Thesis--University of Turku, 1986. / Also published in: Proceedings of the Finnish Dental Society, 1986, Vol. 82, Suppl. VII. Includes bibliographical references.

Thesis--University of Turku, 1986. / Also published in: Proceedings of the Finnish Dental Society, 1986, Vol. 82, Suppl. VII. Includes bibliographical references.

Magister Scientiae Dentium - MSc(Dent) / Purpose: To assess the value of postoperative CT scans in the management of severe cervicofacial infections or deep neck abscesses. Patients and Methods: Thirteen patients underwent post-operative contrast enhanced CT scans after initial incision and drainage followed by a tracheostomy. As per surgical protocol, the CT scans were taken with radiopaque surgical drains in situ from the brain down to the mediastinum and chest/lungs. Data were collected on the presence of abscesses, their location, the location of surgical drains and presence of other pathology. Results: The most common initially affected space was the submandibular space (69%), followed by the submental space (62%). Almost half of the cases studied had two spaces affected and slightly less than a third had three spaces affected. Slightly more than half (54%) of the patients were in good health generally. More than a third (38.5%) of the patients were HIV positive, and thus immuno-compromised. The mean time lapse between the CT and surgery was 2.61 days (SD = 1.56). In the majority (69.23%) of post-operative scans a residual pus collection was found. In just over a quarter (30.8 %) of the patients no residual pus collection was detected on the postoperative CT scan, while in seven patients (53.8%) affected fascial spaces were missed by the surgeon. These spaces included the submasseteric, anteriormediastinum and parotid spaces. Almost half (44.15%) of the patients required a repeatincision and drainage. Conclusion: This study demonstrates clinical value of post-operative CT scans in severe cervicofacial infections. This study also advances the argument for acquisition of preoperative CECT scans for all patients with severe cervicofacial infection.

Necrotizing fasciitis (NF) is a critical and rapidly progressive infection of the skin and soft tissue, and it is associated with a high mortality rate. NF of the cervicofacial region is uncommon due to the rich vascular supply of the head and neck, which promotes an efficient immune response to infection. Patients who are immunocompromised or have comorbidities affecting the vasculature, such as diabetes mellitus or peripheral vascular disease, are at an increased risk of more severe disease and outcome. Cervicofacial necrotizing fasciitis (CNF) is most frequently attributed to mucosal damage, such as those related to dental infections or local trauma including medical procedures. Due to its ability to quickly spread to the neck and mediastinum, CNF must be diagnosed and treated expeditiously. In this report, we present a case of a 28-year-old female with a past medical history significant for obesity and tobacco abuse who presented to the emergency department (ED) with fever, left-sided facial pain, cervical pain, and swelling. She had worsening symptoms despite current treatment with clindamycin for a dental abscess. A CT scan of the head and neck revealed an odontogenic abscess complicated by CNF. Intravenous antibiotics were initiated and she underwent prompt surgical intervention. She remained nasally intubated following her surgery due to concern for postoperative edema leading to airway compromise. Following extubation, she experienced an uncomplicated recovery. This case demonstrates that NF is a complication of dental infection that may occur even in young and relatively healthy patients. Additionally, due to the swiftly destructive nature and high mortality rate of CNF, early diagnosis and aggressive medical and surgical therapy are essential to reduce morbidity and mortality.

Reproduction de : Thèse de doctorat : Odontologie. Biomatériaux : Nantes : 2007. / Bibliogr.

Reproduction de : Thèse d' exercice : Médecine spécialisée : Nancy 1 : 2002. / Thèse : 2002NAN11092. Titre provenant de l'écran-titre.