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Risk factors for delayed oral dietary intake in patients with deep neck infections including descending necrotizing mediastinitis

  • Head and Neck
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Abstract

Although clinical outcomes of descending necrotizing mediastinitis (DNM) and/or deep neck infection (DNI) have been extensively reported, no study has addressed delay in recovering oral ingestion after surgical interventions other than sporadic case reports. We herein compared clinical features of DNM and DNI cases over the same period, and clarified precipitating factors of delay in recovering oral ingestion by logistic regression analysis. We reviewed records of patients with DNI and DNM at our institution from August 2005 to July 2015. We extracted data on patient age, sex, complication with diabetes mellitus, gas gangrene, extension of infections, operative procedure, tracheotomy, bacterial results, and duration of empirical antibiotic therapy. Patients were categorized into three groups according to vertical spread of infection: 60 DNI patients without extension below the hyoid bone (group-A), 48 DNI patients with extension below the hyoid bone without DNM (group-B), and 10 DNM patients (group-C). Age, diabetes mellitus, and gas gangrene were significantly different among the groups. Concerning surgical intervention, tracheotomy was significantly less frequently performed in group-A (25%) than the other groups (74%) (p < 0.001). Logistic regression analyses revealed that extension of infections below the hyoid bone and tracheotomy were significantly associated with delayed oral dietary intake [odds ratios (95% confidence intervals) 2.96 (1.06–8.28) and 10.69 (3.59–31.88), respectively]. Along with DNM patients, patients who undergo tracheotomy for infections that extend below the hyoid bone should receive postoperative care with careful attention to avoid delay in recovering oral ingestion.

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Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan

    Hiroshi Hidaka, Daiki Ozawa, Risako Kakuta, Kazuhiro Nomura, Kenichi Watanabe & Yukio Katori

  2. Division of Molecular Epidemiology, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Japan

    Shinichi Kuriyama

  3. Tohoku University, Tohoku Medical Megabank Organization, Sendai, Japan

    Shinichi Kuriyama & Taku Obara

  4. Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan

    Taku Obara

  5. Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Toru Nakano

  6. Department of Otolaryngology, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Risako Kakuta

Authors
  1. Hiroshi Hidaka
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  2. Daiki Ozawa
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  3. Shinichi Kuriyama
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  4. Taku Obara
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  5. Toru Nakano
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  6. Risako Kakuta
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  7. Kazuhiro Nomura
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  8. Kenichi Watanabe
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  9. Yukio Katori
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Corresponding author

Correspondence to Hiroshi Hidaka.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The present study was performed in accordance with the guidelines of the Declaration of Helsinki and approved by the ethics committee of Tohoku University Hospital (Approval number 2014-1-273).

Informed consent

Informed consent was obtained from the patient included in this report.

Financial disclosures

A portion of this study was supported by JSPS KAKENHI Grant Number JP 15K1548 (to TN) and Grant-in-Aid No. 26462594 (to HH) from the Ministry of Education, Science, and Culture of Japan.

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Hidaka, H., Ozawa, D., Kuriyama, S. et al. Risk factors for delayed oral dietary intake in patients with deep neck infections including descending necrotizing mediastinitis. Eur Arch Otorhinolaryngol 274, 3951–3958 (2017). https://doi.org/10.1007/s00405-017-4716-3

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  • DOI: https://doi.org/10.1007/s00405-017-4716-3

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