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Clinical Medicine Insights. Ear, Nose... 2019Deep neck spaces are regions of loose connective tissue filling areas between the 3 layers of deep cervical fascia, namely, superficial, middle, and deep layers. The...
Deep neck spaces are regions of loose connective tissue filling areas between the 3 layers of deep cervical fascia, namely, superficial, middle, and deep layers. The superficial layer is the investing layer, The pretracheal layer is the intermediate layer and the prevertebral layer is the deepest layer. Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Once the natural resistance of fascial planes is overcome, spread of infection occurs along communicating fascial boundaries. More recent trends include the increasing prevalence of resistant bacterial strains, a decline in DNIs caused by pharyngitis or tonsillitis, and a relative increase in DNIs of odontogenic origin. Most DNIs are polymicrobial. Only 5% are purely aerobic and 25% with isolated anaerobes. The epidemiology of DNIs needs to be monitored for changing trends and the impact of underlying host immunity and developing microbial multidrug resistance is established. Surveillance at laboratory level should include mandatory susceptibility testing of all empiric antibiotics against microbes commonly identified in adult DNI microscopy, culture, and sensitivity (MC&S) specimens. The role of susceptibility testing of microbes not commonly identified in adult DNI MC&S specimens needs further review, on a clinical case-by-case basis.
PubMed: 31496858
DOI: 10.1177/1179550619871274 -
Zhonghua Jie He He Hu Xi Za Zhi =... Aug 2014To explore the shape and the location of mediastinal spaces (mediastinal lymph node locations) associated with conventional transbronchial needle aspiration technique...
OBJECTIVE
To explore the shape and the location of mediastinal spaces (mediastinal lymph node locations) associated with conventional transbronchial needle aspiration technique (C-TBNA), and to determine the relationship between the mediastinal spaces and physiological and anatomical marks in trachea-bronchial lumen for choosing the puncture points of C-TBNA.
METHODS
The chest HRCT images of 1 000 consecutive patients preparing for bronchoscopic examination were analyzed to determine the shape and the location of the mediastinal gap, and which physiological and anatomic markers in the airway were suitable for locating the mediastinal spaces and lymph nodes. Eighty-one groups of lymph nodes from 52 patients were punctured by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to verify the locating of puncture points by these markers for the mediastinal lymph nodes under general anesthesia. The needle was punctured into the wall of the airway first, and then the ultrasound was used to confirm if the needle was in the lymph nodes.
RESULTS
Pretracheal space, aortic-left pulmonary window space, superior-carinal space and subcarinal space showed close relationship with C-TBNA biopsy for mediastinal lymph nodes. The pretracheal space could be located by the physiological and anatomic marks of aortic impression and aortic pulse points. The superior-carinal space was like a triangle and locating in 12 o'clock of the first ring of trachea. The 9-10 o'clock of the first ring of the trachea was the aortic-left pulmonary window. The 8-9 o'clock of the right main bronchus and middle bronchus was for subcarinal space. Eighty-one groups of lymph nodes from 52 patients were punctured by EBUS-TBNA according to the physiological and anatomic markers, and it showed that only 3 groups were missed by C-TBNA. No mediastinal bleeding and pneumomediastinum occurred.
CONCLUSION
Mediastinal spaces(mediastianl lymph nodes) and physiological and anatomical marks within the airway had a relatively fixed relationship. These marks could be used for locating the mediastinal lymph nodes when C-TBNA was performed.
Topics: Biopsy, Fine-Needle; Bronchi; Humans; Lymph Nodes; Mediastinum
PubMed: 25351265
DOI: No ID Found -
Journal of Oral and Maxillofacial... Mar 2024Quick Sequential Organ Failure Assessment (qSOFA) is recommended to identify sepsis. Odontogenic infection (OI) can progress to sepsis, causing systematic inflammatory...
BACKGROUND
Quick Sequential Organ Failure Assessment (qSOFA) is recommended to identify sepsis. Odontogenic infection (OI) can progress to sepsis, causing systematic inflammatory complications or organ failure.
PURPOSE
The purpose of the study was to measure the association between OI location and risk for sepsis at admission.
STUDY DESIGN, SETTING, AND SAMPLE
This retrospective cohort study included subjects treated for OI at Baylor University Medical Center in Dallas, TX, from January 9, 2019 to July 30, 2022. Subjects > 18 years old who were treated under general anesthesia were included. OI limited to periapical, vestibular, buccal, and/or canine spaces were excluded from the sample.
PREDICTOR VARIABLE
The primary predictor variable was OI anatomic location (superficial or deep). Superficial OI infection includes submental, submandibular, sublingual, submasseteric, and/or superficial temporal spaces. Deep OI includes pterygomandibular, deep temporal, lateral pharyngeal, retropharyngeal, pretracheal, and/or prevertebral.
MAIN OUTCOME VARIABLES
The primary outcome variable was risk for sepsis measured using a qSOFA score (0 to 3). A higher score (>0) indicates the patient has a high risk for sepsis.
COVARIATES
Covariates were demographics, clinical, laboratory, and radiological findings, antibiotic route, postoperative endotracheal intubation, tracheostomy, intensive care unit, admission, and length of stay.
ANALYSES
Descriptive and bivariate analyses were performed. A χ test was used for categorical variables. The Mann-Whitney U test was used for continuous variables. Statistical significance was P < .05.
RESULTS
The sample was composed of 168 subjects with a mean age of 42.8 ± 21.5 and 69 (48.6%) subjects were male. There were 11 (6.5%) subjects with a qSOFA score > 0. The relative risk of a qSOFA > 0 for a deep OI is 5.4 times greater than for a superficial OI (136 (95.8) versus 21 (80.8%): RR (95% confidence interval): 5.4 (1.51 to 19.27), P = .004). After adjusting for age, sex, American Society of Anesthesiologists score, and involved anatomical spaces, there was a significant correlation between laterality and the number of involved anatomical spaces and qSOFA score (odd ratio = 9.13, 95% confidence interval: 2.48 to 33.55, adjusted P = <.001).
CONCLUSION AND RELEVANCE
The study findings suggest that the OI location is associated with the qSOFA score >0.
PubMed: 38621664
DOI: 10.1016/j.joms.2024.03.028 -
Journal of Medical Case Reports Feb 2020Papillary breast lesions may be benign, atypical, and malignant lesions. Pathological and clinical differentiation of breast papillomas can be a challenge. Unlike...
BACKGROUND
Papillary breast lesions may be benign, atypical, and malignant lesions. Pathological and clinical differentiation of breast papillomas can be a challenge. Unlike malignant lesions, benign breast papillomas are not classically associated with lymph node and distant metastasis. We report a unique case of a recurrent, benign breast papilloma presenting as an aggressive malignant tumor.
CASE PRESENTATION
Our patient was a 56-year-old postmenopausal African American woman who was followed in the breast clinic with a long history of multiple breast papillomas. She underwent multiple resections over the course of 7-9 years. After being lost to follow-up for 2 years, she once again presented with a slowly enlarging left breast mass. Subsequent imaging revealed a predominantly cystic mass in the left breast, as well as a suspicious hypermetabolic internal mammary node and a hypermetabolic nodule in the pretracheal space. Biopsy of the internal mammary node demonstrated papillary neoplasm with benign morphology and immunostains positive for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2/Neu. Due to the clinical picture concerning for malignancy, the patient was then started on endocrine therapy with palbociclib and letrozole before surgery. She then underwent simple mastectomy and sentinel lymph node dissection with negative nodes and pathology once again revealing benign papillary neoplasm. She underwent adjuvant chest wall radiation for 6 weeks and received letrozole following completion of her radiation therapy. She was without evidence of disease 30 months after surgery.
CONCLUSIONS
We present an unusual case of multiple recurrent peripheral papillomas with entirely benign histologic features exhibiting malignant behavior over a protracted period of many years, with an invasion of pectoralis musculature and possibly internal mammary and mediastinal nodes. Her treatment course included multiple surgeries (ultimately mastectomy), radiation therapy, and endocrine therapy.
Topics: Antineoplastic Agents; Breast Neoplasms; Female; Humans; Letrozole; Lymph Node Excision; Magnetic Resonance Imaging; Mastectomy; Middle Aged; Neoplasm Recurrence, Local; Papilloma, Intraductal; Radiotherapy; Tomography, X-Ray Computed
PubMed: 32070435
DOI: 10.1186/s13256-020-2354-7 -
Journal of Laparoendoscopic & Advanced... Jul 2015Natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and...
BACKGROUND
Natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) is an improvement in surgical interventions. In this study we developed an innovative transtracheal endoscopic thyroidectomy technique and explored its feasibility in animal models.
MATERIALS AND METHODS
Transtracheal endoscopic thyroidectomy was performed in anesthetized dogs and pigs. The endoscope was advanced into the pretracheal space via a longitudinal incision on the anterior tracheal wall. Hemithyroidectomies and partial lobectomy were performed using special double-lumen endotracheal tubes and conventional endoscopic instruments. The tracheal wall incision was closed using absorbable sutures, and the animals were sacrificed at Day 5 postsurgery.
RESULTS
Hemithyroidectomy and partial thyroidectomy were successfully performed on pigs and dogs. The average operative time for each model was 69.4 minutes. No significant complications were encountered during surgery.
CONCLUSIONS
The transtracheal endoscopic thyroidectomy technique is feasible and has the potential to be an alternative method for other types of thyroid surgeries.
Topics: Animals; Dogs; Feasibility Studies; Female; Male; Natural Orifice Endoscopic Surgery; Operative Time; Sutures; Swine; Thyroidectomy; Tracheotomy
PubMed: 26075801
DOI: 10.1089/lap.2014.0452 -
The Annals of Thoracic Surgery Jun 2021Descending necrotizing mediastinitis is a life-threatening disease that extends into the pretracheal, perivascular, retrovisceral, and/or prevertebral spaces, generally...
Descending necrotizing mediastinitis is a life-threatening disease that extends into the pretracheal, perivascular, retrovisceral, and/or prevertebral spaces, generally sparing the esophagus. We report a case of deep neck abscess complicated by phlegmonous esophagitis and mediastinitis. The patient was successfully treated with antibiotics and surgery, combining transcervical and bilateral thoracoscopic transthoracic mediastinal drainage. However, a pseudo-lumen with a large amount of pus remained in the esophagus. The septum between the true and the pseudo-lumen was cut endoscopically, after which the patient recovered well without any complications.
Topics: Abscess; Cellulitis; Esophagitis; Female; Firmicutes; Gram-Positive Bacterial Infections; Humans; Mediastinitis; Middle Aged; Neck
PubMed: 33232726
DOI: 10.1016/j.athoracsur.2020.08.101 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Sep 2015To review the recent diagnosis and treatment experience with deep neck infection and emphasize the importance of radiologic evaluation, microbiology and appropriate...
OBJECTIVE
To review the recent diagnosis and treatment experience with deep neck infection and emphasize the importance of radiologic evaluation, microbiology and appropriate treatment selection in these patients.
METHODS
A respective review was conducted in 95 cases who were diagnosed as having deep neck from Jan. 2006 to March 2015.
RESULTS
The primary diseases in 95 patients with deep neck infection were acute tonsillitis or acute laryngitis (27 cases), infection of upper respiratory tract (23 cases), odontogenic infection or oral inflammation (16 cases), foreign bodies in esophagus (9 cases), acute cervical lymphadenitis (5 cases) and cause uncertain (15 cases). Computed tomography was performed in all of patients to identify the location, extent, and character (cellulitis in 47 cases or abscesses in 48 cases) of the infections. The locations of abscess were parapharyngeal abscess (25 cases), retropharyngeal abscess (9 cases), submaxillary space abscess (6 cases), pretracheal space abscess (5 cases) and esophageal abscess (3 cases).
COMPLICATIONS
mediastinitis (2 cases), pericarditis (1 case), bilateral pneumothorax (2 cases), and upper digestive tract (1 case). Bacterial cultivation performed in 35 patients and positive results were detected in 21. All patients were given intravenous antibiotic therapy. Tracheotomy was performed in 4 cases. Preoperative contrast enhanced CT was performed in 42 patients and indicated the formation of abscess. Three cases with the symptoms of septic shock were transferred to ICU and one was cured. All the patients were cured except two who died of massive hemorrhage of upper digestive tract and septic shock.
CONCLUSIONS
The airway patency in patients with deep neck infections must be ensured. Drainage may be mandatory in selected cases at presentation or in cases who fail to respond to parenteral antibiotics within the first 24-48 hours. Imaging evaluation plays a significant role in the diagnosis and rational therapeutic management in deep neck infection. Bacterial cultivation can help to make the effective treatment and provide reliable evidence for the etiopathogenisis.
Topics: Anti-Bacterial Agents; Bacterial Infections; Cellulitis; Drainage; Esophagus; Foreign Bodies; Humans; Laryngitis; Neck; Retropharyngeal Abscess; Retrospective Studies; Tomography, X-Ray Computed; Tonsillitis; Treatment Outcome
PubMed: 26696352
DOI: No ID Found -
Journal of Visualized Experiments : JoVE Dec 2014Thymectomy in neonatal rodents is an established and reliable procedure for immunological studies. However, in adult rats, complications of hemorrhage and pneumothorax...
Thymectomy in neonatal rodents is an established and reliable procedure for immunological studies. However, in adult rats, complications of hemorrhage and pneumothorax from pleural disruption can result in a significant mortality rate. This protocol is a simple method of rat thymectomy that utilizes a mini-sternotomy and endotracheal intubation. Intubation is accomplished with a non-invasive and easily reproducible method and allows for positive pressure ventilation to prevent pneumothorax and a controlled airway that allows sufficient time for careful thymus dissection to minimize pleural disruption. A 1.5 cm sternal incision decreases contact with mediastinal vessels and pleura, while still providing full visualization of the thymus. Following exposure of the mediastinum, the thymus is removed by blunt dissection under magnification. The pleural space is then sealed by suture closure of the pre-tracheal muscles followed by the application of surgical glue. The thorax is then closed by suture closure of the sternum, followed by suture closure of the skin. All thymectomies were complete as evidenced by immunohistochemical (IHC) staining of mediastinal tissue, and absence of naïve T-cells by flow cytometry, and the procedure had a 96% survival rate. This method is suitable when complete thymectomy with minimal complications is desired for further immunological studies in athymic adult rats.
Topics: Animals; Intubation, Intratracheal; Rats; Thymectomy
PubMed: 25590868
DOI: 10.3791/52152 -
Cureus Sep 2022Ectopic thyroid is a rare clinical presentation to encounter in day-to-day clinical practice. It occurs due to developmental defects in the early stages of the thyroid...
Ectopic thyroid is a rare clinical presentation to encounter in day-to-day clinical practice. It occurs due to developmental defects in the early stages of the thyroid gland embryogenesis during its descent from the floor of the primitive foregut to its final pre-tracheal position. It is usually present along the extent of the thyroglossal duct as well as in distant locations such as sub-diaphragmatic or mediastinal spaces. The diverse clinical presentation of this rare entity often causes a diagnostic dilemma. A thyroid scintigraphy scan is pivotal in the diagnosis of ectopy, but ultrasonography is done more frequently. Surgical management is preferred for symptomatic cases, followed by radioactive iodine ablation and levothyroxine supportive therapy for refractory cases. We present a case of a 62-year-old female patient who presented with pain and swelling of the right submandibular region. On ultrasonography, a 5*4 cm firm mobile swelling of the right submandibular region was found, suggestive of right submandibular sialadenitis. Fine needle aspiration cytology (FNAC) was subsequently done, and it showed features of basaloid neoplasm like pleomorphic adenoma, and as the thyroid tissue was in an ectopic location, it must have been misdiagnosed. The patient was then taken up for right submandibular sialoadenectomy, and the histopathological examination of the operative specimen showed nodular colloidal goiter and mild chronic sialadenitis. Ectopic thyroid can present at various anatomical locations and thereby has varied clinical presentations which makes it a diagnostic dilemma for clinicians. The usual radiological investigations done include USG and CT scan, whereas thyroid scintigraphy is more precise in reaching the diagnosis of ectopic thyroid. The confirmatory diagnostic method is the histopathological examination of the excised specimen. Most cases of ectopic thyroid are asymptomatic and require regular follow-up. Symptomatic cases are managed by surgical excision followed by periodic monitoring and adequate thyroxine replacement.
PubMed: 36204041
DOI: 10.7759/cureus.28717 -
The Journal of Laryngology and Otology Sep 2017To identify deep neck infection factors related to life-threatening complications.
Univariate and multivariate models for the prediction of life-threatening complications in 586 cases of deep neck space infections: retrospective multi-institutional study.
OBJECTIVE
To identify deep neck infection factors related to life-threatening complications.
METHODS
This retrospective multi-institutional study comprised 586 patients treated for deep neck infections between 2002 and 2012. The statistical significance of variables associated with life-threatening complications of deep neck infections was assessed.
RESULTS
During treatment, life-threatening complications occurred in 60 out of 586 cases. On univariate analysis, life-threatening complications were linked to: dyspnoea, neck movement disturbance and dysphonia (all p < 0.001); and parapharyngeal, anterior visceral or pretracheal deep neck involvement (all p < 0.002). Aetiology was significantly linked to tonsils (p < 0.001). Regarding infection type, fasciitis was a significant factor (p < 0.001). Candida albicans was a significant bacterial culture (p < 0.001). A multivariate step-wise model disclosed fewer significant variables: retropharyngeal space (p = 0.005) and major blood vessels area (p = 0.006) involvement, and bacterial culture C albicans (p < 0.001).
CONCLUSION
It can be predicted that patients with deep neck infections, with neck movement disturbances, dysphonia, dyspnoea and swelling of the external neck, accompanied by severe pain, and inflammatory changes in the retropharyngeal space and large vessel areas, with culture-confirmed infection of C albicans, are likely to develop life-threatening complications.
Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Female; Humans; Male; Middle Aged; Models, Theoretical; Neck; Retrospective Studies; Severity of Illness Index; Survival Analysis; Young Adult
PubMed: 28578716
DOI: 10.1017/S0022215117001153