Predictive factors in difficult postoperative airway management of severe odontogenic deep neck infection.

Autor: Iwata E; Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. eiwata@med.kobe-u.ac.jp.; Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan. eiwata@med.kobe-u.ac.jp., Inokuchi G; Department of Otolaryngology, Kakogawa Central City Hospital, Kakogawa, Japan., Kawakami M; Department of Anesthesiology, Kakogawa Central City Hospital, Kakogawa, Japan., Matsui T; Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan., Kusumoto J; Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan., Tachibana A; Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan., Akashi M; Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Jazyk: angličtina
Zdroj: Odontology [Odontology] 2024 Dec 14. Date of Electronic Publication: 2024 Dec 14.
DOI: 10.1007/s10266-024-01041-w
Abstrakt: In this study, we aimed to identify risk factors that predict the postoperative need for advanced or prolonged airway management in patients with severe odontogenic deep neck infections (DNIs). This retrospective case-control study included patients of both sexes aged ≥ 18 years who had undergone surgical drainage including debridement of necrotic tissues of odontogenic deep neck abscesses and necrotizing soft tissue infection under general anesthesia between April 2016 and September 2023 at a single center. The patients' characteristics, laboratory tests, and computed tomography (CT) findings were analyzed and compared between the difficult postoperative airway group, which required prolonged intubation or tracheostomy, and the short-term intubation group. Statistical significance was set at P < 0.05. Sixty-four patients required surgical drainage including debridement under general anesthesia. Of them, 7 (10.9%) patients were included in the difficult postoperative airway group. In addition to increased inflammatory markers, the presence of arytenoid edema among laryngeal edema and retro- and parapharyngeal space abscesses on preoperative CT images were identified as risk factors. The presence of pharyngeal space abscesses was significantly associated with laryngeal edema, and the intubation period was longer in patients with more elements relevant to these two factors. Thus, the presence of pharyngeal space abscesses and degree of laryngeal edema on preoperative CT images can be used to predict the complexity of postoperative airway management. Our results suggest that tracheostomy is preferable for patients with retropharyngeal space abscesses, and that patients with parapharyngeal space abscesses and laryngeal edema are desirable to undergo prolonged intubation.
Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: This study was conducted in accordance with the 1964 Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board (IRB) of Kakogawa Central City Hospital (authorization number: 2019–85). The ethics committee approved the study and gave us administrative permission to access the data used in this study. Since this was a retrospective study, the research plan was published on the homepage of the participating hospitals according to the instructions of the IRB, in accordance with the guaranteed opt-out opportunity. Informed consent: For this type of study, formal consent is not required.
(© 2024. The Author(s).)
Databáze: MEDLINE
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