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Prognostic factors for descending necrotizing mediastinitis development in deep space neck infections—a retrospective study

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Abstract

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.

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Funding

The authors declare that the work reported in this paper was not supported by any person or organisation.

Author information

Authors and Affiliations

  1. Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Hajduk Veljkova 1-9, 21000, Novi Sad, Serbia

    Denis Brajkovic & Aleksandar Kiralj

  2. Faculty of Medicine, Department for Dentistry and Maxillofacial Surgery, University of Novi Sad, Novi Sad, Serbia

    Denis Brajkovic & Aleksandar Kiralj

  3. Clinical Center of Vojvodina, Clinic for Anesthesiology, Intensive Care and Pain Management, Novi Sad, Serbia

    Severina Zjalić

Authors
  1. Denis Brajkovic
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  2. Severina Zjalić
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  3. Aleksandar Kiralj
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DB, SZ and AK. The first draft of the manuscript was written by DB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Denis Brajkovic.

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Conflict of interest

Author D.B. declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Author S.Z. declares that she has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Author A.K. declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical approval

Approval was obtained from the ethics committee of Clinical center of Vojvodina. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Informed consent

For this type of study, formal consent is not required.

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Brajkovic, D., Zjalić, S. & Kiralj, A. Prognostic factors for descending necrotizing mediastinitis development in deep space neck infections—a retrospective study. Eur Arch Otorhinolaryngol 279, 2641–2649 (2022). https://doi.org/10.1007/s00405-021-07081-0

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  • DOI: https://doi.org/10.1007/s00405-021-07081-0

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