Introduction: The complications of cervicofacial cellulitis are one of the most serious emergencies Oto-Rhino-Laryngology (ORL). These complications are still observed in our context despite the advent of antibiotics. The aim of our study was to describe the clinical presentation and management of patients admitted to our institution for complications of cervicofacial cellulitis. Patients and Methods: It came from a retrospective study in the ORL service, a department of Yalgado Ouédraogo Hospital of Ouagadougou, between January 2005 and December 2014, during which all patients with cervicofacial cellulitis complications were identified. Results: We collected over 10 years, 69 cases of complicated cellulitis, a frequency of 54.3% of cervicofacial cellulitis and 2.3% of all hospitalizations. The group included 33% women and 67% men to 29 years of average age. The non-steroidal anti-inflammatory isolated was the main factor contributing 59.4%. The front door was mainly dental 43.5% and pharyngeal 36.2%. The most frequent complications were mediastinitis thoracic dissemination 24.6%, sepsis 21.7% and spontaneous fistula 20.3% with orostome or pharyngostome. Medico-surgical treatment was associated with a reanimation in most cases. The outcome was favorable in 79.7% of cases. Mortality was 17.4%. Conclusion: The complications of cervicofacial cellulitis are frequent and often life-threatening. Their management is done in a multidisciplinary framework. The prevention and early treatment remain the pledge of their control.
The cervicofacial cellulitis and fasciitis Anglos-Saxons are infections of fatty cellular tissue of the head and neck [
In our socio-economic context of poverty, the evolution is often marked by complications and these complications can be life-threatening [
Several authors [
The complicated cervicofacial cellulitis is dreadful disease that poses therapeutic management difficulties. They are still observed in our practice despite the advent of antibiotics. The absence of similar studies of these complications in Burkina Faso led us to conduct this study. The aim of this study was to describe the clinical presentation and management of patients admitted to our institution for this pathology.
This is a retrospective study conducted in the Oto-Rhino-Laryngology (ORL) service, a department of Yalgado Ouédraogo hospital from January 2005 to December 2014. This study included all patients who experienced a complication of cervicofacial cellulitis. Of 127 cases of cervicofacial cellulitis supported, 69 complicated cellulitis records were retained.
For each folder, were evaluated: age, sex, field, risk factors, the gateway, the clinical signs of severity, the germ causes, types of complications, treatment and evolution.
The data collection was performed using a structured questionnaire used collection sheet. The data were collected from clinical records of patients, consultation records.
We included in our study the patients who presented a complication of cellulitis, either at the entrance or during hospitalization.
We considered complication, the occurrence on a cervicofacial cellulitis a mediastinitis, sepsis, cutaneous necrosis with orostome or pharyngostome, a lung disease, thrombosis of the jugular vein, meningoencephalitis, osteitis and multiple organ failure.
The data were analyzed using Epi Info 3.5.1 in its French version. The ethical considerations have been approved by the patient and ethics and compliance committee.
In 10 years, 69 patients with complications of cervicofacial cellulitis were registered, representing an annual incidence of 6.9 cases. Complications cellulite represented 2.3% of all hospitalized patients and 54.3% of cervicofacial cellulitis. Our patients were 7 months to 70 years with an average age of 29 years. The dominance was masculine with 39 men (67%) for 30 women (33%) of the patients is a sex ratio of 1.3. On admission, all patients have received first isolated anti-inflammatories and antibiotics.
The contributing factors were constituted by anti-inflammatory drugs (NSAIDs) (59.4%), diabetes (20.3%), intoxication with alcohol and tobacco (14.5%), the immunosuppression (2.9%), pregnancy (2.9%).
The front door was especially dental (43.5%) and amygdala (36.2%). Other entry points were found: sinus (5.8%), trauma broken skin (4.4%), parotid (1.4%), indeterminate (8.7%).
At the clinical level, the average time of consultation was 12 days and ranged from 2 and 120 days. The inflammatory swelling cervicofacial or cervical-thoracic, the tight trismus and the dysphagia were the most frequent signs. The clinical signs are presented in the following table (
Fever was observed in 49 patients (71%) and ranged between 38˚C and 40˚C.
The scanner (brain, cervicofacial, cervicothoracic) was performed in 32 patients. It was a capital contribution in the diagnosis of certain complications of cellulitis (
The complications were diagnosed at the entrance to 54.3% and in 45.7% of cases per hospital. The most frequent complications were mediastinitis in 17 cases (24.6%) followed by sepsis in 15 cases (21.7%), spontaneous fistula and diffuse cutaneous necrosis in 14 cases (20.3%) with orostomes (5 cases) and pharyngostomes (9 cases) (
Other types of complications were constituted by thrombosis of the jugular vein in 5 cases (7.2%), meningoencephalitis in 3 cases (4.3%), osteitis ramus in 2 cases (2.9%), and organ failure in 1 case (1.4%).
Clinical signs | Effective (n) | Percentage (%) |
---|---|---|
Inflammatory tumefaction | 69 | 100 |
Tight trismus | 58 | 84 |
Dysphagia | 49 | 71 |
fistula endobuccal | 28 | 40.6 |
Chest pain | 13 | 18.8 |
Moderate dyspnea | 9 | 13 |
Skin necrosis | 4 | 5.8 |
Crepitation neizeuse sub cutaneous | 3 | 4.3 |
The evolution of the jugular vein thromboses was marked by vascular rupture, 1 case of aorto-esophageal fistula having led hematemesis of great abundance and patients, 1 case of ischemic stroke, 1 case of pulmonary embolism (Lemierre’s syndrome). No cases of cerebral venous thrombosis were found.
Bacteriological examination was performed in all patients. It was positive in 42% of cases. The germs were identified Streptococcus in 12 cases (41.3%), Pseudomonas aeruginosa in 7 cases (24.1%), Staphylococcus in 07 cases (24.1%), Escherichia coli in 2 cases (6.9%), Haemophilus influenzae in 1 case (3.4%). Other samples were sterile 58%.
The treatment was medical and surgical. The initial antibiotic therapy was probabilistic then it was adapted according to the germs found. So 46% had ceftriaxone-metronidazole-gentamicin, 23% amoxicillin-clavu-lanic acid-metronidazole and 31% amoxicillin-clavulanic acid. The average duration of antibiotic treatment parenterally was 1 week. Surgical treatment was performed in all patients. This treatment was associated with a reanimation of which 6 cases received oxygen therapy. Hospital stay ranged from ten (10) and thirty five (35) days with an average of fifteen days.
The evolution was favorable in 55 cases (79.7%) (
The complicated cervicofacial cellulitis is relatively frequent in our practice, 2.3% of hospitalized patients. Its frequency varies depending on the series. It would be exceptional to some authors [
The average time of consultation was 12 days in our series. The same was done by Sérémé [
Severe dysphagia, painful swelling, fever and trismus were the most commonly reported warning signs in our study and in the literature [
The mediastinitis, sepsis and pneumonia complications frequently encountered in our series, have also been reported by several authors [
the cervical spine with myelitis. Infection of the cervical wall and the vascular sheath favored the occurrence of septic thrombosis of the vein will eroded the vascular wall with probably an aorto-esophageal fistula. The fistula is related to the long consultation period.
The main risk factors found in our series are isolated NSAIDs (59.4%) and diabetes (20.3%). Promote diabetes complications by immunosuppression that leads [
Biologically, bacteriological results could levy vary depending on the series. These samples were sterile in 58% of cases in our work. For Miloundja, this rate was 25% [
The treatment of complications of cervicofacial cellulitis is medical and surgical combined with a suitable reanimation [
All patients have benefited from a surgical drainage. This drainage may require in some cases mediastinitis thoracotomy [
The early diagnosis is a key element in the management and prognosis of cervcicofacial cellulitis. More than half of patients were received at the stage of complications hence the need for education of the population on the early consultation.
The prognosis of these complications is also related primarily to the field, the effectiveness of the initial treatment, including the isolation of the causative organism, is a crucial step [
The complications of cervicofacial cellulitis are frequent in our context and serious as they undertake the vital or functional prognosis. Their support is heavy and can only be conceived within a multidisciplinary framework. The early treatment of cervicofacial cellulitis and better prevention is the pledge of the control of these infections.
Yvette Marie Chantal Gyébré,Aboubacar Gouéta,Noé Zaghré,Moustapha Sérémé,Bertin Priva Ouédraogo,Kampadilemba Ouoba, (2016) Complications of Cervicofacial Cellulitis Supported in University Hospital Yalgado Ouedraogo. International Journal of Otolaryngology and Head & Neck Surgery,05,115-120. doi: 10.4236/ijohns.2016.53019