Drainage Incision Research Articles

Successful management of renal abscess secondary to diabetes mellitus with surgical treatment and hyperbaric oxygen therapy

ABSTRACT Yanagida K, Watanabe D, Yoshida T, Nakagawa T, Mizushima A, Miura K, Ishihara T. Successful management of renal abscess secondary to diabetes mellitus with surgical treatment and hyperbaric oxygen therapy. Undersea Hyperb Med. 2024 Third Quarter; 51(3):231-235. Renal abscess (RA) is a collection of infective fluid in or around the renal parenchyma. It typically occurs in immunocompromised patients, including those with diabetes mellitus (DM), poor nutritional status, or steroid administration. We herein report a case of RA associated with DM in which hyperbaric oxygen (HBO2) therapy greatly contributed to the resolution of this disease. The patient was an 85-year-old man with poorly controlled type 2 DM. Contrast-enhanced computed tomography for postoperative follow-up of appendiceal cancer showed a mass lesion with poor contrast enhancement extending from the upper pole of the left kidney to the dorsal side. Therefore, a diagnosis of RA was established. The lesion was percutaneously punctured, and a drainage tube was placed. Antibiotics following sensitivity testing were administered. The catheter was removed six days after its placement. However, pus discharge continued from the catheter removal site, with persistent redness around the wound. Therefore, a lumbotomy incision for abscess drainage was performed on the 49th day. However, the pus discharge persisted, and we decided to perform HBO2 therapy, expecting decreases in bacterial proliferation, reduction in local edema, and improvement of host defense. HBO2 therapy for 90 min at two atmospheres absolute was performed ten times. The amount of pus discharge decreased, and redness improved from the fifth day after HBO2 therapy. One month after starting HBO2 therapy, the wound was closed, and the pus discharge resolved completely. Four years have passed since the HBO2 therapy, and there have been no symptomatic or imaging relapses of RA. Keywords: hyperbaric oxygen therapy; renal abscess; SGLT2 inhibitor; type 2 diabetes mellitus

Treatment of Fournier's gangrene with "firebreak" drainage based on skin preservation

Objective: To observe the clinical efficacy of a new type of "firebreak" drainage with skin preservation in the treatment of Fournier's gangrene. Methods: This technique is suitable for patients with perianal necrotizing fasciitis who can tolerate surgery without large area of skin blackness and necrosis. Procedure and key points: (1) The dividing line between inflammatory tissue and normal tissue was determined according to imaging examination and intraoperative exploration; (2) The abscess cavity was cut along the most obvious part of the abscess fluctuation, with a long diameter of 3~4 cm and a short diameter of 1~2 cm; (3) Necrotic tissue was discreetly separated and removed from the main incision to the outer edge of the infection. A fusiform incision was made every 3 to 5 cm, with a long diameter of 2 to 3 cm and a short diameter of 1 cm, and discreetly separated until the normal tissue, and a hose was hung between the adjacent incisions for drainage. (4) Each adjacent edge cut between the stealth separation and hanging hose drainage, forming a "firebreak"; (5) Rinse the wound repeatedly; (6) If the infection invades the rectum, colostomy is performed as required. The case data of 11 patients with perianal necrotizing fasciitis admitted to the Second Affiliated Hospital of Nanjing University of Chinese Medicine from July 2019 to February 2023 were retrospectively analyzed. All patients were treated with emergency surgical debridement by "firebreak" drainage with skin preservation. Results: All 11 cases were cured with 100%. One case underwent multiple operations. The hospitalization time was 11-46 days, with an average of 22 days. The wound healing time was 28-75 days, with an average of 43 days. Except for 1 patient with trauma, all the other patients had no significant anal function injury after surgery. All the 11 patients recovered and were discharged from hospital with a median follow-up of 136 (115-413) days. Conclusions: The "firebreak" drainage based on skin preservation has the advantages of less trauma and faster recovery, and do not cause obvious anal function damage.

Management of Severe Odontogenic Infection: Case Report

Introduction: Submandibular abscess caused by odontogenic infection is a frequent case, but in some cases it can be deadly because it spreads and blocks the respiratory tract. The purpose of this study is to described a case of fatal submandibular abscess with early management effective. Case report: A 46 years old male patient with complaints of left submandibular, submental, left buccal and left temporal swelling. History of systemic disease was denied. Patients complain of tightness and changes in voice. Therapeutic intervention consists of Covid- 19 screening, complete blood lab, abscess decompression under local anesthesia, left submandibular and submental through and through drainage incisions, drainage incisions in the buccal area as well as multiple tooth extractions and penrose drain applications both extra oral and intra oral carried out in general narcotics, and swab culture sensitivity and antibacterial resistance tests were carried out. The antibiotics given were ceftriaxone and metronidazole. The patient was followed up and showed good general condition and decreased swelling. Conclusion: Odontogenic infections that spread and block the respiratory tract can be deadly. The abscess can expand even more quickly during preparation for surgery. Decompression of an abscess can be an effective treatment so that the abscess does not spread further and can reduce the risks of the operation being carried out. The management carried out must be complete and comprehensive, in this case a drainage incision and extraction of the focal infection are carried out. Initially, broad spectrum antibiotics can be given, but if the results of the antibacterial resistance test are obtained, it is very important to give more specific antibiotics. Submandibular abscess with poor prognostic consequences obstructed respiratory tract must be treated immediately and closely monitored. Keywords: Abscess, Odontogenic infection, Decompression

Blok Pleksus Servikalis Superfisialis pada Insisi Abses Submandibula

This case study explores the use of bilateral superficial cervical plexus block as a regional anesthesia method in a 44-year-old male patient with a submandibular abscess. The patient, who has comorbidities of type 2 diabetes mellitus, renal insufficiency, and grade 1 obesity, underwent a 60-minute abscess drainage incision operation. This technique was chosen based on patient factors and the medical team's preference, avoiding the risks associated with general anesthesia. Lidocaine 2% at 6cc per side was used, demonstrating the effectiveness of the cervical plexus block in this procedure and others such as lymph node dissection and laceration repair. The study confirms that regional anesthesia guided by ultrasound is a quick, resource-efficient, and safe option, with the potential to avoid improper analgesic dosing. For longer procedures, local anesthetics like ropivacaine or bupivacaine can be utilized. The main conclusion is that the superficial cervical plexus block is an effective and safe alternative for anesthesia in certain neck procedures.

Canine Fossa Abscess In Pediatric: Case Report

Odontogenic infections are a major reason for consultation in dental practice especially in pediatric population. It comprises various clinical conditions, whose importance varies depending on their potential severity. Pediatric patients with active infections pose additional challenges and difficult to manage. Insufficiency or late treatment may lead to serious and possibly life-threatening complications. This case report is to discuss the management of treatment in canine fossa abscess in pediatric patient. A-3 years-old male patient referred to the Oral and Maxillofacial Surgery Clinic with complaints of swelling in his left cheek since 3 days ago. Physical examination showed fluctuant swelling in left infraorbital region. The patient was diagnosed with canine fossa abscess. The treatment was given are intravenous antibiotics, multiple tooth extraction and drainage incision under general anesthesia. Early identification, proper intravenous antibiotics and elimination of source of infection are the keys to the treatment.

Recurrent Orbital Subperiosteal Abscess in Patient with Nasopharyngeal Carcinoma

Introduction : Subperiosteal abscess (SPA) is a rare finding in cancer patients with orbital cellulitis. Severe complications associated with this condition are permanent visual loss, intracranial extension, and death.
 Case Illustration : A 38-year-old male with history of nasopharyngeal carcinoma (NPC) came with progressive right eyelid swelling, non-axial proptosis, and visual acuity was NLP. CT scan revealed right SPA associated with frontal sinusitis. NPC staging was T3N2M0. Despite the treatment of intravenous antibiotics and drainage incision of SPA, there was recurrence of right SPA two weeks after procedure and re-staging revealed T4N3M0. A joint operation with otolaryngology department to do debulking of the mass, frontal sinus surgery, and drainage incision was held. Culture resulted in Talaromyces marneffei. Patient was assessed with talaromycosis and given itraconazole for ten weeks. Moreover, patient came again with proptosis seven weeks postoperatively. Re-drainage incision was performed and clinical presentation was improved.
 Discussion : This case describes rare biological nature of NPC where extensive blockage of paranasal sinuses allows microorganism overgrowth and infection. The anatomical changes and cancer-related immunosuppression contribute to recurrent SPA. Chemotherapy and radiotherapy are ideal treatments for our patient, however, infection must be treated adequately first. Surgical interventionis needed to manage the infection by SPA drainage where antimicrobial has poor penetration into the abscess and debulking of tumor to clear the blockage of drainage pathway.
 Conclusion : Recurrent orbital SPA could happen in patients with NPC, therefore appropriate medical treatment and timely surgical intervention are essential in managing orbital SPA. Multidisciplinary management is required to optimize patient outcomes.

Parotid Abscess In Young Adult: Case Report

Parotid abscess is a rare pathology in maxillofacial. In some countries, it occurs in elderly patients and patients with history of oral sepsis. A-25-years-old male patient came to the Oral and Maxillofacial Surgery Clinic with complaints of swelling in his right cheek since 2 weeks ago. Physical examination showed fluctuant swelling in front of right tragus. The patient was diagnosed with parotid abscess. The treatment was given are intravenous antibiotics, and drainage incision under general anesthesia. Early diagnosis and proper intravenous antibiotics are the keys to the treatment.

Safety and feasibility of a novel chest tube placement in uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer.

The type and placement of chest tube for patients undergoing uniportal video-assisted thoracoscopic lobectomy remains controversial. The aim of this study was to assess the efficacy and safety of a novel technique in which a pigtail catheter was used alone as the chest tube and placed near the incision for chest drainage after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy. A total of 217 patients undergoing uniportal video-assisted thoracoscopic lobectomy were retrospectively reviewed and divided into two groups. In group A, a 12-Fr pigtail catheter with several side ports was placed next to the uniportal wound. In group B, a conventional 20-Fr chest tube was placed through the uniportal wound itself. Postoperative complications related to chest tube placement and patients' subjective satisfaction were compared between the two groups. Postoperative pain management effect and other clinical outcomes such as duration of chest drainage and postoperative stay were also compared. There were 112 patients in group A and 105 patients in group B. A significantly lower incidence of wound complications was found in group A postoperatively (p = 0.034). The pain score on coughing in group A was significantly lower than that in group B on postoperative day two (POD2) (p = 0.021). There was no significant difference of other clinical outcomes such as duration of chest drainage and postoperative stay as well as major complications between the two groups. Placing a 12-Fr pigtail catheter alone next to the uniportal wound for chest drainage might be effective and safe after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy.

High rate of early recurrence of peritonsillar abscess among adolescents and young adults

Background Peritonsillar abscess (PTA) can be treated with aspiration or incision for drainage, but a subsequent PTA can occur if tonsillectomy is not performed. Better understanding is needed of when tonsillectomy should be performed to avoid PTA recurrence. Objective This study investigated the recurrence rate of PTA following aspiration or incision for drainage and evaluated the risk factors for recurrence. Methods The medical records of 292 patients treated for PTA were reviewed. Recurrence of PTA and elective or quinsy tonsillectomy were the primary endpoints. A Cox proportional hazards regression model for PTA recurrence was constructed with sex, age, and PTA history as predictors. Results Young age was the only significant predictor of PTA recurrence. Patients aged 15 to 24 years had a 30-day recurrence rate of 15.5% and a total recurrence rate of 26.6%. The total recurrence rate among patients over 30 years of age was significantly less at 4.0% (Fisher’s exact test, p < .05). Conclusion and Significance Based on our results, tonsillectomy should be considered for PTA in patients between 15 and– 25 years of age and, to effectively avoid future recurrence of PTA, should be performed urgently.

Principles Treatment Of Septic Arthritis Of The Knee: A Brief Review

Septic arthritis is an emergency condition in which infection occurs in the synovial joints, resulting in the formation of pus in the synovial spaces. Theincidence of septic arthritis increases in patients with an increased risk such as rheumatoid arthritis. The etiology of septic arthritis is mainly bacterial. Risk factors include iatrogenic procedures (surgery, implant placement, joint puncture) and systemic conditions (diabetes mellitus, rheumatoid arthritis receiving immunosuppressants, etc). Pathophysiology of septic arthritis is due to blood flow stasis in metaphyseal areas especially in children and intraarticular minimal blood circulation. Clinical pictures include sudden onset of fever, malaise, localized pain in the infected joint, joint swelling, and reduced range of motion. Examination for septic arthritis is a physical examination carried out are inspection (see), palpation (touch), and movement. supporting examinations include blotestsest, PCR, radiological and joint fluid tests. Treatments include non-pharmacological such as rest and physical therapy, pharmacological the form of antibiotics, and surgicaltherapy such as drainage incision. This study is a brief review of the current Principles Treatment Of Septic Arthritis Of The Knee. The reference to this review was taken from the latest journal up to 5 years and the latest book up to 10 years.

Closed reduction and drainage incision for the treatment of neglected and infected mandibular fractures

Background: Jaw fracture is the most common facial fracture in oral and maxillofacial bone and is usually caused by trauma. The fracture itself could lead to infection due to bone and tissue damage, which is the port of entry for microorganisms. Fracture-related infection (FRI) in the patient discussed in this study manifested as a submandibular abscess. The goals of fracture treatment were achieving the anatomic reduction of the fracture line and regaining acceptable occlusion. There are two methods for treating mandibular fractures: the closed method, also called conservative treatment, and the open method, which requires advanced surgery. Closed method treatment uses a maxillomandibular fixation (MMF) device in order to reduce and immobilize fracture fragments. Treatment of FRI should use a multidisciplinary approach to achieve an outstanding result, such as wound debridement, antimicrobial therapy, and implant retention. Purpose: The purpose of this article is to report a case of neglected mandibular fracture with a submandibular abscess, which was treated with a combination of the closed reduction method and incision drainage. Case: A 25-year-old female visited Nala Husada Hospital because of a submandibular abscess on the neglected mandibular fracture of the right parasymphysis and left corpus. Case management: The case was managed using an arch bar in the mandible and an eyelet in the maxilla while continuing with MMF and an extra oral drainage incision. Conclusion: Combination therapy (MMF and incision drainage) was needed to treat this case because of the occurrence of a submandibular abscess due to a neglected mandibular fracture.

PATHWAY OF INFECTION IN CANINE FOSSA SPACE ABSCESS

ABSTRACTBackground: Most of fascial space infections of head and neck caused by odontogenic infections. The canine space becomes involved primarily as the result of infections from the maxillary canine tooth. The buccal space may become infected from extensions of infection from either the maxillary or mandibular teeth.Purpose: This case report discusses the management of canine fossa space abscess extending to buccal space.Case: A-45-years-old male patient came to the A.W. Sjahranie Hospital with complaints of swelling in his left face since two weeks ago. Physical examination showed swelling in the upper left jaw. CT scan’s view showed a radiolucent appearance of the canine fossa region. Panoramic radiograph pointed upper left canine (23) and first molar (26) as source of infection. Based on clinical and radiographic examinations, the patient was diagnosed with a canine fossa space abscess. Case Management: The treatment was given are intravenous antibiotics, multiple tooth extraction followed by intraoral drainage incision under general anesthesia.Conclusion: Extension of infection of the canine fossa space can lead to the buccal space and maxillary sinus at the same time due to multiple carious tooth. Keywords : Buccal space abscess, Canine fossa space abscess, Maxillary sinus, Odontogenic infection

Successful management of renal abscess secondary to diabetes mellitus with surgical treatment and hyperbaric oxygen therapy

Renal abscess (RA) is a collection of infective fluid in or around the renal parenchyma. It typically occurs in immunocompromised patients including those with diabetes mellitus (DM), poor nutritional status, or steroid administration. We herein report a case of RA associated with DM in which hyperbaric oxygen (HBO2) therapy greatly contributed to the resolution of this disease. The patient was an 85-year-old man with poorly controlled type 2 DM. Contrast-enhanced computed tomography for postoperative follow-up of appendiceal cancer showed a mass lesion with poor contrast enhancement extending from the upper pole of the left kidney to the dorsal side. Therefore, a diagnosis of RA was established. The lesion was percutaneously punctured and a drainage tube was placed. Antibiotics following sensitivity testing was administered. The catheter was removed six days after its placement. However, pus discharge continued from the catheter removal site, with persistent redness around the wound. Therefore, lumbotomy incision for abscess drainage was performed on the 49th day. However, the pus discharge persisted, and we decided to perform HBO2 therapy, expecting decreases in bacterial proliferation, reduction in local edema, and improvement of host defense. HBO2 therapy for 90 minutes at two atmosphere absolute was performed 10 times. The amount of pus discharge decreased and redness improved from the fifth day after HBO2 therapy. One month after starting HBO2 therapy, the wound was closed and pus discharge resolved completely. Four years have passed since the HBO2 therapy, and there have been no symptomatic or imaging relapses of RA.

Emergency Treatment of Submandibular Abscess Spreading to Buccal and Submental Spaces in Uncontrolled Diabetic Patients: A Case Study

Emergency Treatment of Submandibular Abscess Spreading to Buccal and Submental Spaces in Uncontrolled Diabetic Patients: A Case Study Cahyono Yudianto1*, Endang Sjamsudin2, Winarno Priyanto3, Agus Nurwiadh4, 1Resident of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Padjadjaran/ RSUP Dr. Hasan Sadikin, Bandung, Indonesia 2,3,4Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Padjadjaran/ RSUP Dr. Hasan Sadikin, Bandung, Indonesia *Email correspondence: cahyono19001@mail.unpad.ac.id ABSTRACT Introduction: Dental infections can extend to the maxillofacial space causing severe infections such as abscesses. Abscess in the maxillofacial space aggravated by the systemic disease of diabetes mellitus can delay healing and cause further complications. This case report discusses the emergency treatment of a submandibular abscess that extends to the buccal and submental spaces in a patient with diabetes mellitus. Case Report: A 41-year-old female patient came to the Emergency Department of Hasan Sadikin Hospital in Bandung, complaining of swelling on the right cheek. The swelling was felt for seven days which started in the right submandibular area and extended to the right cheek and submental area. The patient had a history of diabetes mellitus for eight years, and on arrival, his current blood sugar was 365 mg/dL. The patient was diagnosed with a submandibular abscess that extends to the right buccal and submental area with uncontrolled diabetes mellitus. Treatment includes a drainage incision, Penrose drain, extraction of the causative tooth, and administration of ceftriaxone, metronidazole, ketorolac, and omeprazole drugs. Conclusion: Submandibular abscess that extends to several maxillofacial spaces is an emergency condition that requires immediate management to prevent the spread of infection to other tissues, which can cause mortality. Keywords: Abscess, Submandible, Buccal, Submental, Diabetes Mellitus

Estimating the long-term slip rate of active normal faults: The case of the Paganica Fault (Central Apennines, Italy)

The footwall of the surface rupturing Paganica normal fault, the source of the 2009 L’Aquila earthquake (Mw 6.1) in the Central Apennines (Italy), was investigated using integrated geological and geomorphological approaches. The aim was to constrain the active tectonics by studying the Raiale River that orthogonally crosscuts the fault trace, where it provides a useful geomorphological marker of long-term fluvial incision and footwall uplift. Using morphostratigraphy and paleomagnetic analysis, the Plio–Pleistocene morphotectonic evolution of the area was reconstructed, comprising an ancient continental basin and paleolandforms that predate the footwall incision. Starting from the Late Early Pleistocene–Middle Pleistocene, fluvial dissection was mainly due to marked river downcutting triggered by significant activity of the Paganica Fault, which caused progressive base-level lowering. The Raiale River downcutting formed five Middle–Late Pleistocene fluvial terraces, that, along with absolute Optically Stimulated Luminescence (OSL) dating, allowed the identification of paleolongitudinal profiles with a diverging downstream configuration. Terrace dating yielded a minimum incision rate of 0.25 ± 0.02 mm/a, which only partially compensates the footwall uplift and can thus be considered as a minimum value for the Paganica Fault throw rate, which could reach up to ~0.45 mm/a. In parallel, using terrestrial cosmogenic nuclides, a denudation rate of 0.02–0.04 mm/a was measured on the summit of the footwall block. This denudation is in keeping with the drainage incision, suggesting a non-steady state for the fault footwall topography and a dominance of relief growth. Last, the analysis of the modern Raiale River longitudinal profile denoted an ungraded status, with two main knickzones that we interpret as transient forms due to tectonic perturbations, likely triggered by activity of the Paganica Fault during the end Early Pleistocene and the Late Pleistocene. Considering the 2009 L’Aquila earthquake coseismic rupture, we observe that the younger transience on the Raiale River longitudinal profile, if it is of tectonic origin, could have only been produced by much larger seismic events (i.e., Mw > 6.5) than those documented in the area by paleoseismological investigations. The collective results confirmed that in the Central Apennines, conditions of dynamic equilibrium are often not met, and that the persistence of transient perturbations induced by tectonics should be accounted for.

Negative pressure wound therapy promotes healing and reduced pain in patients with acute suppurative mastitis

BackgroundThe purpose of this study was to compare the outcomes of vacuum sealing drainage (VSD) and conventional incision and drainage (I&D) for treating acute suppurative mastitis.MethodsHospital medical records were searched for patients 20–50 years of age who were diagnosed with acute suppurative mastitis from January 2014 to December 2018, and treated with traditional I&D or VSD. Patients were divided into those treated with VSD and I&D, and outcomes including pain, healing time, length of hospital stay, and length of antibiotic course were compared between the groups. Pain was evaluated with a numeric rating scale from 0 (no pain) to 10 (most severe pain). Subgroup analysis of lactating women was also performed.ResultsThere were 110 women who received traditional I&D, and 105 women that received VSD included. The 2 groups were similar with respect to age (31.1 ± 4.8 vs. 29.9 ± 4.4, p = 0.058), and disease characteristics. The median pain score of women who received VSD (5 [IQR 5–6]) was significantly less than that of women who received I&D (8 [IQR 7–8]) (p < 0.001). The time for healing was significantly less in women who received VSD (40 days [IQR 30–45 days]) compared to I&D (60 days [IQR 45–70 days]) (p < 0.001). The length of hospital say and the length of antibiotic treatment were similar between the 2 groups. Results were similar for lactating women.ConclusionsVSD is effective for treating acute suppurative mastitis with reduced pain and shortening healing time.

LAPORAN KASUS: SELULITIS PRESEPTAL DENGAN ABSES FRONTAL

The objective of study is to report a case and management of preseptal cellulitis caused by dental infection. A case report, a 45 years old man presented at outpatient clinic with painful and swollen eyelids on the both eyes in 3 days, fever, and headache. The bumps in both eyes burst by themselves 1 day before hospital admission. The complaint begins with a toothache, then swelling in the cheek, then the swelling spreads to the eyes and head. Computed Tomograph (CT) scan examination revealed Soft tissue swelling in the right frontotemporoparietal region, left frontotemporoparietooccipital to periorbital bilateral and right maxilla with massive air density &amp; air fluid level on the left frontotemproparietooccipital according to the picture of Abscess. The patient consulted to neurosurgeon doctor and perform an abscess drainage incision. Adequate treatment and multidisciplinary management are needed to prevent more severe complications.

EMERGENCY TREATMENT OF SEVERE ODONTOGENIC INFECTION EXTENDING TO THE FOUR MAXILLOFACIAL SPACES: CASE REPORT

Severe odontogenic infection involving multiple maxillofacial spaces can lead to complications and even life-threatening. Immediate treatment is needed, mainly to prevent airway obstruction and sepsis. This case report aims to describe and discuss the immediate treatment of a severe odontogenic infection that extends to the submandibular, submental, buccal, and parapharyngeal spaces. Case report: A 52-year-old male patient came to the Emergency Department (IGD) Hasan Sadikin Hospital, Bandung, with complaints of swelling in the lower jaw and right neck, painful swallowing, and difficulty opening the mouth wide preceded by a history of toothache. Extraoral; facial asymmetry, right submandibular swelling, right cheek, neck, and chest, redness, warm, localized, fluctuating, and painful palpation. Intraoral; trismus generalized hyperemia of the gums, pulp necrosis of tooth 46, and impacted tooth 48. Routine blood laboratory count of leukocytes 18,280 mm3 and platelets 510,000 mm3. Neck Soft Tissue AP-Lat radiograph shows soft tissue swelling in the right submandibular with multiple air density radiolucency in it, suggesting an abscess. The patient's diagnosis was a right odontogenic submandibular abscess that extended to the right submental, buccal, parapharyngeal, and clavicle. Immediate management includes fluid regulation, administration of antibiotics, analgesics, and incision drainage. Conclusion: In this case of severe odontogenic infection, the patient was saved by prompt treatment of a pus drainage incision to prevent the expansion of infection and airway obstruction. Keywords: odontogenic infection, maxillofacial space, incision drainage, emergency

Atlantoaxial instability secondary to Bartonella henselae osteomyelitis managed surgically by atlantoaxial instrumentation: A case report and systematic review.

Cat scratch disease (CSD), caused by Bartonella henselae, may atypically present with vertebral osteomyelitis. Antibiotic regimens are tailored to presentation, which is markedly variable and not well defined for any atypical disease. In cases of spinal instability, the use of antibiotics alone may not be sufficient. Atlantoaxial instability caused by osteomyelitis is a rare complication of CSD. In this report, we describe the rare case of vertebral osteomyelitis complicated by atlantoaxial instability, requiring both antibiotics and atlantoaxial fusion. We discuss our case, surgical technique, rationale, and outcome. In addition, we conducted a systematic review of the literature of vertebral osteomyelitis in pediatric secondary to B. henselae. A 2-year-old child presented with a 2-month history of irritability, fever, and rigid neck pain along with a recent history of feline exposure. Physical examination revealed cervical tenderness and decreased range of motion. Computed tomography (CT) showed osteolysis of the right C1 lateral mass and pars articularis; T1-weighted magnetic resonance imaging with contrast showed enhancement around the right C1 lateral mass. The titer for B. henselae was high. A diagnosis of cat scratch osteomyelitis with cervical instability was made, for which the patient underwent surgery with atlantoaxial fusion. Postoperative imaging demonstrated resolution of the contrast-enhanced lesion. At 6-year follow-up, the patient showed no signs of residual complications from surgical intervention with a solid fusion. Our review revealed 44 cases of pediatric CSD vertebral osteomyelitis. Conservative management with antibiotic employed in 86% while antibiotics with surgical intervention in 14% of the cases. Surgical intervention was most often in the form of incision for drainage and decompression without fusion. Average follow-up 10 months with 86% achieved complete resolution. Cervical instability caused by osteolysis is a rare complication of CSD. This can subsequently lead to vertebral instability, requiring definitive surgical intervention.

Medical Infrared Thermography in Odontogenic Facial Cellulitis as a Clinical Decision Support Tool. A Technical Note.

Background: Odontogenic cellulitis are frequent infections of the head and neck fascial spaces that can sometimes spread and be life-threatening, requiring urgent hospitalization. Early diagnosis of facial cellulitis with diffuse inflammatory process is crucial in patient management but not always obvious in the field. Medical infrared thermography (MIT) is a noninvasive tool increasingly used to evaluate skin temperature maps and delineate inflammatory lesions. Objective: The aim of this work was to evaluate the use of MIT to improve the clinical examination of patients with facial cellulitis. Methods: Image processing work was carried out to highlight the thermal gradient resulting from inflammation linked to infection, in 2 patients with facial cellulitis. Results: In real-time, MIT allowed to precisely locate the inflammatory focus linked to cellulitis with no propagation to danger areas such as infraorbital space or around pharyngeal axis. Conclusions: Here, we show the first cases using MIT as a powerful complementary tool in the clinical evaluation of patients with facial cellulitis. Significance: This technology could help optimize the hospitalization decision through a facilitated assessment of infection spread in head and neck tissues and helping to incision for drainage.