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“The Study of Etiopathogenesis and Management of Deep Neck Space Infections”

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“The Study of Etiopathogenesis and Management of Deep Neck Space Infections” “THE STUDY OF ETIOPATHOGENESIS AND MANAGEMENT OF DEEP NECK SPACE INFECTIONS” A DISSERTATION SUBMITTED TO THE TAMILNADU Dr. MGR MEDICAL UNIVERSITY CHENNAI In partial fulfilment of the Regulations for the award of the Degree of M.S. (OTO-RHINO-LARYNGOLOGY &HEAD AND NECK SURGERY) BRANCH-IV Registration No.: 221714302 DEPARTMENT OF E.N.T &HEAD AND NECK SURGERY TIRUNELVELI MEDICAL COLLEGE TIRUNELVELI MAY 2020 CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “THE STUDY OF ETIOPATHOGENESIS AND MANAGEMENT OF DEEP NECK SPACE INFECTIONS” is a bonafide research work done by Dr. S.KOUSALYA DEVI, Postgraduate M.S. student in Department of E.N.T & HEAD AND NECK SURGERY, Tirunelveli Medical College & Hospital, Tirunelveli, in partial fulfilment of the requirement for the degree of M.S. in OTO-RHINO- LARYNGOLOGY. Dr. S.SURESHKUMAR MS(E.N.T) D.L.O, Professor and HOD of E.N.T, Date: Department of E.N.T & HEAD AND NECK Place: Tirunelveli SURGERY, Tirunelveli Medical College, Tirunelveli CERTIFICATE BY THE HEAD OF THE DEPARTMENT This is to certify that the dissertation entitled “THE STUDY OF ETIOPATHOGENESIS AND MANAGEMENT OF DEEP NECK SPACE INFECTIONS” is a bonafide research work done by Dr. S.KOUSALYA DEVI, Postgraduate student in M.S E.N.T in Department of E.N.T & HEAD AND NECK SURGERY, Tirunelveli Medical College & Hospital, Tirunelveli, under the guidance of Dr.S.SURESHKUMAR, Professor and HOD, Department of E.N.T & HEAD AND NECK SURGERY, Tirunelveli Medical College & Hospital, Tirunelveli, in partial fulfilment of the requirements for the degree of M.S in OTO-RHINO-LARYNGOLOGY.. Dr.S.SURESHKUMAR MS(E.N.T) Date: D.L.O, Place: Tirunelveli Professor and HOD of E.N.T, Department of E.N.T & HEAD AND NECK SURGERY, Tirunelveli Medical College, Tirunelveli CERTIFICATE BY THE HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “THE STUDY OF ETIOPATHOGENESIS AND MANAGEMENT OF DEEP NECK SPACE INFECTIONS” is a bonafide and genuine research work carried out by Dr.S.KOUSALYA DEVI, post graduate student in M.S(E.N.T) under the guidance of Dr.S.SURESHKUMAR ,M.S(E.N.T) D.L.O.,Professor and HOD, Department of ENT & HEAD AND NECK SURGERY, Tirunelveli Medical College, Tirunelveli. Date: Dr.S.M.KANNAN, MS., MCh., Place: Tirunelveli DEAN Tirunelveli Medical College, Tirunelveli COPYRIGHT DECLARATION BY THE CANDIDATE I hereby declare that dissertation entitled “THE STUDY OF ETIOPATHOGENESIS AND MANAGEMENT OF DEEP NECK SPACE INFECTIONS” is a bonafide and genuine research work carried out by me under the guidance of Dr.S.SURESHKUMAR M.S(E.N.T) D.L.O., Professor and HOD, Department of E.N.T& HEAD AND NECK SURGERY, Tirunelveli Medical College, Tirunelveli. The Tamil Nadu Dr.M.G.R. Medical University, Chennai shall have the rights to preserve, use and disseminate this dissertation in print or electronic format for academic/research purpose. Date: Dr. S.KOUSALYA DEVI, MBBS., Place:Tirunelveli Registration No.: 221714302 Postgraduate in ENT & HEAD AND NECK SURGERY, Department ENT & HEAD AND NECK SURGERY, Tirunelveli Medical College, Tirunelveli ACKNOWLEDGEMENT I am obliged to record my immense gratitude to Dr. S.M.Kannan MS., MCh, Dean, Tirunelveli Medical College Hospital for providing all the facilities to conduct the study. I express my deep sense of gratitude and indebtedness to my respected teacher and guide Prof.Dr. S.Suresh Kumar M.S ENT , HOD, Department of General Surgery, Tirunelveli Medical College, Tirunelveli, whose valuable guidance and constant help have gone a long way in the preparation of this dissertation. I Sincerely thank my Professors Dr. C. Ravikumar MS ENT, Dr. Senthil Kanitha MS ENT, for his inspiring suggestions and valuable guidance at every stage of study. I am also thankful to my Assistant Professors in the department, Dr. C.Karuppasamy MS ENT, DLO, Dr. D.Rajkamal Pandian MS ENT DNB, Dr. S.Ganapathy MS ENT DNB, Dr. A.Vijay Nivas MS ENT, Dr. Priya Dharshini MS ENT., for their constant guidance and support throughout my study period. I express my heartfelt thanks to my PG seniors &juniors and other friends for their help during my study and preparation of this dissertation and also for their co- operation. I extend my thanks to my family, who supported and helped me a lot in completing the study. Dr. S.KOUSALYA DEVI, MBBS., Date: Postgraduate in ENT, Place: Tirunelveli Department of ENT&HEAD AND NECK SURGERY, Tirunelveli Medical College, Tirunelveli ERTIFICATE – II This is to certify that I have verified this dissertation work titled “THE STUDY OF ETIOPATHOGENESIS AND MANAGEMENT OF DEEP NECK SPACE INFECTIONS” of the candidate Dr. S.KOUSALYA DEVI,MBBS. with registration Number 221714302 for the award of M.S., (OTO – RHINO – LARYNGOLOGY & HEAD AND NECK SURGERY) in the branch of IV. I personally verified the urkund.com website for the purpose of plagiarism check. I found that the uploaded thesis file contains from introduction to conclusion page and result shows 19 percentage of plagiarism in the dissertation. Guide & Supervisor sign with Seal. CONTENTS SL. NO. TOPIC PAGE NO. 1. INTRODUCTION 1 2. AIM OF THE STUDY 3 3. MATERIALS AND METHODS 4 4. REVIEW OF LITERATURE 6 5. RESULTS 55 6. DISCUSSION 69 7. CONCLUSION 74 8. BIBLIOGRAPHY 9. ANNEXURE I - PROFORMA 10. ANNEXURE II - CONSENT FORM 11. ANNEXURE III - MASTER CHART ABBREVIATIONS DNSI -Deep neck space infection C&S -Culture and sensitivity I&D -Incision and drainage USG -Ultrasonography CT -Computed tomography MRI -Magnetic resonance imaging NP -Neck pain NS -Neck swelling O -Odynophagia D -Dysphagia T -Trismus TA -Tooth ache AC -Airway compromise VC -Voice change INTRODUCTION Deep neck spaces are spaces situated between the 3 layers of deep cervical fascias of neck. There are 11 deep spaces in the neck formed by the facial planes, giving possible infection sites. According to their relationship with hyoid bone the spaces are divided into suprahyoid spaces [peritonsillar space, submandibular space, buccal space, parotid space, masticator space, parapharyngeal space], infrahyoid spaces [anterior visceral space or pretracheal spaces], spaces involving entire length of the neck [pre vertebral space, danger space, retropharyngeal space, carotid space] DNSI are potentially lethal infection & need immediate appropriate treatment. Poor dental hygiene is responsible for the DNSI. Eventhough with the evolution of higher antibiotics they can still causes significant morbidity & mortality. In Addition to dental infection, IV drug abuse, DM, HIV, surgical injuries, pharyngitis, tonsillitis are at risk of developing complications. The common symptoms are fever, neck swelling, dysphagia, neck pain, sorethroat & other symptoms related to the neck spaces. Present study is to find out etiology, risk factors, causative organism & management by appropriate antibiotics. Deep neck space infections are polymicrobial in nature. Peptostreptococci, streptococci, staphaureus and 1 anaerobes are the most common organisms causing deep neck space infections. Treatment part consists of conservative management and surgical intervention. The life threatening and common complications include airway obstruction, mediastinitis, jugular vein thrombosis, sepsis, respiratory distress, cavernous sinus thrombosis. 2 AIM OF THE STUDY To evaluate the etiopathogenesis and management of deep neck space infections. OBJECTIVES: 1. To evaluate the prevalence and various etiological factors associated with DNSI. 2. To find out distribution of DNSI among sexes and various age groups. 3. To analyse the various clinical presentations and microbiological profiles of DNSI. 4. To find out relevant investigation for early detection and effective treatment. 5. To study about the management and its outcome. 6. To find out association of other systemic disease with DNSI. 3 MATERIALS AND METHODS Cases with neck swelling =, neck pain, fever, sorethroat, dysphagia, odynophagia, change in voice were selected. Patient attending or reffered to ENT OPD were included in this study. All patients underwent a thorough history taking and a detailed clinical examination. X-ray neck lateral and antero-posterior view, chest X-ray, Ultra Sound neck, computed tomography scan neck and culture & sensitivity studies was done in selected individuals according to their findings. Then the patients were started on broad spectrum antibiotics and converted to selective antibiotics based on culture report. Incision and drainage were done in patients with diabetes mellitus, patients with no improvement after 48 hours of parentral antibiotics, and patients with airway compromise. Management and the improvement were analysed. INCLUSION CRITERIA: - All ages - Both sexes - Patients with symptoms suggestive of deep neck space infections. EXCLUSION CRITERIA: - Patients not willing for the study. - Patients with post traumatic infected wounds 4 - Wounds secondary to malignancy. STUDY AREA: Department of ENT, Tirunelveli Medical College Hospital. STUDY PERIOD: November 2017 to June 2019 METHOD OF STUDY Prospective study STUDY POPULATION Average 40-80 (78 patients) Patients attending TVMCH ENT Department 5 ANATOMY one of the major consideration in the diagnosis and treatment of deep neck space infections is the ability of infections to travel from one anatomical region to another via planes or potential spaces created by the various fascias of head and neck .This arrangement is somewhat unique in the body and thorough understanding of their anatomy and the potential spaces they create is essential to the effective treatment of these
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