| PURPOSE: Descending necrotizing mediastinitis is one of the most common complications of maxillofacial and cervical multiple space infections,and its mortality rate is high.The aim of this study is to campare clinical information of maxillofacial multiple space infection patients with or without descending necrotic mediastinitis,to analyze the risk factors for descending necrotic mediastinitis,so as to provide clinical support for early diagnosis and treatment for descending necrotic mediastinitisMETHODS: This study was divided into two parts: retrospective cohort study and prospective cohort study.Through the retrospective analysis,the data of the patients diagnosed with maxillofacial and cervical multiple space infections with/without descending necrotizing mediastinitis and hospitalized at Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine during January 2012 to October 2016 were collected.Data included age,gender,comorbidities(diabetes,hypertension,etc.),sources of infection(odontogenic,glandular origin etc.),CT imaging(name of affected spaces and number of involved space),laboratory tests(white blood cells count,Neutrophil percentage,blood glucose),and treatment of descending necrotizing mediastinitis.According to whether the descending necrotizing mediastinitis occured,the patients was divided into two groups.Continuous variables were analyzed by Wilcoxon rank sum test between the patients in these two groups,and discrete variables were analyzed with Fisher exact test.The variables with p <0.1 were taken into logistic regression analysis.The second part of this study was prospectively designed.The patients with severe maxillofacial and cervical multiple space infections who were referred to the Department of Oral Surgery at the Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine from December 2016 to December 2017 were included.The clinical data were recorded,such as gender,age,education status,smoking history,comorbidity(diabetes,hypertension,anemia,etc.),the source of original infection,duration before diagnosis,CT imaging(involved spaces,number of involved spaces,and gas formation),laboratory tests(white blood cell count,neutrophil percentage,C-reactive protein,procalcitonin,blood glucose),bacterial culture,occurrence of descending necrotic mediastinitis.According to whether descending necrotizing mediastinitis occurred,the patients were divided into two groups.Continuous variables were compared by t or t’ test between these two groups,and discrete variables were analyzed with Fisher exact test.The variables with P <0.1 were taken into logistic regression analysis.RESULTS:In the retrospective analysis,296 patients were included.The average age was 53.62 ± 15.40 years.There were 220 males and 76 females,with a ratio of 2.9: 1.111 patients were diagnosed with descending necrotizing mediastinitis due to maxillofacial multiple space infections.Odontogenic infection was the most common source of infection,accounting for 75.2%(221 cases)of the total.Diabetes mellitus was the most common comorbidity,accounting for 27.7%.Submandibular space(77.7%)was the most involved space,followed by pterygomandibular space(50.3%).After univariate analysis,gender(p = 0.001),age(p = 0.002),infection source(p = 0.004),number of spaces(p <0.001),parotid space(p <0.001),submandibular space(P <0.001),submental space(p <0.001),pterygomandibular space(p <0.001),parapharyngeal space(p <0.001),retropharyngeal space(p <0.001),and neutrophil percentage(p <0.001)had significant statistical significance.After Logistic regression analysis,parapharyngeal space(p = 0.008),the number of involved spaces(P <0.001)and source of infection(p =0.037)were statistically significant.In prospective study,201 patients with maxillofacial and cervical multiple space infection during 12 months were enrolled.14 patients were with secondary descending necrotizing mediastinitis,and the occurrence was 6.97%.Among the 201 patients,there were 142 males and 59 females,with a ratio of 2.44: 1.The average age of patients was 52.98 ± 17.12 years.The number of patients with middle school education status(62 cases)was the highest,and 90 patients had the habit of smoking.Common comorbidities were diabetes and hypertension,both with 49(24.3%),followed by anemia 36(17.6%).The most common causes were periapical periodontitis in 90 cases,accounting for 44.8% of the total,followed by wisdom teeth pericoronitis in 50 cases(24.9%).In addition,the most commonly site of primary source was mandibular posterior teeth in 140 cases(69.7%).After univariate analysis,anemia(p = 0.005),site of onset(p <0.001),dyspnea(p <0.001),pterygomandibular space(p=0.005),parapharyngeal space(p <0.001),retropharyngeal space(p <0.001),the number of involved spaces(p <0.001),gas formation((p<0.001),neutrophil percentage(p=0.004),C-reactive protein(p<0.001),procalcitonin(p=0.003)had significant statistical significance.Logistic regression analysis showed that C reactive protein(P = 0.002),parapharyngeal space(p=0.047),gas formation(p=0.039),site of onset(p=0.018),and dyspnea(p=0.008)has statistical significance.CONCLUSIONS: Among the patients with maxillofacial and cervical multiple space infections who were referred to Department of Oral Surgery in our hospital,the occurrence of descending necrotizing mediastinitis was 6.97%.We believe that secondary descending necrotizing mediastinitis are more likely to occur in the patients with dyspnea,primary infection in the pharynx,parapharyngeal space involved,gas formation in CT or high level of C-reactive protein. |
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