2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Eur Arch Otorhinolaryngol (2012) 269:1241–1249

upper aerodigestive tract flora and includes both aerobic and anaerobic microorganisms. As a consequence, the microbiology of DNIs is similar and no correlation usually exists between the anatomical region and microbiology of the infection [ 3 ]. The management of DNIs requires a multidisciplinary approach including head and neck surgeon, thoracic sur- geon, infectious disease specialist, and radiologist. The aims of this investigation were to review the clinical behavior of DNIs treated in our institution in order to propose valuable recommendations for management and identify the predisposing factors of life-threatening complications. This is an observational descriptive retrospective study of all cases of DNIs treated at the Department of Surgery, Treviso Regional Hospital over a period of 15 years (between May 1995 and November 2010). Clinical charts, imaging and bacteriologic studies were reviewed. Patients with head and neck cancer, peritonsillar cellulitis or abscess, and post-traumatic infections were not included in the study. The following variables were reviewed: demographic and clinical data, associated sys- temic diseases, bacteriology, imaging studies, source, site, and character of the infections, medical and surgical treatment, complications, and outcome. The infection was categorized according to the character of infections (cellulitis vs. abscess) and to the involved spaces (submandibular space, lateral pharyngeal space, retropharyngeal space, prevertebral space, parotid space, masticatory space, temporal space, visceral vascular space, anterior visceral space) according to Levitt [ 4 ]. Patients with involvement of two or more spaces were classified as having multiple spaces infection. The reference ranges for standard values at our labora- tory were 4 9 10 3 –11 9 10 3 /mm 3 for white blood cell count (WBC), 1.8 9 10 3 –8 9 10 3 /mm 3 for neutrophil count, 1 9 10 3 –4.5 9 10 3 /mm 3 for lymphocytic count, 0–10 mm/h for erythrosedimentation rate (ESR), and less than 0.5 mg/dL for C-reactive protein (CRP). Descriptive data are reported as median, range, and percentages, as appropriate. Data were recorded from all patients unless otherwise specified. Following parameters were analyzed in order to identify potential risk factors for life-threatening complications: gender, age, body temper- ature, WBC, diabetes mellitus, character of infection, multiple space involvement. A multivariate logistic regression analysis was undertaken using a forward step- wise technique, in which including significant risk factors Patients and methods

in univariate analysis, in order to identify independent risk factors for complications. Statistical analysis was per- formed using the SPSS/PC software package (SPSS Inc., Chicago, IL, USA).

Results

Demographic and clinical data

A total of 365 adult patients with DNI were identified for this evaluation. The 365 patients consisted of 205 males (56.2%) and 160 females (43.8%) ranging in age from 18 to 96 years (median 52). Patients were symptomatic for a median of 5.5 days prior to admission to our institution ranged from 1 to 22 days. On admission neck swelling ( n = 340; 93.2%), throat pain ( n = 205; 56.2%), and dysphagia ( n = 201; 55.1%) were the most common symptoms. Other symptoms and signs included fever ( n = 257; 70.4%), swelling of the upper aero-digestive tract ( n = 218; 59.7%), dyspnea ( n = 54; 14.8%), neck stiffness ( n = 54; 14.8%), trismus ( n = 51; 14.0%), dysphonia ( n = 50; 13.7%), and otalgia ( n = 19; 5.2%). The total WBC count (median 11.8 9 10 3 /mm 3 ; range 2.5–33.6 9 10 3 /mm 3 ) was increased above the upper limit of normal in 171 cases (46.8%), normal in 192 cases (52.6%), and under the lower limit of normal in two cases. Neutrophil count (median 8.7 9 10 3 /mm 3 , range 1.1–26.9 9 10 3 /mm 3 , rate of unknown data 16.4%) was increased above the upper limit of normal in 172 cases (56.4%), normal in 129 cases (42.3%), and under the lower limit of normal in 4 cases. Lymphocytic count (median 1.4 9 10 3 /mm 3 , range 0.1–6.2 9 10 3 /mm 3 , rate of unknown data 16.4%) was decreased under the lower limit of normal in 76 cases (24.9%), normal in 224 cases (73.4%), and above the upper limit of normal in 5 cases. ESR (median 50 mm/h, range 2–140 mm/h, rate of unknown data 26.8%) and CRP concentration (median 17.5 mg/dL, range 2–45 mg/dL, rate of unknown data 56.2%) were elevated above the upper limit of normal in 260 cases (97.4%) and in all cases, respectively.

Comorbidity

Eighty-two patients (22.5%) had relevant associated sys- temic disorders including cardiovascular diseases ( n = 53), diabetes mellitus ( n = 52), pulmonary diseases ( n = 14), liver diseases ( n = 13), hematological diseases ( n = 13), renal diseases ( n = 5), connective tissue diseases ( n = 3).

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