Mihail Dan Cobzeanu

Deep neck infection is a pathology at the border of two specialties, otorhinolaryngology and maxillofacial surgery, and represents a medico-surgical emergency. In terms of its evolution, it can extend to the level of the thorax and result in mediastinitis, with difficult evolution and poor prognosis. The aims of this scoping review are to present the etiology, bacteriology, clinical manifestations, and diagnostics, as well as treatment, in light of the research published in the last 5 years on deep neck infection associated with descending necrotizing mediastinitis. The most common primary sources of deep neck infection are odontogenic and tonsillar. The other sources that are involved in deep neck infection are salivary glands, foreign bodies, malignancies, and iatrogenic causes after endoscopic maneuvers. The bacteriologic aspect is polymorphic, including both aerobic and anaerobic species. Complications that may appear include jugular vein thrombosis, airway obstruction, acute respiratory distress syndrome, sepsis, and disseminated intravascular coagulation. Timely diagnosis is important for ensuring the positive evolution of a deep neck infection. A CT scan is important for characterizing the nature of a deep neck lesion and identifying the spaces involved, and this method represents the gold standard for diagnosis of these lesions. Following the establishment of a definitive diagnosis, antibiotic therapy is initiated empirically, and is modified according to bacteriological exam results. The administration of antibiotics is an essential part of the treatment strategy for patients with a deep neck infection. Based on CT results, different surgical methods are applied under general anesthesia. The surgical strategy involves opening and draining the cervical spaces and debriding the necrotic tissue. In the cases of odontogenic causes, drainage and extraction of the infected teeth are performed. It is especially important to follow up on the dynamic progression of the patient. In the management of a deep neck infection associated with descending necrotizing mediastinitis, a multidisciplinary team is necessary.

Background and Objectives: Deep neck infections (DNIs) are severe diagnoses that can cause serious complications. However, there are insufficient data to predict the evolution of this pathology. This study aims to review the microbiology of DNIs and to identify the factors that influence prolonged hospitalization. Materials and Methods: The present retrospective cohort observational analytical study analyzed 138 patients with DNIs who were diagnosed and received surgical treatment over a 8-year period. Results: Reduced lymphocyte percentages and increased neutrophil-to-lymphocyte ratios (NLRs) were significantly associated with complications (p < 0.001 and p = 0.0041, respectively). Laryngotracheal infections were significantly associated with complications (25.53%) (p = 0.0004). Diabetes mellitus (DM) and immunocompromised status were strongly associated with complications (p < 0.001 and p = 0.0056, respectively), establishing these conditions as significant risk factors. Patients with complications experienced substantially longer hospitalizations, with a mean duration of 24.9 days compared to 8.32 days in patients without complications (p < 0.001). Complications were observed in 47 patients (34.06%). The most common complications were airway obstruction, which occurred in 26 patients (18.84%), and mediastinitis, which was noted in 31 patients (22.46%). Patients requiring tracheotomy due to airway obstruction had 6.51 times higher odds of long-term hospitalization compared to those without airway obstruction (OR = 6.51; p < 0.001). Mediastinitis was associated with a 4.81-fold increase in the odds of prolonged hospitalization (OR = 4.81; p < 0.001). Monomicrobial infections were observed in 35.5% of cases, with no significant difference between the short-term (p = 0.8472). Conversely, polymicrobial infections were significantly associated with prolonged hospitalization, occurring in 20.63% of the long-term cases compared to 6.66% of the short-term cases (p < 0.001). The most common aerobic bacteria observed were Staphylococcus aureus (14.28%), Streptococcus constellatus (12.69%) and Streptococcus viridans (7.93%) during long-term hospitalization. Comparative analysis of the Kaplan–Meier survival curves based on the presence of infection revealed a significantly lower survival in cases with a positive culture. Conclusions: Deep neck infection has a complex pathology, whose therapeutic management remains a challenge in order to reduce the length of hospitalization and mortality.

Background and Objectives: Deep neck infections (DNI) are severe diagnoses that can cause serious complications. However, are not available enough data to predict the evolution of this pathology. This study aimed to review the microbiology of DNI and to identify the factors that influence prolonged hospitalization. It was designed so that based on the results obtained, the evolution of patients with this pathology could be evaluated. Materials and Methods: In retrospective cohort observational analytical study a 7-years, we analyzed 138 patients with DNI who were diagnosed and received surgical treatment. Results: Reduced lymphocyte percentages and increased neutrophil-to-lymphocyte ratios (NLR) were significantly associated with complications (p < 0.001 and p = 0.0041, respectively). Laryngo-tracheal infections were significantly associated with complications (25.53%) (p = 0.0004). Diabetes mellitus and immunocompromised status, were strongly associated with complications (p < 0.001 and p = 0.0056, respectively), establishing these conditions as significant risk factors. Patients with complications experienced substantially longer hospitalizations, with a mean duration of 24.9 days compared to 8.32 days in patients without complications (p < 0.001). Complications were observed in 47 patients (34.06%). The most common complications were airway obstruction, which occurred in 26 patients (18.84%), and mediastinitis, which was noted in 31 patients (22.46%). Patients requiring tracheotomy due to airway obstruction had 6.51 times higher odds of long-term hospitalization compared to those without airway obstruction (OR = 6.51; p < 0.001). Mediastinitis was associated with a 4.81-fold increase in the odds of prolonged hospitalization (OR = 4.81; p < 0.001). Monomicrobial infections were observed in 35.5% of cases, with no significant difference between short-term (< 2 weeks, 37.33%) and long-term (≥ 2 weeks, 33.33%) hospitalization groups (p = 0.8472). Conversely, polymicrobial infections were significantly associated with prolonged hospitalization, occurring in 20.63% of long-term cases compared to 6.66% of short-term cases (p < 0.001). The most common aerobic bacteria were observed Staphylococcus aureus (14.28%) Streptococcus constellatus (12.69%) and Streptococcus viridans (7.93%) during long-term hospitalizations. The comparative analysis of the Kaplan-Meier survival curves according to the presence of infection revealed a significantly lower survival in cases with a positive culture. Conclusions: Deep neck infection is a complex pathology, whose therapeutic management remains a challenge in order to reduce the length of hospitalization and mortality.

Background and Objectives: In the context of complex aerodigestive cervical traumas, the prognosis and outcome heavily depend on risk factors, particularly injuries to the larynx, trachea, major digestive tissues, cervical vertebrae, and vascular structures. With the increasing prevalence of trauma as a public health concern, there is a pressing need for epidemiological research and the implementation of preventative measures. The purpose of this research is to establish the profile of the predictable impact factors that determine the prognosis of patients with complex cervical trauma. Methods and Methods: The study group consisted of 106 patients with complex cervical trauma pathology developed by various mechanisms such as car accidents, home-related accidents, aggression, gunshot wounds, and self-inflicted attempts, resulting in hospitalization in the E.N.T. Clinic at “St. Spiridon” Iași Hospital, from 2012 to 2016; medical records were the source of the collected data. Results: Hemodynamic instability upon admission associated with age, muscle and laryngeal injuries, and anemia were identified as negative prognostic factors. Additionally, the utilization of imaging-based paraclinical investigations for diagnosing traumatic lesions emerged as a positive prognostic factor in managing this pathology. The management of penetrating cervical trauma remains a subject of debate, with some advocating for surgical exploration beyond the platysma layer in all cases, while others argue for a more selective conservative approach due to a high rate of negative explorations. Conclusions: The statistical evaluation of epidemiological, clinical, lesion, paraclinical, and therapeutic parameters is needed to establish predictable risk factors in the prognosis of complex aerodigestive cervical trauma.

Background and Objectives: The internal carotid artery (ICA) is a vascular structure that can be easily injured during sinus endoscopic procedures, and surgeons should be familiar with its anatomic variants. The aim of this study was to describe the anatomical variations in the internal carotid artery in relationship to sphenoidal sinuses, using computed tomography (CT). Materials and Methods: In this retrospective study, we evaluated the variations of the ICA in relationship to sphenoidal sinuses in a cohort of 600 patients who were assessed between January 2020 and December 2022 in ‘Saint Spiridon’ Emergency Hospital, Iasi, Romania. Descriptive statistics were used to characterize our data. Results: The most prevalent anatomical variant was represented by intrasinusal septa with posterior insertion on the ICA (58.6%), followed by procident ICA (58%) and dehiscent ICA (52%). We could not find any statistical significance regarding demographic characteristics among groups. Conclusions: A thorough CT examination should be performed before functional endoscopic sinus surgery, with the identification of anatomical variants of the ICA, in order to prevent its injury with potentially fatal consequences.

Background and Objectives: In the current literature, mandatory surgical exploration is a controversial topic, with some advocating for it and others against it, proposing a selective conservative management. This multidisciplinary therapeutic approach is based on clinical examination and serial paraclinical explorations associated with supportive drug treatment. Materials and Methods: The study group consisted of 103 patients with complex cervical trauma pathology produced by various mechanisms such as car or domestic accidents, aggression, ballistic trauma, self-inflicted attempts, hanging or strangulation hospitalized in the Ear, Nose and Throat (E.N.T.) Clinic, at “St. Spiridon” Iași Hospital, between 2012 and 2016. Results: The universal clinical indication for urgent surgical exploration of the patient with complex cervical trauma is the presence of the following symptoms: unstable vital signs, significant pulsatile bleeding, hematoma with a substantial increase in size, shock, airway obstruction, open airway wound, hematemesis, or hemoptysis. In this context, we considered it worthwhile to research the management of complex cervical trauma in a reference university medical center, alongside the analysis of the patient’s characteristics under different aspects (demographic, pathological aspects, therapeutic). Conclusions: Complex cervical trauma has a variety of clinical aspects, with a variable evolution, which involves multidisciplinary therapeutic management. The increasing trauma rate is one of the main public health problems, requiring epidemiological studies, and the implementation of control strategies.

Midface fractures are common injuries that are the result of interpersonal violence, traffic accidents, falls, work-related accidents, sports-related accidents, or animal aggression. In the northeastern part of Romania, these injuries are a significant health concern that, if left untreated, may lead to functional and esthetic sequelae. Background and Objectives: This study aims to update the statistical data available to help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence. Materials and Methods: This research was conducted over five years and included 651 patients of both sexes, with ages between 3 and 95 years, that addressed our center for midface fracture treatment. Results: The authors of this study found that men are more predisposed to fractures of the middle third of the face, with anterior laterofacial fractures being the most common type of fracture. Interpersonal violence was the most incriminated etiology for all midface fractures. Conclusions: The present study regarding midfacial fractures shows similar results compared to the medical literature. These findings could help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence.

(1) Background: Magnetic resonance imaging (MRI) is the gold standard investigation for all patients who present with asymmetrical hearing loss (AHL) and a high index of suspicion for vestibular schwannoma (VS). However, pure-tone audiometry (PTA) is an investigation that can be used for the screening of these patients in order to reduce the costs. The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of different PTA protocols for VS in patients with ASHL, when compared with MRI; (2) Methods: Medline, Embase, and Cochrane databases were used to find relevant studies. All prospective and retrospective observational studies that evaluated the accuracy of PTA protocols for the screening of VS were assessed, according to the international guidelines; (3) Results: We analyzed seven studies (4369 patients) of poor-to-moderate quality. Their pooled sensitivity was good (0.73–0.93), but their specificity was low (0.31–0.60). All protocols were located in the right lower quadrant on the likelihood scattergram, and the post-test probabilities for positive and negative diagnosis of these protocols were extremely low; (4) Conclusions: PTA protocols cannot be used for a proper screening or diagnosis of vestibular schwannoma despite their good sensibility, and MRI remains the gold standard for this purpose.

Background: Naso-orbito-ethmoido-maxillary (NOEM) fractures are usually the result of a high or moderate intensity impact to the upper midface. These types of fractures are difficult to treat and are frequently misdiagnosed. Craniometric analysis can be of real aid in the treatment of NOEM complex fractures by establishing midfacial proportions. Aim: This study aims to establish the distances between selected anthropometric points and midfacial proportions found in the adult Caucasian population and to determine if any differences exist between genders. Methodology: Measurements between anthropometric points, nasion (N), dacryon (D), infraorbital foramen (IOF), frontomalare orbitale (FMO), rhinion (Rhi) and porion (Po), were made on 3D models obtained using patients’ CT exams. Results: Significant differences were found between genders for the orbital dimensions represented by N–FMO (p = 0.000), N–IOF (p = 0.000), Rhi–FMO (p = 0.000), Rhi–IOF (p = 0.000), nose bridge width N–D (p = 0.001), Rhi–D (p = 0.016), D–D (p = 0.038) and the projection of the nose evaluated by Rhi–Po (p = 0.000), N–Po (p = 0.000), while a t-test showed that there are no significant differences between males and females for the N–Rhi (p = 0.254). Conclusions: The values of these measurements can be utilized during skeletal reconstruction after NOEM fractures, especially for bilateral comminuted fractures where no points of comparison are available.

Background and objectives: Knowledge of the interactions and influences of infectious, genetic, and environmental factors on the evolution and treatment response of malignant tumors is essential for improving the management of the disease and increasing patient survival. The objective of this study was to establish the contribution of human papillomavirus (HPV), as well as p53 and p16 tumor markers, alongside associated factors (smoking and alcohol consumption), in the progression of malignancies located in the oropharynx and at the retromolar trigone–oropharyngeal junction. Materials and Methods: We performed a prospective study including 50 patients with malignant tumors of the oropharynx and retromolar trigone–oropharyngeal junction. In all patients, the presence and type of HPV were determined, as well as the status of the tumor markers p53 and p16. The associated risk factors, biopsy results, treatment method, and post-treatment evolution were all documented. Statistical analyses were performed to evaluate the correlations between the determining factors and their influence on the post-treatment evolution. An overall increased survival rate was found in HPV(+) patients. Results: Our study outlined the prevalence of different high-risk subtypes of HPV from the ones presented by other studies, suggesting a possible geographic variation. Correlations between the p53 and p16 statuses and patient survival could be established. The association of smoking and alcohol consumption strongly correlated with an unfavorable evolution. Conclusions: Awareness of the differences in the post-treatment evolution of the patients in relation to the presence of the factors determined in our study could change the future management of such cases for ensuring improved treatment outcomes.