Application of Disposable Multifunctional Drainage Tube-Assisted Irrigation in Patients With Severe Multi-Space Infections in Oral and Maxillofacial Head and Neck Regions.

PURPOSE: To compare the clinical efficacy of disposable multifunctional drainage tube (DMDT)-assisted irrigation with the traditional abscess incision rubber drainage technique in patients with severe multi-space infections in oral and maxillofacial head and neck regions. PATIENTS AND METHODS: The data of 74 patients with severe multi-space infections in oral and maxillofacial head and neck regions, who were admitted to the Department of Oral and Maxillofacial Surgery, Central Hospital of Panzhihua City, Sichuan Province, China, between January 2015 and January 2019, were retrospectively studied. According to the treatment method, the patients were divided into 2 groups: the DMDT-assisted irrigation group and the abscess incision rubber drainage group. Cure rate, complications, length of hospitalization, days of antimicrobial use, cost of antimicrobial drugs, total hospitalization cost, number of dressing changes, and patient pain during dressing changes were compared between the 2 groups. RESULTS: Of the 74 patients, 38 were treated with the DMDT-assisted irrigation, and 36 with the traditional abscess incision rubber drainage. Compared with the traditional treatment group, the total hospitalization cost of the DMDT-assisted irrigation group is not much different (P = 0.72), but the patients in the DMDT-assisted irrigation group have higher cure rate, fewer complications, less antibiotics cost, shorter hospitalization length and fewer dressing changes than the control group (P < 0.05). CONCLUSIONS: The DMDT-assisted irrigation technique not only improves the cure rate, reduces complications, shortens hospitalization, reduces the use of antibiotics, and alleviates patient pain during dressing changes, but also improves clinical and therapeutic efficacy by reducing the number of dressing changes.

Surgical management of osteoradionecrosis of the jaws.

OBJECTIVE: The objective of this study is to evaluate our 10-year clinical experience in surgical management of patients with osteoradionecrosis (ORN) unresolved with conservative nonoperative treatment. PATIENTS AND METHODS: The medical records of 120 patients who had been surgically treated for ORN during a 10-year period (January 2003 to January 2013) were retrospectively reviewed. RESULTS: The most predilection ORN site was mandible (82.5%), followed by the maxilla (11.7%). ORN developed within initial 12 months in 39.2% and within the first 3 years in 68.3%. The median radiation dose was 68.1 Gy (range, 35-148 Gy), but 51 patients (42.5%) experienced ORN even though radiation doses were controlled under 60 Gy. Surgical trauma, as we believed, was the most important factor leading to this result. Among all the patients, 12 (10.0%) patients were found ineligible for operative treatment due to comorbid systematic diseases whereas none healed or improved. In terms of surgical management of the rest of the 108 patients, 90 (75.0%) patients underwent radical resection (4 patients unhealed), and 18 (15.0%) patients underwent mild surgical procedures such as sequestrectomy or debridement (1 patient unhealed). Of the 90 radical resection patients, 58 patients underwent radical resections and immediate microvascular flap reconstruction (19 bone flaps and 39 soft flaps), and 32 patients only experience radical resection (5 patients received second-stage reconstruction). According to follow-up information, 55 patients were free of disease. CONCLUSION: Though priority should be given to surgical treatment for the patient whose ORN does not respond to conservative nonoperative treatment, we may as well take into account more individualized regimens based on ORN severity. A hard lesson learned from our article is that the oral maxillofacial surgeon should minimize the trauma for jaws as possible as he can, especially to patients who need to receive postoperative radiotherapy.

Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report.

BACKGROUND: Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions. Clinically, if early odontogenic infections such as acute periapical periodontitis, alveolar abscess, and pericoronitis of wisdom teeth are not treated timely, effectively and correctly, the infected tissue may spread up to the skull and brain, down to the thoracic cavity, abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck. Severe multi-space infections are formed and can eventually lead to life-threatening complications (LTCs), such as intracranial infection, pleural effusion, empyema, sepsis and even death. CASE SUMMARY: We report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions. One week before admission, due to pain in the right lower posterior teeth, the patient placed a cigarette butt dipped in the pesticide "Miehailin" into the "dental cavity" to relieve the pain. Within a week, the infection gradually spread bilaterally to the floor of the mouth, submandibular space, neck, chest, waist, back, temporal and other areas. The patient had difficulty breathing, swallowing and eating, and was transferred to our hospital as an emergency admission. Following admission, oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology, thoracic surgery, general surgery, hematology, anesthesia and the intensive care unit to assist with treatment. The patient was treated with the highest level of antibiotics (vancomycin) and extensive abscess incision and drainage in the oral, maxillofacial, head and neck, chest and back regions. Unfortunately, the patient died of septic shock and multiple organ failure on the third day after admission. CONCLUSION: Odontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions, which can result in multiple LTCs. The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.

Nomogram model to predict postoperative infection after mandibular osteoradionecrosis surgery.

Osteoradionecrosis of the mandible (ORNM) is one of the most dreaded complications of radiotherapy. The poor healing capacity of soft tissue after radiation may lead to surgical failure. The current study was designed to identify prognostic factors for postoperative infection (PPI) and propose corresponding prophylaxis and intervention protocols. A retrospective study was conducted concerning ORNM patients from 2000 to 2015. A risk-stratification score and nomogram model were established to predict the risk of PPI. A total of 257 patients were analyzed, and the total incidence of PPI was 23.3% (60/257). In multiple logistic regression analysis, radiation dose [Formula: see text]80 Gy (versus <80 Gy, OR = 2.044, P = 0.035, 95% CI: 1.05-3.979), bilateral ORNM (versus unilateral, OR = 4.120, P = 0.006, 95% CI: 1.501-11.307), skin fistula (versus none, OR = 3.078, P = 0.040, 95% CI: 1.05-9.023), and implant utilization (versus none, OR = 2.115, P = 0.020, 95% CI: 1.125-3.976) were significantly associated with PPI. The susceptibility to PPI in patients with risk-stratification scores of 14-22 was 2.833 times that of patients with scores of 7-13, and 7.585 times that of cases defined as scores of 0-6. The discrimination capability of the nomogram model was estimated using a ROC curve with an AUC of 0.708, revealing potentially useful predictive abilities. In conclusion, current risk-stratification scores and nomogram models effectively predicted the risk of PPI in ORNM patients.

Higher positive lymph node ratio indicates poorer distant metastasis-free survival in adenoid cystic carcinoma patients with nodal involvement.

OBJECTIVE: Extensive studies have been conducted to analyze adenoid cystic carcinoma (ACC) in the head and neck region. No research has been published focusing on ACC patients with cervical lymph node (LN) metastasis. The aims of current investigation were to summarize the clinical characteristics of ACC patients with LN metastasis (ACC-LNM) and to identify prognostic factors for tumor-related outcomes. MATERIAL AND METHODS: A retrospective review was conducted with respect to ACC patients with nodal involvement between 2000 and 2013. The clinical variables and outcomes of these special cases were recorded and further analyzed. Metastasis-free survival and overall survival rate were calculated using the Kaplan-Meier method, and the log-rank test and Cox regression analysis were applied to identify the prognostic factors. RESULTS: A total of 47 patients (34 male and 13 female) 32-77 years of age (mean: 54.6 years; median: 54 years) were analyzed in the current protocol. The recurrence-free survival (RFS), distant metastasis-free survival (MFS), and overall survival (OS) rate in all patients were 90.1%, 55.6%, and 60.1%, respectively. In univariate analysis, T stage, positive LN ratio, LN-involved section, and extracapsular spread were strongly associated with poorer MFS rate. The predictive roles of LN-involved section and surgical margin on the OS rate were also identified. In multivariate analysis, positive LN ratio and surgical margin were predictors for MFS and OS rate, respectively. CONCLUSIONS: Positive LN ratio was strongly associated with distant metastasis. Comprehensive treatment should be performed in ACC patients with higher positive LN ratios. In addition, ideal surgical margin should be achieved to acquire better overall survival rate.