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Comparison of intubation and tracheotomy in patients with deep neck infection

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Possible airway compromise further complicates treatment of deep neck infections (DNI). Airway management is crucial, but factors affecting the method of choice are unclear. We retrospectively evaluated adult DNIs in a single tertiary center covering 10 years, with special attention on airway management. Patient data were retrieved from electronic data files from 2007 to 2016, and included adult patients with DNI operated through the neck. Of the 202 patients, 127 (63%) were male, with a median age of 47 years. Odontogenic (n = 74; 35%) infection was the most common etiology. Intubation was the most common method of airway management (n = 165; 82%), and most patients (n = 102; 50%) were extubated immediately after surgery. Tracheotomy was performed primarily for 35 (17%) patients, and secondarily for 25 (15%). Two patients were managed in local anesthesia. Altogether 80 (40%) patients required care in the intensive care unit for a median of 7 days. Median hospital stay was 6 days for intubated patients and 10 days for primarily tracheotomized (p = 0.036). DNI extended to the mediastinal space in 25 (12%) patients, most of whom with odontogenic infection (48%), and necrotizing fasciitis (32%). Odontogenic infection was the most common etiology for DNI with increased risk for mediastinal involvement. Intubation was most common type of airway management with high success in immediate extubation after surgery. The need for tracheotomy seemed to lead to a longer hospital care and was associated with a more severe clinical course.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, 00029, Helsinki, Finland

    Laura Tapiovaara, Leif Bäck & Katri Aro

  2. Department of Dentistry, University of California, Los Angeles, CA, USA

    Katri Aro

Authors
  1. Laura Tapiovaara
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  2. Leif Bäck
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  3. Katri Aro
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Correspondence to Laura Tapiovaara.

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Conflict of interest

Author LT declares that she has no conflict of interest. Author LB declares that he has no conflict of interest. Author KA declares that she has no conflict of interest.

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This article does not contain any studies with human or animal participants performed by any of the authors. This research involved only patient charts. For this type of study formal consent is not required.

Funding

This study was supported by grants from the Sigrid Jusélius Foundation and the Finnish Otorhinolaryngology Research Foundation.

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Tapiovaara, L., Bäck, L. & Aro, K. Comparison of intubation and tracheotomy in patients with deep neck infection. Eur Arch Otorhinolaryngol 274, 3767–3772 (2017). https://doi.org/10.1007/s00405-017-4694-5

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  • DOI: https://doi.org/10.1007/s00405-017-4694-5

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