Infecciones cervicofaciales graves. Nuestra experiencia en el Hospital Universitario Ramón y Cajal de Madrid

Abstract

Introduction: Cervical infections are a very common reason for consultation in the emergency services of our country. However, in certain cases, these infections are a cause of a great morbidity and important complications, including the compromise of the upper airway. For all these reasons, early diagnosis and treatment are of a great importance. The main objective is to perform a retrospective study of patients diagnosed with severe cervicofacial infection in our department, analyzing multiple demographic variables, treatment administered, time of hospitalization and complications observed. Material and methods: Retrospective descriptive observational study based on a sample of 47 patients diagnosed with severe cervicofacial infection in our center between April 2016 and March 2018. Multiple variables were collected, among which are: sex, etiology, associated symptoms, microbiological isolation, treatment established, comorbidities, time of hospital admission and complications. Results: 51 % of the sample were patients under 50 years of age without comorbidities. The most frequent comorbidities were toxic habits (tobacco and alcohol), hypertension and diabetes. Regarding the etiology, 91 % were odontogenic, being the third inferior molars the most frequently affected (79.06 %). The characteristic clinical presentation was the triad of facial swelling, pain and trismus (up to 60 %). The most frequently affected cervicofacial space was the submandibular space (56 %). The microbiological isolation showed that the majority were mixed polymicrobial infections (18 of 38 isolates) with predominance of the Streptococcus and Prevotella groups. The complications that we found were: two upper airway obstructions, a cervical bleeding, three reinterventions for a bad clinical evolution and a patient with mediastinitis. Conclusions: We can conclude that odontogenic etiology is the most frequent in severe cervicofacial infections, with the submandibular space being the most affected. Most of severe cervicofacial infections in Ramón y Cajal Hospital were polymicrobial and mixed infections. The combined treatment with surgery and intravenous antibiotic therapy was the therapeutic option chosen for all patients. Amoxicillin-Clavulanic was the most used broad-spectrum antibiotic. Complications are uncommon with an adequate treatment.