Features of course and surgical treatment of tonsillogenic neck phlegmons and mediastinitis
Background. The problem of adequate treatment for deep neck and mediastinal suppuration is one of the most difficult in surgery. It leads to such complications as mediastinitis, sepsis, arrosive bleeding, etc. The purpose was to investigate clinical, diagnostic and treatment features in patients with neck phlegmons and mediastinitis caused by pharyngeal suppurations. Materials and methods. The results of treatment of 31 patients with parapharyngeal phlegmons were presented. The average age of them was 48.24 ± 15.60 years, men were 18 (58 %), women — 13 (42 %). All persons suffered from severe endogenous intoxication. The time from the onset of the disease to surgery was about 4 days (from one to seven). Results. Most frequently, parapharyngeal suppuration was detected — in 16 (51.6 %) patients, then paratonsillar abscesses — in 11 (35.5 %), retropharyngeal suppurations — in 3 (9.7 %), and laryngeal cancer — in 1 (3.2 %). Lateral neck radiographs were performed in all patients preoperatively. Sensitivity of this investigation was 100 %. At the same time, chest X-ray to detect mediastinitis showed low rates of sensitivity — 60 %. Surgical approaches included extensive cervicotomy (often bilateral) and penetrative polydrainage of prevertebral space. Mediastinitis was found in 15 cases (48.4 %). It was enough to use blind drainage for upper posterior mediastinitis (11 cases, or 73.3 %). Right-sided thoracotomy was performed in one case of total posterior mediastinitis. Four patients died (13 %). Descending mediastinitis and sepsis were found in all lethal cases. Mortality rate in the group of patients with mediastinitis was 26.7 %. Conclusions. Neck phlegmons as a result of parapharyngeal suppuration are characterized by an aggressive course with significant endogenous intoxication and spread to the mediastinum in 48.4 % of cases with a lethality of 13 %. The lateral neck X-ray must be performed to all patients with suspicion of a deep neck phlegmon. In most cases (80 %), suppuration spreads from the parapharyngeal spaces to posterior mediastinum, which should be taken into account when opening purulent abscesses.
Full Text:PDF (Українська)
Svistushkin, V. M., & Mustafaev, D. M. (2013) Parafaringit, tonzillogennyj sepsis: osobennosti patogeneza, klinicheskaya kartina i sovremennye predstavleniya o lechenii [Parapharingitis, tonsillogenic sepsis: peculiarities of pathogenesis, clinical picture, and modern approaches to the treatment]. Vestnik Otorinolaringologii [Bulletin of Otorhinolaryngology], 78 (3), 29-34. [in Russian].
Shevchuk, І. М., & Snizhko, S. S. (2017) Prychyny ta shliakhy poshyrennia flehmony chyi na seredostinnia z vynyknenniam nyzkhidnoho hniinoho mediastynitu [Causes and ways of the neck phlegmon spreading on mediastinum with a descending purulent mediastinitis occurrence]. Klinicheskaia Khirurgiia [Clinical surgery], 897 (1), 36-38. [in Ukrainian].
Sapunar, Z. J., Cabello, V. A., & Godoy, R. E. (2008) Retropharyngeal phlegmon caused by a group B Streptococcus in a diabetic patient: report of one case. Rev Med Chil, 136 (3), 351-355. doi: /S0034-98872008000300011.
Cheng, Z., Yu, J., Xiao, L., Lian, Z., Wei, Y., & Wang, J. (2015) Deep neck infection: clinical analyses of 95 cases. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 50(9), 769-772. doi: 10.3760 / cma.j.issn.1673-0860.2015.09.014 [in Chinese].
Yang, W., Hu, l., Wang, Z., Nie, G., Li, X., Lin, D., Luo, J., Qin, H., Wu, J., Wen, W., & Lei, W. (2015) Deep Neck Infection: A Review of 130 Cases in Southern China. Medicine (Baltimore), 94 (27), e994. doi: 10.1097/MD.0000000000000994
Kalashnik Yu. M., Chigirik A. A. (2014) Tonzillogennyie flegmonyi shei [Tonsillogenic neck phlegmons]. Medytsyna tretoho tysiacholittia: zb. tez mizhvuz. konf. molodykh vchenykh ta studentiv. Kharkiv, 2014, pp.110-111. [In Russian].
Abakumov, M. M. (2004) Gnojnyj mediastinit [Purulent mediastinitis]. Hirurgija [Surgery], 5, 82-85. [in Russian].
Dobrokvashin, S. V., Mustafin, R. R., Hakimov, A. G., Bolshakov, D. V., Minnemullin, R. K., & Demyanov, S. L. (2014) Taktika hirurgicheskogo lecheniya bolnyih ostryim mediastinitom [Surgical treatment of patients with acute mediastinitis]. Vestnik sovremennoy klinicheskoy meditsinyi [The Bulletin of Contemporary Clinical Medicine], 7 (1), 64-67. [in Russian].
Morozova, M. N. (2014) Shkaly otsenki tyazhesti sostoyaniya patsientov s odontogennymi flegmonami [Scales of estimation of weight of the state of patients in cases of odontogenous]. Visnyk problem biologiyi i medyczyny [Reports of problems of biology and medicine], 4, 341-345. [in Russian].
Copyright (c) 2018 UKRAINIAN JOURNAL OF SURGERY
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2018