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Ear, Nose, & Throat Journal Jun 2017Idiopathic pretracheal deep neck space infection is an extremely rare condition with potentially devastating complications. We present a series of 3 cases of pretracheal...
Idiopathic pretracheal deep neck space infection is an extremely rare condition with potentially devastating complications. We present a series of 3 cases of pretracheal deep neck space infection that arose in the absence of trauma or a congenital lesion and that exhibited mediastinal spread. To the best of our knowledge, these cases represent the first reported series of this rare condition to be published in the English-language literature. All cultures grew Streptococcus milleri, and all patients had a favorable outcome. A high index of suspicion for a deep neck space infection is warranted in view of the devastating complications of this condition. Computed tomography is the investigation of choice. Treatment with intravenous antibiotics and surgical drainage, particularly when mediastinitis is present, is recommended. This rare presentation warrants a thorough investigation to identify the source of infection.
Topics: Administration, Intravenous; Adult; Anti-Bacterial Agents; Drainage; Female; Humans; Male; Mediastinitis; Microbial Sensitivity Tests; Middle Aged; Neck; Neck Dissection; Soft Tissue Infections; Streptococcal Infections; Streptococcus milleri Group; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28636733
DOI: 10.1177/014556131709600622 -
Oral Oncology Mar 2022To assess the anatomical relationships and variations in the pretracheal space and to guide tracheotomy procedures in a safe manner with image-based evidence.
OBJECTIVES
To assess the anatomical relationships and variations in the pretracheal space and to guide tracheotomy procedures in a safe manner with image-based evidence.
MATERIALS AND METHODS
A retrospective study was conducted on unirradiated patients requiring elective tracheotomies. Preoperative contrast-enhanced CT (CECT)/CT venography (CTV) was applied for an anatomical evaluation of the pretracheal region. Vascular morphologies were compared for three vessels: the anterior jugular vein (AJV), the innominate artery (IA) and the inferior thyroid vascular plexus (ITVP). The relationships between the thyroid isthmus and the 2nd-4th tracheal rings were also analyzed.
RESULTS
A total of 120 patients were identified, most of whom (n = 110, 91.7%) had head and neck squamous cell carcinomas. Patients with recognizable AJVs (n = 118) were divided into 3 groups: single-branch (n = 11, 9.2%), double-branch (n = 105, 87.5%), and multibranch (n = 2, 1.7%). In addition, IAs were categorized as low-bifurcation (n = 51, 42.5%), high-bifurcation (n = 40, 33.3%), platform (n = 27, 22.5%) and variant types (n = 2, 1.7%). Within the platform types, high-lying IAs (n = 15, 8.3%) might have interfered with the standard tracheal incisions due to possible IA-tracheal overlay. This interference was also related to the height of intraoperative tracheal incisions (r = 0.364, P = 0.001). Within ITVPs, independent-trunk types were found in 71 cases (59.2%), while common-trunk types were found in 45 (37.5%). In addition, a low thyroid isthmus (suprasternal-isthmus distance <3 cm) was found in 83 cases (69.2%).
CONCLUSIONS
CT image-based evidence can prepare junior practitioners with important pretracheal anatomical information, thereby facilitating safer tracheotomy procedures. Our results shed light on vascular relationships for emergent tracheotomy.
Topics: Humans; Retrospective Studies; Tomography, X-Ray Computed; Trachea; Tracheostomy; Tracheotomy
PubMed: 35121399
DOI: 10.1016/j.oraloncology.2022.105719 -
European Archives of... May 2022Descending necrotizing mediastinitis (DNM) is the most serious complication of deep neck infections (DNI). The objective of this retrospective study was to evaluate...
OBJECTIVES
Descending necrotizing mediastinitis (DNM) is the most serious complication of deep neck infections (DNI). The objective of this retrospective study was to evaluate prognostic factors for DNM development in deep space neck infections.
METHODS
The study enrolled patients admitted to the Emergency Center of Vojvodina with the diagnosis of multispace DNI with or without DNM either as the primary diagnosis or with discharged diagnosis after surgical treatment during 7-year period. The data were obtained from patient medical records.
RESULTS
After final analysis total of 141 charts were randomized for statystical analysis, 124 charts in DNI and 17 in DNI + DNM groups. The most common cause of infection in both groups was odontogenic. On multivariate regression analysis of collected data infection of retropharyngeal, pretracheal and carotid space, C-reactive protein and procalcitonine values were statistically significant predictors for DNM development.
CONCLUSIONS
Treatment and diagnosis of DNM requires multidisciplinary approach, with prompt clinical and radiological examinations, empirical broad spectrum antibiotic therapy and radical surgical debridement. Multispace neck infection and especially infection of retropharyngeal, carotid and pretracheal spaces are the most sensitive predictors for DNM development in deep space neck infections.
CLINICAL RELEVANCE
If the infection from deep neck spaces reach retropharyngeal, carotid or pretracheal space, the DNM is probable to occur.
TRIAL REGISTRATION
ClinicalTrials.gov ID NCT04865003. Date of registration 27.4.2021.
Topics: Drainage; Humans; Mediastinitis; Neck; Necrosis; Prognosis; Retrospective Studies
PubMed: 34542654
DOI: 10.1007/s00405-021-07081-0 -
Biomedicine & Pharmacotherapy =... 2002We recently developed a new surgical technique for carrying out thyroidectomy, to minimize surgical invasiveness and improve the cosmetic result. Our procedure differs... (Review)
Review
We recently developed a new surgical technique for carrying out thyroidectomy, to minimize surgical invasiveness and improve the cosmetic result. Our procedure differs from conventional thyroidectomy in requiring a 3-cm skin incision and no raising of the skin flap. Since this technique decreased tissue trauma by obviating unnecessary neck exploration, hypesthesia or paresthesia in the neck and discomfort while swallowing, related to a large skin incision and raising of the skin flap, are minimized. Since thyroidectomy is performed after delivering the thyroid gland through the small skin incision, sufficient exposure for dissection of the pretracheal and paratracheal space can be obtained. Therefore, injuring the recurrent laryngeal nerve and the parathyroid gland can be avoided. Although the number of patients that we have treated in this manner is still small, we believe that our new procedure constitutes a useful surgical treatment for patients with thyroid disease.
Topics: Adult; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Thyroid Diseases; Thyroidectomy
PubMed: 12487254
DOI: 10.1016/s0753-3322(02)00257-3 -
AJR. American Journal of Roentgenology Feb 1981The ability of computed tomography to visualize the normal pretracheal retrocaval (PTRC) space and its contents, at the level of the azygous arch, was investigated in... (Comparative Study)
Comparative Study
The ability of computed tomography to visualize the normal pretracheal retrocaval (PTRC) space and its contents, at the level of the azygous arch, was investigated in 127 normal subjects. The scan level which shows the azygous vein entering the posterior aspect of the superior vena cava was analyzed. The perimeter of the PTRC space could be accurately delineated by following the trachea, azygous arch, superior vena cava, and aorta. The size, density, and contents of the PTRC space were measured. The surface area of the PTRC space increases significantly with the degree of mediastinal adiposity (p less than 0.0001), age (p less than 0.0001), and aortic unfolding (p less than 0.001). The mean density of the PTRC space was negative in the majority of subjects but varied from -107 to +48 H. Normal lymph nodes (azygous nodes) were detected in 88.1% of subjects. More than one lymph node was present in 29.9% of subjects. Three nodes were visible in each of nine subjects. There were 160 lymph nodes with a diameter of 5.5 +/- 2.8 mm visable in the 127 subjects. Eleven nodes were larger than 10 mm. Normal azygous lymph nodes can be visualized and subtle enlargement of these nodes detected.
Topics: Adipose Tissue; Adult; Aged; Aorta, Thoracic; Azygos Vein; Female; Humans; Lymph Nodes; Male; Mediastinum; Middle Aged; Statistics as Topic; Tomography, X-Ray Computed
PubMed: 6781251
DOI: 10.2214/ajr.136.2.303 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Jun 2016To study the pathological and clinical features and the surgical results of the mass in the pretracheal space.
OBJECTIVE
To study the pathological and clinical features and the surgical results of the mass in the pretracheal space.
METHODS
From 1999 to 2004, 8 females and 3 males with an average of 43 years (from 32 to 61 years) were included CT scan, nuclear imaging, ultrasound and ultrasound-guided aspiration, endoscopic and laboratory measure were used in the evaluation for the masses before operation. Complete removal of mass was carried out in all patients under general anesthesia, and continuous negative pressure draining was routinely used.
RESULTS
Six masses with firm consistency could be moved easily transversely, but slightly moveable with swallowing. On contrast CT or ultrasound, all the masses had clear circumscription and showed rounded or lobular shape. No hemorrhage, chylous or lymph leakage, or recurrent laryngeal injury was encountered. Goiter was found in 6 cases, parathyroid adenoma in 2 cases, and thymoma, parathyroid cyst or lymphatic cyst was diagnosed in the rest three patients respectively. No recurrence was found with the following-up of 7 - 42 months.
CONCLUSIONS
Goiter, parathyroid adenoma and thymoma were common lesions presenting as mass in the pretracheal space and surgically curable without complications.
Topics: Adult; Cysts; Endoscopy; Female; Goiter; Humans; Male; Middle Aged; Parathyroid Diseases; Parathyroid Neoplasms; Thymoma; Tomography, X-Ray Computed; Ultrasonography
PubMed: 27345882
DOI: 10.3760/cma.j.issn.1673-0860.2016.06.010 -
Journal of Intensive Care Medicine 1995The tracheoarterial fistula is an unusual but devastating complication of tracheostomy. It occurs with a frequency of approximately 0.7%, and it is uniformly fatal if... (Review)
Review
The tracheoarterial fistula is an unusual but devastating complication of tracheostomy. It occurs with a frequency of approximately 0.7%, and it is uniformly fatal if not recognized and surgically corrected. Mucosal damage from the tracheal cannula, pressure necrosis from high cuff pressure, or mucosal trauma from an improperly positioned cannula tip results in erosion through the tracheal wall into the vascular structures that lie in the pretracheal space. Bleeding from this complication almost always occurs late (> 48 hours postprocedure). It is often preceded by sentinel hemoptysis. A paucity of signs and symptoms that precede or are associated with this complication require a high index of clinical suspicion to make the diagnosis. In addition to bleeding, other potential clues include a low-lying tracheostomy tube, pulsation of the tracheostomy tube, and the presence of infection, hypotension, malnutrition, and corticosteroid use. Unfortunately, there are no consistently useful diagnostic tools for tracheoarterial fistula. Fiberoptic bronchoscopy and angiography have been performed with mixed results. Should no other cause be found to explain the hemorrhage from or around the tracheostomy, or from disease distal to the primary carina, the patient must be taken to the operating room for a more definitive examination and possible vascular repair. Management is divided into acute stabilization and support, with protection of the airway and restoration of circulating blood volume, followed by definitive repair should the patient survive. Measures to prevent tracheal damage by the tracheostomy tube, such as proper surgical technique and proper inflation of the tracheostomy tube cuff, may go a long way to avoid this potentially lethal complication. Early consideration of this entity may be what saves the life of its victim.
Topics: Brachiocephalic Trunk; Critical Care; Fistula; Hemorrhage; Humans; Tracheal Diseases; Tracheostomy; Vascular Diseases
PubMed: 10155173
DOI: 10.1177/088506669501000203 -
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 -
Surgery, Gynecology & Obstetrics Sep 1957
Topics: Humans; Neck; Trachea; Tracheotomy; Vascular Malformations
PubMed: 13467665
DOI: No ID Found