Search

Author(s): Hélène Nougué [sup.1], Anne-Laure Le Maho [sup.1], Mourad Boudiaf [sup.2], Jean-Philippe Blancal [sup.3], Etienne Gayat [sup.1], Mathieu Le Dorze [sup.1], Fabrice Vallée [sup.1], Benjamin Verillaud [sup.3], Joaquim Mateo [sup.1], [...], Purpose Cervical necrotizing fasciitis (CNF) is a severe and debilitating disease that requires intensive care unit (ICU) management and prompt surgical treatment to reduce morbidity and mortality. The aim of this study was to estimate the incidence and factors associated with severe complications of CNF. Methods We reviewed the medical records of consecutive patients hospitalized in an ICU from 2007 to 2012. The data were collected retrospectively; initial cervical and thoracic computed tomography (CT) scans, performed on admission, were reviewed by an experienced and blinded radiologist to determine CNF complications. Results A cohort of 160 patients admitted for CNF was included. The following complications of CNF were found: bilateral extension of CNF (28 %), internal jugular vein thrombosis (21 %), descending necrotic effusion (14 %), mediastinitis (24 %), and mortality (4 %); 53 % had at least one complication, and 48 % had at least one cervical complication. On the basis of a univariate analysis, the significant independent factors are odynophagia, dyspnea, oral glucocorticoids intake before admission, and pharyngeal source. Oral nonsteroidal anti-inflammatory drug intake before admission does not have any impact. The initial CNF complications increased both the duration of mechanical ventilation and the length of stay in the ICU. On the basis of a multivariate analysis, the independent factors for severe complications are pharyngeal CNF and oral glucocorticoid intake before admission. Conclusions Our study demonstrated that an initial cervico-thoracic CT scan revealed a high incidence of cervical and mediastinal CNF complications that all needed immediate management. Those severe complications might be avoidable as they were associated, at least partially, with prehospital oral glucocorticoid intake.

Background Ethmoid sinus osteomas are uncommon, benign, osteogenic tumors. The purpose of this retrospective study was to describe their usual clinical presentation and to discuss their surgical management. Methods The medical records of 25 patients treated for ethmoid osteoma between March 2001 and December 2010 were retrospectively reviewed. Results The average tumor size was 18.5 ± 14 mm. Only 3 patients were asymptomatic, 14 had a history of frontal sinusitis (complicated with orbital cellulitis in 4 cases), and 4 patients presented with diplopia. An endoscopic approach was performed in 19 cases, a coronal approach in 4 cases, and a combined approach (endoscopic + coronal) in 2 cases. No recurrence was reported. Conclusion Ethmoid sinus osteoma can be asymptomatic and detected incidentally on CT scans, but often causes frontal sinusitis and orbital complications. The endoscopic approach offers the possibility of safe removal with cosmetic advantages compared to coronal approach. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Background: We conducted a study to determine factors associated with the occurrence of mediastinitis in patients hospitalized for cervical necrotizing fasciitis (CNF). Methods: We reviewed the medical records of 130 consecutive patients in an intensive care unit (ICU) who were hospitalized with a diagnosis of CNF. Two radiologists reviewed cervical and thoracic computed tomography (CT) scans to determine the source and extension of the infection in each patient. Results: Among the cohort of 130 patients with CNF, 37 (28%) had mediastinitis at the time of their admission (which in 13 cases was superior, or above the aortic arch, and in 24 cases inferior). Cervical necrotizing fasciitis complicated by mediastinitis resulted in a longer stay in the ICU than did CNF without mediastinitis, of a mean of 29 days (range, 18 to 39 days) versus 14 days (range, 9 to 19) days, respectively (p < 0.0001). Multivariate analysis revealed that the presence of mediastinitis was associated with oral intake of glucocorticoids before admission (odds ratio [OR], 2.17; range, 0.99 to 4.76), a pharyngeal focus of CNF (OR, 2.17; range, 1.04 to 4.53), or gas seen on an initial CT scan (OR, 4.49; range, 2.15 to 9.38). Both a pharyngeal focus of fasciitis and the presence of gas were strong independent predictors of inferior mediastinitis (OR, 15.1; range, 4.9 to 46.4; p < 0.0001). Conclusions: The present study is the first to describe three independent factors associated with extension of cervical fasciitis to the thoracic cavity, including glucocorticoid intake before admission, and confirms previous reports of a high incidence of mediastinitis in patients with CNF. [ABSTRACT FROM AUTHOR]