Retrospective analysis of the effectiveness of treating multi-space infection combined with descending necrotizing mediastinitis at oral maxillofacial and cervical region via multidisciplinary team collaboration

Abstract

Objective: To explore the strategy and experience for treating maxillofacial and cervical multi-space infection combined with descending necrotizing mediastinitis (DNM) via multidisciplinary team (MDT) collaboration. Methods: A total of 36 patients with maxillofacial and cervical multi-space infection complicated with DNM admitted to the First Affiliated Hospital of Zhengzhou University from July 2011 to July 2019 were included in the study. The clinical data of the patients were retrospectively analyzed, including gender, age, symptoms at admission, source of infection, preoperative and postoperative evaluation indicators, MDT strategy and prognosis. Results: There were 26 males and 10 females with an average age of (51.6±17.6) years (8-80 years). The course of disease before admission was (8.9±8.4) days (2-30 days). All patients were admitted with maxillofacial and neck swelling and pain as the main complaints. Odontogenic infection accounted for 39% (14/36), throat floor swelling and pain accounted for 25% (9/36) and unknown maxillofacial swelling accounted for 36% (13/36). There were 28 cases receiving surgical treatment, 26 cases were cured and discharged (72%), 10 cases died (28%). In the patients treated with multidisciplinary therapy (mainly by surgery), the white blood cell count, neutrophil percentage, C-reactive protein and procalcitonin levels were significantly improved compared with those at admission at each observation time point after operation (P<0.05). The length of stay was positively correlated with the levels of C-reactive protein (r=0.545, P<0.05) and procalcitonin (r=0.504, P<0.05). The prognosis of patients treated with surgery (26/28) was better than that of patients without surgery (0/8) (P<0.01). Conclusions: The patients with maxillofacial and cervical multi-space infection combined with DNM might be in critical condition. The surgical based MDT strategy has an important impact on the prognosis of patients. White blood cell count and other inflammatory indicators monitoring can effectively observe the changes of the patient's condition.