RESUMO
Introducción: la fascitis necrotizante cervical es una entidad poco frecuente en la cabeza y el cuello, pero su importancia está dada por la elevada tasa de mortalidad. La importancia clínica de este estudio se debe al hecho de que no hay muchos reportes de casos de esta patología en América Latina, por lo cual queremos describir la experiencia en nuestro Hospital. Objetivo: describir la experiencia en fascitis necrotizante cervical en el Hospital General Dr. Manuel Gea González. Materiales y métodos: estudio descriptivo, retrospectivo y transversal de historias clínicas del Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital General Dr. Manuel Gea González, de 2011 a 2017. Resultados: se incluyeron 11 historias clínicas con diagnóstico de fascitis necrotizante cervical, de las cuales 8 (72,7 %) eran hombres y 3 (27,2%) mujeres, con una edad promedio de 49,1 años. 5 (45,4 %) pacientes debutaron con diabetes mellitus tipo 2 (DM2). El origen de la infección fue odontogénico en 3 (27,2 %) pacientes. Los microorganismos más frecuentes fueron Klebsiella pneumoniae, Streptococcus anginosus y Staphylococcus epidermidis. Los 11 pacientes (100 %) fueron intervenidos quirúrgicamente e impregnados con antimicrobianos empíricos, que posteriormente fueron modificados o no según los resultados del antibiograma. La hospitalización promedio fue de 18,7 días. 3 (27,2 %) pacientes presentaron mediastinitis como complicación. Hubo 2 muertes (18,1 %). Conclusión: el diagnóstico temprano y el tratamiento antimicrobiano empírico y quirúrgico agresivo pueden reducir significativamente la morbimortalidad.
Introduction: Cervical necrotizing fasciitis is a rare entity in the head and neck, but its importance is given by the high mortality rate. The clinical importance of this study is due to the fact that there are not many case reports of this pathology in Latin America, which is why we want to describe the experience in our hospital. Objective: To describe the experience in cervical necrotizing fasciitis at the Hospital General Dr. Manuel Gea González. Materials and methods: Descriptive, retrospective and cross-sectional study of medical records of the Otorhinolaryngology and Head and Neck Surgery Service of the Hospital General Dr. Manuel Gea González, from 2011 to 2017. Results: 11 medical records with a diagnosis of cervical necrotizing fasciitis were included, of which 8 (72.7%) were men and 3 (27.2%) were women, with a mean age of 49.1 years. 5 (45.4%) patients presented with type 2 diabetes mellitus. The origin of the infection was odontogenic in 3 (27.2%) patients. The most frequent microorganisms were Klebsiella pneumoniae, Streptococcus anginosus and Staphylococcus epidermidis. The 11 patients (100%) underwent surgery and impregnated with empirical antimicrobials, which were later modified or not, according to the results of the antibiogram. The average hospitalization was 18.7 days. 3 (27.2%) patients presented mediastinitis as a complication. There were two deaths (18.1%). Conclusion: Early diagnosis and aggressive empirical and surgical antimicrobial treatment can significantly reduce morbidity and mortality.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Fasciite Necrosante/diagnóstico , Pescoço , Fasciite Necrosante/etiologia , Fasciite Necrosante/terapiaRESUMO
RESUMEN: Las infecciones en el territorio maxilofacial, son cuadros frecuentes, de origen polimicrobiano, con manifestaciones clínicas muy variables y que están asociadas a múltiples vías de ingreso de los microorganismos al territorio. Un gran porcentaje de estas infecciones se origina en la cavidad oral, principalmente en lesiones bacterianas que sufren los dientes. La compleja anatomía de la cabeza y el cuello, permiten que muchas de estas infecciones se diseminen por espacios profundos, llegando a comprometer órganos o regiones anatómicas adyacentes, que pueden llevar a cuadros clínicos de alto riesgo vital. Los casos clínicos presentados en este artículo corresponden a pacientes tratados en el hospital San Juan de Dios a causa de procesos infecciosos del territorio maxilofacial, por equipos multidisciplinarios.
ABSTRACT: Infections in the maxillofacial territory are frequent cases of polymicrobial origin, with very variable clinical manifestations and are associated with multiple entering pathways of microorganisms in the territory. A large percentage of these infections originate in the oral cavity, mainly in bacterial lesions that undergo experienced by the teeth. The complex anatomy of the head and neck allows many of these infections to spread through deep spaces, leading to compromising adjacent organs or anatomical regions, which can lead to high-risk clinical conditions. The clinical cases presented in this article correspond to patients treated at the San Juan de Dios hospital because of infectious processes of the maxillofacial territory, by multidisciplinary teams.
Assuntos
Humanos , Masculino , Adulto , Idoso , Doenças Maxilares/cirurgia , Doenças Maxilares/microbiologia , Doenças Maxilares/tratamento farmacológico , Face/microbiologia , Drenagem , Fasciite Necrosante/complicações , Tumor de Pott/complicações , Infecções/cirurgia , Infecções/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
Fasceíte necrotizante é uma doença polimicrobiana em sua maioria, com a presença de anaeróbios ou anaeróbios facultativos, de diagnóstico ainda impreciso nos serviços de emergência em geral, com a característica de desenvolvimento rápido acometendo as fáscias e muitas vezes os tecidos musculares mais profundos. O tratamento cirúrgico e seu diagnóstico precoce são imperativos para o restabelecimento do paciente assim como uma terapia antibiótica imediata. As fasceítes necrotizantes cervicais são mais raras e normalmente têm causa odontogênica. O tratamento utilizando-se da terapia de pressão negativa favorece a diminuição do tempo, a revascularização tecidual, diminui a morbidade e facilita o fechamento primário da ferida. Este trabalho tem como objetivo relatar um caso de fasceíte necrotizante em região da face, que foi tratada pela técnica de pressão negativa após desbridamento da área necrosada, reduzindo o tempo de cicatrização tecidual e permitindo o fechamento da ferida cirúrgica.
Necrotizing Fasciitis is a polimicrobianic illness in its majority, with the presence of anaerobic or facultative anaerobic, still inexact diagnosis in the emergency services in general, with the characteristic of fast development affecting the fascia and many times deeper the muscular structure. The surgical treatment and its precocious diagnosis are imperative for the reestablishment of the patient as well as an immediate antibiotic therapy. The cervical necrotizing fasciitis are rarer and normally it has odontogenic causes. The treatment using the therapy of negative pressure favors the reduction of time, tecidual revascularization, diminishes the morbidity and facilitates the primary closing of the wound. This work has as objective to tell a case of necrotizing fasciitis in region of the face, that was dealt with by the technique to negative pressure after debridement the necrosed area, reducing time of tecidual cicatrization and allowing the closing of the surgical wound.