surgical intervention, such as extraction of teeth, incision and drainage through clinical features. But, odontogenic infections have the potential to spread via the fascial spaces in the head and neck region, and, they spread to cavernous sinus, deep musculofascial space and other vital structure. We have undertaken clinical studies on infections in the oral and maxillofacial regions by analyzing retrospectively hospitalized patients in the Dept. of Oral and Maxillofacial Surgery, Chonbuk National University Hospital past 5 years from 2000 to 2004. And, the patients' age, sex, medical history, causes of the infection, surgical intervention, and other clinical parameters were reviewed. The obtained results were as follows : 1. The most frequent cause of oral and maxillofacial infection was odontogenic. And in the odontogenic cause, dental caries was the most common cause (47.2%). 2. The most common fascial space involved was the submandibular space (15.7%), followed by the buccal space (14.8%). 3. 60.4% of all patients required surgical drainage of the abscess, endodontic treatment or tooth extraction or periodontal treatment with drainage. 4. The most causative organism isolated from the pus culture were streptococcus viridans (53.9%). 5. Underlying medical problems were found in 136 patients (41.9%), the most common being hypertension (27.9%) and diabetes (14.7%).

• Korean Journal of Veterinary Service
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• v.42 no.1
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• pp.39-42
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• 2019

Tetanus is an acute, often fatal, and infectious disease of all species of domestic animals caused by the neurotoxin of Clostridium tetani (C. tetani). This disease is usually known to develop after microbial contamination in the deep or penetrating wound sites. In February 2017, a farmer who was raising 76 cows injected foot and mouth disease vaccine to three or more cows with one syringe. Their clinical symptoms were observed 2 to 16 days after the vaccination. The initial symptoms were stiffness, rigidity of the neck and limbs, pricked ears, and prolapse of the third eyelid. Subsequently, there was recumbency with extension of the limbs, convulsions and opistotonus and the affected 20 cows were all died. Two dead cows were submitted to Animal and Plant Quarantine Agency for disease diagnosis. At necropsy, a focal edematous abscess of 15 to 20 cm in diameter was grossly observed in the subcutaneous and intramuscular tissue of scapular region and filled with a large amount of greenish pus. The feed was full in oral cavity and slightly observed in the trachea and lobes of lung. Histopathologically, focal granulomatous nodules with eosinophilic materials in the tissue were observed. In the lung, aspiration pneumonia and gram (+) bacteria were seen. The C. tetani was isolated in samples anaerobically cultured using reinforced clostridial medium and identified by PCR. To our knowledge, no previous outbreak of tetanus in cattle has affected such a high number of animals; neither has it been associated with misuse of the same syringe and needle to administer multiple individuals.