Abstract Diabetes mellitus is a systemic condition potentially related to an increased risk of progression of various infections such as chronic osteomyelitis by accelerating the inflammatory process with bone tissue necrosis and suppuration. Therefore, if there is no proper management of these infections, they can be life-threatening as they spread to deeper spaces in the head and neck. We describe the case of a 52-year-old male patient with a history of diabetes mellitus and grade III osteoarthritis who was diagnosed with chronic suppurative osteomyelitis of the mandible. He underwent a multidisciplinary surgical intervention in which he underwent a hemimandibulectomy with immediate mandibular reconstruction. The present case highlights the importance of early and radical treatment of patients with chronic suppurative osteomyelitis of the mandible and systemic comorbidities. In addition, this case presents a review of diabetes mellitus and the risk of developing odontogenic infections and complications when invading deeper spaces in the head and neck. Therefore, in this population, careful planning is required for early surgical and pharmacological treatment.

Resumen La diabetes mellitus es una condición sistémica potencialmente relacionada con un mayor riesgo de progresión de diversas infecciones como la osteomielitis crónica al acelerar el proceso inflamatorio con necrosis del tejido óseo y supuración. Por lo tanto, si no hay un manejo adecuado de estas infecciones pueden ser potencialmente mortales al llegar a propagarse a espacios más profundos de la cabeza y cuello. Describimos el caso de un paciente varón de 52 años con antecedentes de diabetes mellitus y osteoartrosis grado III a quien se le diagnosticó de osteomielitis crónica supurativa mandibular. Se le realizó una intervención quirúrgica multidisciplinaria en la cual se le realizó una hemimandibulectomía con reconstrucción mandibular inmediata. El presente caso destaca la importancia del tratamiento temprano y radical de los pacientes con osteomielitis mandibular crónica supurativa y comorbilidades sistémicas. Además, en este caso se presenta una revisión sobre la diabetes mellitus y el riesgo de desarrollar infecciones odontogénicas y complicaciones al invadir espacios más profundos de la cabeza y cuello. Por lo tanto, en esta población se requiere de una planificación cuidadosa para realizar un tratamiento quirúrgico y farmacológico temprano.

Aim To investigate the bacteriological profile of oral and maxillofacial infections and the pattern of sensitivity to a specific group of antibiotics in a reference emergency hospital in Brazil. Methods This is a prospective cohort institutional study that studied patients affected by oral and/or maxillofacial infections in a Brazilian emergency hospital, over a 12-month period, of different etiologies, through data collection, culture and antibiogram tests, and monitoring of the process of resolution of the infectious condition. The variables were analyzed using the chi-square and Mann-Whitney tests, using a significance level of 5%. Results The sample consisted of 61 patients, 62.3% male. The mean age of participants was 34.3 years. Odontogenic infection was the most frequent etiology and the submandibular space was the most affected. The bacterial species Streptococcus viridans was isolated in 21.6% of cases. Levofloxacin, vancomycin and penicillin were the antibiotics with the highest frequency of bacterial sensitivity, while clindamycin and erythromycin showed the highest percentages of resistance. Conclusions The results suggest that, among the most used antibiotics for the treatment of these infections, penicillin remains an excellent option of choice for empirical therapy. Brazil andor or 12month month 12 period etiologies collection tests condition chisquare chi square MannWhitney Mann Whitney 5 5% 6 623 62 3 62.3 male 343 34 34. years 216 21 21.6 cases Levofloxacin resistance therapy 1 62. 2 21.

ABSTRACT Background: Patients with deep infections may present with extremely serious and life-threatening conditions. It is unbelievable that someone could die from a molar infection in the 21st century, but it is real. Objective: The aim of the present study is to describe the diagnosis and treatment results of a series of patients with odontogenic deep neck infections, and to establish criteria for the management of these infections. Material and methods: We conducted a retrospective and descriptive study based on records from a database from September 2006 to June 2022. Only patients with odontogenic deep neck infections were included. The demographic variables, those related to the origin of the complication, the treatment performed, and the patients’ progress were evaluated. Results: The sample was made up of 499 patients; mean age was 29 years (12-70) and 288 (57.7%) were men. Late visits and self-medication were recorded in 269 patients (53.9%) and 271 patients (54.3%), respectively. Most of them had not received treatment for the affected tooth at the primary healthcare center. Surgical treatment was performed in 267 cases (53.5%), and the rest were managed with conservative approach. The disease had a favorable course in 497 patients (99.6%) and two patients died of mediastinitis. Conclusion: Odontogenic infections should be adequately diagnosed and treated correctly and early to avoid extremely serious complications. Population-based educational campaigns and training for physicians and dentists working in primary care centers and emergency departments could improve this issue.

RESUMEN Antecedentes: los pacientes con infecciones cervicales pueden presentar cuadros de extrema gravedad que ponen en riesgo su vida. Parece increíble que en pleno siglo XXI alguien muera por la infección de una muela, pero es real. Objetivo: describir los resultados con el diagnóstico y tratamiento de una serie de pacientes con infecciones de los espacios profundos del cuello de origen dentario, y establecer criterios para su manejo. Material y métodos: se realizó un estudio descriptivo y retrospectivo a partir de los registros en nuestra base datos entre septiembre de 2006 y junio de 2022. Se incluyeron sólo pacientes con infecciones cervicales de origen dentario. Se evaluaron las variables demográficas, las relacionadas al origen de la complicación, el tratamiento realizado y la evolución de los pacientes. Resultados: la muestra quedó conformada por 499 pacientes, con promedio de edad de 29 años (12- 70); 288 (57.7%) eran hombres. Consultaron en forma tardía 269 (53,9%) y se automedicaron en forma inicial 271 pacientes (54.3%). La mayoría no había recibido tratamiento de la pieza dentaria en el centro de atención primaria. Se realizó tratamiento quirúrgico 267 casos (53.5%), y el resto pudo tratarse de forma conservadora. La evolución fue favorable en 497 pacientes (99.6 %), y dos fallecieron por mediastinitis. Conclusión: las infecciones odontógenas deben ser diagnosticadas y tratadas apropiadamente en forma precoz a fin de evitar cuadros de extrema gravedad. Las campañas de educación poblacional y la instrucción de los médicos/odontólogos de centros de atención primaria y servicios de guardia podría mejorar esta problemática.

Abstract Osteomyelitis is defined as the inflammation of the either medullary, cortical, or cancellous bone, including nerves and blood vessels, causing necrosis and bone sequestrum formation; this condition has become a rare pathology, and odontogenic infections are considered the most frequent causal factor. This case shows a patient with bi-maxillary osteomyelitis caused by Actinomyces spp, which was worsened for severe COVID-19 infection. Patient was submitted at surgery as, amplified total bilateral maxillectomy through the surgical technique Weber-Fergusson, and prolonged use of combination of antibiotics, achieved a good recovery. Two years later follow- up, the patient no show imaging or clinical evidence of the infection of osteomyelitis. The present case shows an interesting relationship between a rare infection and its association with COVID-19.

Resumen La osteomielitis se define como la inflamación del hueso medular, cortical o esponjoso, incluyendo nervios y vasos sanguíneos, causando necrosis y formación de secuestro óseo; esta condición es una patología rara, y las infecciones odontogénicas son consideradas como el factor causal más frecuente. En este caso, se muestra un paciente con osteomielitis bi-maxilar causada por Actinomyces spp, la cual empeoró por la infección de COVID-19 severo. El paciente fue sometido a una cirugía, maxilectomía bilateral total amplificada, a través de la técnica quirúrgica de Weber- Fergusson, y el uso prolongado de una combinación de antibióticos, logrando una buena recuperación. A los 2 años de seguimiento, el paciente no mostró evidencia clínica o imagenológica de la infección de osteomielitis. El presente caso muestra una interesante relación entre una infección rara y su asociación con COVID-19.

Abstract Objective: Assess epidemiological data and clinical predictors of mediastinitis in deep neck infections (DNI) submitted to surgery. Study Design: Retrospective observational Methods: Data analysis of every DNI patient submitted to surgery from January 2015 to December 2021 in the Otorhinolaryngology department of a tertiary hospital center. Results: A total of 165 patients with a mean age of presentation of 48,5 years were included. The most frequent etiology was odontogenic infection (51,5%) and the most involved cervical space was the submandibular space (60,6%). Furthermore, the most isolated bacteria in patients with and without mediastinitis was Streptococcus spp. Progression to mediastinitis occurred in 20 (12,1%) patients. In a multivariate analysis, a bilateral DNI location (p=0,015) and a higher neutrophil to lymphocyte ratio (NLR) (0,037) were associated with progression to mediastinitis. Conclusion: The presence of a bilateral DNI and NLR seem to be the most important clinical predictors of mediastinitis.

Resumo Objetivo: Avaliar dados epidemiológicos e fatores preditivos de mediastinite em abcessos cervicais profundos (ACP) submetidos a cirurgia. Desenho de Estudo: Observacional retrospetivo. Material e Métodos: Avaliação de adultos com ACP submetidos a cirurgia de janeiro de 2015 a dezembro de 2021 no serviço de Otorrinolaringologia de um hospital terciário português. Resultados: Foram incluídos 165 doentes com uma idade média de 48,5 anos. O espaço cervical envolvido mais frequentemente foi o espaço submandibular (60,6%) e a etiologia mais comum foi a infeção odontogénica (51,5%). Os microrganismos isolados mais frequentemente em pacientes com e sem mediastinite foram da espécie Streptococcus spp. Ocorreu evolução para mediastinite em 20 (12,1%) doentes. Numa análise multivariada, a presença de abcesso bilateral (p=0,015) e o aumento do rácio de neutrófilos para linfócitos (NLR) (0,037) associaram-se à evolução para mediastinite. Conclusão: A presença de abcesso bilateral e o aumento do NLR são os fatores preditivos mais importantes na evolução para mediastinite.

ABSTRACT Introduction: odontogenic infection is that which has its origin in the structures that form the tooth and the periodontium, and which by extension will affect the maxillary or mandibular bone in its periapical region. This type of infection is usually superficial, localized and limited, but on some occasions a secondary dissemination of the odontogenic infection to other anatomical regions can be observed. Objective: to determine the risk factors for the instauration of odontogenic infections. Methods: a systematic literature review was carried out at the Universidad Regional Autónoma de los Andes between December 2022 and April 2023 on the risk factors for the dissemination of odontogenic infections. Articles in English, Spanish and Portuguese published in PubMed, SciELO and LILACS databases were studied. Development: Of the 512 articles recovered, eight were identified after the screening process, which studied the risk factors for the spread of odontogenic infections. Most belonged to the Journal of Applied Oral Science and 100 % were descriptive studies. Conclusions: Obesity, immunosuppression and diabetes mellitus have a direct influence on the aggravation of odontogenic infections. On the other hand, factors such as oral hygiene, diet, tobacco and drug use are associated with the spread of odontogenic infections.

RESUMEN Introducción: la infección odontogénica es aquella que tiene su origen en las estructuras que forman el diente y el periodonto, y que por extensión afectará al hueso maxilar o mandibular en su región periapical. Este tipo de infecciones generalmente suelen ser superficiales, localizadas y limitadas, pero en algunas ocasiones puede observarse una instauración secundaria de la infección odontogénica hacia otras regiones anatómicas. Objetivo: determinar los factores de riesgo para la para la instauración de infecciones odontogénicas. Métodos: se realizó una revisión sistemática de la literatura en la Universidad Regional Autónoma de los Andes entre diciembre de 2022 y abril de 2023 sobre los factores de riesgo para la instauración de infecciones odontogénicas. Se estudiaron artículos en inglés, español y portugués publicados en las bases de dato PubMed, SciELO y LILACS. Desarrollo: de los 512 artículos recuperados se identificaron ocho tras el proceso de cribado, los cuales estudiaron los factores de riesgo para la instauración de infecciones odontogénicas. La mayor parte pertenecieron a la revista Journal of Applied Oral Science y el 100 % fueron estudios descriptivos. Conclusiones: la obesidad, inmunosupresión, diabetes mellitus, influyen de manera directa en la agudización de las infecciones odontogénicas. Por su parte, factores como la higiene oral, dieta, consumo de tabaco y drogas se encuentran se asocian a la instauración de infecciones odontogénicas.

Abstract Objectives: Odontogenic infections are frequent and can spread, leading to complications such as sepsis and the need for admission to an Intensive Care Unit (ICU). The purpose of this study was to perform a computed tomography analysis of the fascial space involvement and correlate with personal data, laboratory tests, length of hospital stays and admission to the ICU in patients with odontogenic infections who required hospitalization. Methods: Patients with odontogenic infections admitted between June 2017 and May 2018 were prospectively evaluated. The fascial spaces involved were studied using computed tomography with contrast. The possible correlations of tomographic findings with comorbidities, nutritional status, the causative tooth, laboratory tests, length of hospital stays and admission to the ICU were analyzed. Results: We identified 66 cases of odontogenic infections which were admitted in the period analyzed. The involvement of primary spaces (86.7%) predominated, followed by secondary ones (8.7%), and cervical (4.6%). The most frequently involved fascial spaces were submandibular (27.1%), buccal (20.8%), sublingual (18.3%), submental (16.7%), and others (17.1%). There were significant differences between laboratory tests (p < 0.001), mean hospital stays (p < 0.001), and admissions to the ICU (p < 0.001) depending on the number of fascial spaces involved. There was no influence of comorbidities, nutritional status, or causative tooth on fascial space involvement. Conclusion: There was a relationship between greater involvement of fascial spaces assessed by computed tomography and higher values of laboratory tests, more extended hospitalization stays and admission to the ICU. Level of evidence: Level 2b. Objectives spread . (ICU) data Methods 201 evaluated contrast comorbidities status analyzed Results 6 86.7% 867 86 7 (86.7% predominated 8.7%, 87 8.7% , 8 (8.7%) 4.6%. 46 4.6% 4 (4.6%) 27.1%, 271 27.1% 27 1 (27.1%) 20.8%, 208 20.8% 20 (20.8%) 18.3%, 183 18.3% 18 3 (18.3%) 16.7%, 167 16.7% 16 (16.7%) 17.1%. 171 17.1% 17 (17.1%) p 0.001, 0001 0.001 0 001 Conclusion evidence 2b b (ICU 86.7 (86.7 8.7 (8.7% 4.6 (4.6% 27.1 2 (27.1% 20.8 (20.8% 18.3 (18.3% 16.7 (16.7% 17.1 (17.1% 000 0.00 00 86. (86. 8. (8.7 4. (4.6 27. (27.1 20. (20.8 18. (18.3 16. (16.7 17. (17.1 0.0 (86 (8. (4. (27. (20. (18. (16. (17. 0. (8 (4 (27 (20 (18 (16 (17 ( (2 (1

Abstract: Introduction: descending necrotizing mediastinitis (DNM) refers to mediastinal infections originating in the oropharyngeal and cervicofacial region that spread through the deep planes of the cervical fascia into the mediastinum. Multiple organ failure and high mortality are related to the delay in diagnosis and medical-surgical treatment. Surgical treatment remains controversial, with supports ranging from isolated cervical drainage to cervical drainage and thoracotomy and/or median sternotomy. Objective: to know the morbidity and mortality related to the surgical management of NDM as well as the main etiology prevalent in our environment. Material and methods: it is a retrospective study in a period between 2006 and 2022 of patients with MND who were hospitalized and surgically treated in the Thoracic Surgery Service of the National Institute of Respiratory Diseases Ismael Cosío Villegas. Results: 51 patients were included, 38 men, age 39.19 ± 14.06 years. 41 patients were classified ENDO IIB, 9 ENDO I, the main cause was odontogenic in 28 patients. Days of hospital stay of 22.65 ± 15.61 days. 12 patients operated by cervicotomy and 39 patients combined approach. 22 patients required reintervention. 14 deaths, the most prevalent cause of septic shock. Conclusions: the approaches used according to the availability of resources over time and hospital stay and mortality do not differ from what is reported in the literature.

Resumen: Introducción: la mediastinitis necrosante descendente se refiere a las infecciones mediastínicas que se originan en la región orofaríngea y cervicofacial que se diseminan a través de los planos profundos de las fascias cervicales hacia el mediastino. La falla orgánica múltiple y la alta mortalidad están relacionadas con el retraso en el diagnóstico y tratamiento médico-quirúrgico. El tratamiento quirúrgico sigue siendo controvertido, con soportes que van desde el drenaje cervical aislado hasta el drenaje cervical y la toracotomía y/o esternotomía media. Objetivo: conocer la morbimortalidad relacionada con el manejo quirúrgico de la mediastinitis necrosante descendente, así como la principal etiología prevalente en nuestro medio. Material y métodos: es un estudio retrospectivo en un período comprendido entre 2006 y 2022 de pacientes con mediastinitis necrosante descendente que fueron hospitalizados y tratados quirúrgicamente en el Servicio de Cirugía Torácica del Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Resultados: se incluyeron 51 pacientes, 38 hombres, edad de 39.19 ± 14.06 años; 41 pacientes se clasificaron como ENDO IIB, nueve ENDO I, la causa principal fue odontogénica en 28 pacientes. Días de estancia hospitalaria de 22.65 ± 15.61 días. Operados por cervicotomía 12 pacientes y abordaje combinado 39 pacientes. 22 pacientes requirieron reintervención quirúrgica. Hubo 14 defunciones, la causa más prevalente fue choque séptico. Conclusiones: los resultados no difieren de los reportados en la literatura, en cuanto al tipo de abordaje de acuerdo con la disponibilidad de los recursos con el paso del tiempo, la estancia hospitalaria y mortalidad.

Introduction: Inappropriate and ineffective treatment of odontogenic infections can cause life-threatening complications such as Descending Necrotizing Mediastinitis (MND). MDN is a serious infection that affects the neck-thorax, with a high mortality rate from sepsis and organ failure if it is not treated quickly and effectively. Aim: To describe a case of MND of odontogenic origin and its medical-surgical management. Case report: We present a 34-year-old male patient who is admitted with an acute infectious condition of odontogenic origin, which compromises spaces of the head, neck and thorax (upper mediastinum), which is treated successfully. Discussion: Odontogenic infections are generally localized and can be treated by conventional therapies. In spite of this, if these infections cannot be controlled, either by not carrying out appropriate treatments or by immunosuppressed states of the patient, different complications such as MND can develop. Conclusion: A rapid diagnosis, aggressive surgical treatment, adequate antibiotic therapy and supportive care are the fundamental pillars for the management of MND.

Resumen Introducción: El tratamiento inoportuno e ineficaz de las infecciones odontogénicas puede causar complicaciones potencialmente mortales como la mediastinitis necrotizante descendente (MND). La MDN es una infección grave que afecta al cuello-tórax, con una alta tasa de mortalidad por sepsis e insuficiencia orgánica si no se trata de manera rápida y efectiva. Objetivo: Describir un caso de MND de origen odontogénico y su manejo médico-quirúrgico. Caso clínico: Presentamos un paciente de sexo masculino de 34 años que ingresa con un cuadro infeccioso agudo de origen odontogénico, que compromete espacios de la cabeza, cuello y tórax (mediastino superior), el cual se trata exitosamente. Discusión: Las infecciones odontogénicas son generalmente localizadas y que se pueden tratar mediante terapias convencionales. A pesar de esto, si estas infecciones no pueden controlarse, ya sea por no realización de tratamientos oportunos o por estados inmunosuprimidos del paciente, se pueden desarrollar diferentes complicaciones como la MND. Conclusión: Un diagnóstico rápido, el tratamiento quirúrgico agresivo, la terapia antibiótica adecuada y la atención de apoyo son los pilares fundamentales para el manejo de la MND.

ABSTRACT Objective: Odontogenic infection is a common condition in America; the aim of this research was to determine the profile of odontogenic maxillofacial infections and to identify the link between these and the pain felt by patients admitted to the emergency dental service of the Hernân Henriquez Aravena Hospital in Temuco, Chile. Methods: A cross-sectional, double-blind study analysed 49 individuals admitted for emergency dental care. Included were admissions associated with odontogenic infection identified by clinical examination, establishing a relation to pain through a survey. The diagnosis was made clinically using the fascial spaces involved in the infection, presence of self-medication prior to admission, need for surgical treatment and the patient ‘s systemic conditions. The data were analysed using descriptive statistics, Chi-squared, ANOVA, considering a value of p < 0.05 as significant. Results: The average pain level measured by visual analogue scale (VAS) in emergency admission was 8.1. There was no association between the diagnosis (pulp infection, periodontal infection or pericoronitis) and the VAS (p = 0.078), but there was association between age and the diagnosis (p = 0.022), and the VAS was associated with pain compared to other types of pathologies or traumas (p = 0.011). Conclusion: Odontogenic infection is frequent and linked to age and high-pain values. New public policies should be adopted based on these results. New studies are needed to assess new variables associated with these pathologies.

ABSTRACT: The purpose of this study was to evaluate the changes in vital signs and laboratory tests of patients with odontogenic infections who required hospitalization as well as checking their effectiveness in determining the severity of the case and possible correlations with the length of stay. Patients with odontogenic infections who required hospitalization were assessed prospectively between October 2016 and April 2018. The patients were divided into two groups considered as simple (Group 1) or complex (Group 2) cases according to the length of stay. The personal data, comorbidities, signs and symptoms, vital signs and laboratory tests were analyzed. In this study, 84 cases of maxillofacial infections were detected and 50 cases of odontogenic infections were included. There were significant increases in heart rate (p = 0.012), leukocytosis (p = 0.037), neutrophilia (p = 0.021), neutrophil/lymphocyte (N/L) ratio (p = 0.044) and C-reactive protein (CRP) levels (p = 0.004) in Group 2. Additionally, there were positive correlations between the length of stay and the following variables: heart rate (p = 0.028), leukocytosis (p = 0.045), neutrophilia (p = 0.033), N/L ratio (p = 0.041) and CRP level (p = 0.003). The N/L ratio was found to have a greater value in regression analysis. It was concluded that there were significant increases in heart rate, leukocytosis, neutrophilia, N/L ratio and CRP levels for the complex cases. There were also positive correlations between the length of stay and the following variables: heart rate, leukocytosis, neutrophilia, N/L ratio and CRP level.

RESUMEN: El propósito de este estudio fue evaluar los cambios en los signos vitales y las pruebas de laboratorio de pacientes con infecciones odontogénicas que requirieron hospitalización, así como verificar su efectividad para determinar la gravedad del caso y las posibles correlaciones con la duración de la internación. Pacientes con infecciones odontogénicas que requirieron hospitalización fueron evaluados prospectivamente entre octubre de 2016 y abril de 2018. Los pacientes se dividieron en dos grupos considerados como casos simples (Grupo 1) o complejos (Grupo 2) según la duración de la internación. Se analizaron los datos personales, comorbilidades, signos y síntomas, signos vitales y pruebas de laboratorio. En este estudio, se detectaron 84 casos de infecciones maxilofaciales y se incluyeron 50 casos de infecciones odontogénicas. Hubo aumentos significativos en la frecuencia cardíaca (p = 0,012), leucocitosis (p = 0,037), neutrofilia (p = 0,021), relación neutrófilos / linfocitos (N/L) (p = 0,044) y niveles de proteína C reactiva (PCR) (p = 0,004) en el Grupo 2. Además, hubo correlaciones positivas entre la duración de la internación y las siguientes variables: frecuencia cardíaca (p = 0,028), leucocitosis (p = 0,045), neutrofilia (p = 0,033), relación N/L (p = 0,041) y nivel de PCR (p = 0,003). Se encontró que la relación N/L tenía un mayor valor en el análisis de regresión. En conclusión, hubo aumentos significativos en la frecuencia cardíaca, leucocitosis, neutrofilia, relación N/L y niveles de PCR para los casos complejos. También hubo correlaciones positivas entre la duración de la internación y las siguientes variables: frecuencia cardíaca, leucocitosis, neutrofilia, relación N/L y nivel de PCR.

ABSTRACT Introduction and objective: At least 36% of deep cervical infections may have a dental origin. Case description: A 44-year-old woman who consulted for dysphonia of a week of evolution. Rhinofibrolaryngoscopy revealed left arytenoid edema and paralysis of the left hemilarynx and normal neck. A computerized axial tomography was performed, finding left parapharyngeal abscess. Systemic and surgical antibiotic treatment was performed with cervicotomy and drainage of the abscess in whose culture Prevotella buccae was isolated. Comments: The result of the culture helped establish the dental origin of the infection. In the dental history, a history of pericoronitis associated with 3.8 was found. Conclusions: The diagnosis of the dental origin of a deep cervical infection is established by dental history, oral examination, oral radiology and microbiological culture.

RESUMEN Introducción y objetivo: Al menos el 36% de las infecciones cervicales profundas pueden tener un origen dental. Descripción del caso: Mujer de 44 años que consultó por disfonía de una semana de evolución. La rinofibrolaringoscopia reveló edema aritenoideo izquierdo y parálisis de la hemilaringe izquierda y cuello normal. Se realizó una tomografía axial computarizada, encontrando absceso parafaríngeo izquierdo. Se realizó tratamiento antibiótico sistémico y quirúrgico con cervicotomía y drenaje del absceso en cuyo cultivo se aisló Prevotella buccae. Comentarios: El resultado del cultivo ayudó a establecer el origen dental de la infección. En la historia dental, se encontró una historia de pericoronitis asociada con 3.8. Conclusiones: el diagnóstico del origen dental de una infección cervical profunda se establece mediante la historia dental, el examen oral, la radiología oral y el cultivo microbiológico.

Abstract Introduction: Ludwig's angina constitutes one of the most admitted infections of the soft tissues of the neck and floor of the tongue in the intensive care units (ICU) due to its airway compromise and complications from septic shock. The incidence is higher in the adult population, and with the use of the latest generation antibiotics, its incidence has decreased. One of the most frequent causes is the presence of an odontogenic focus, such as abscesses, mainly on the second and third molars. Objective: To describe a clinical case that was admitted to the ICU of the Hospital, highlighting comprehensive management and adequate antibiotic therapy. Main data of the case: 24-year-old female patient, a native of Latacunga, goes to the emergency service of the Hospital del sur de Quito due to fever of 10 days of evolution and general condition with signs of shock, and severe pain in the tongue, with edema, and impaired phonation. For initial management, tramal is administered intravenously, Hydrocortisone IV, and broad-spectrum antibiotic with piperacillin with tazobactam 4 grams intravenously every 6 hours, and intravenous metronidazole every 8 hours. Conclusions: Ludwig's angina is a pathology that usually involves young patients, whose evolution is rapid and its inadequate management leads to death associated with obstructive respiratory failure and severe sepsis, which therefore requires a timely diagnosis.

Resumen Introducción: La angina de Ludwig constituye una de las infecciones de los tejidos blandos del cuello y piso de la lengua con más ingresos en las unidades de cuidados intensivos (UCI) por su compromiso de la vía aérea y complicaciones por choque séptico. La incidencia es mayor en la población adulta, y con el uso de los antibióticos de última generación, su incidencia ha disminuido. Una de las causas más frecuentes es la presencia de un foco odontogénico como los abscesos, principalmente en el segundo y el tercer molar. Objetivo: Describir un caso clínico, internado en la UCI del hospital, destacando el manejo integral y la terapia antibiótica adecuada. Datos principales del caso: paciente femenina de 24 años, natural de Latacunga, acude al servicio de emergencias del Hospital del sur de Quito por fiebre de 10 días de evolución y toma del estado general con signos de shock, y dolor intenso en lengua, con edema, y deterioro de la fonación. Para el manejo inicial se administra tramal por vía intravenosa, hidrocortisona IV y antibiótico de amplio espectro con piperacilina con tazobactam 4 gramos IV cada 6 horas, y metronidazol IV cada 8 horas. Conclusiones: la angina de Ludwig es una patología que habitualmente involucra pacientes jóvenes, cuya evolución es rápida y su inadecuado manejo conlleva a la muerte, asociado con insuficiencia respiratoria obstructiva y sepsis grave, por lo que requiere un diagnóstico oportuno.

Resumo A angina de Ludwig apresenta-se como uma celulite grave que envolve o espaço submandibular, de início agudo e evolução rapidamente progressiva. Descreve-se o quadro clínico de um homem de 33 anos com uma tumefação submandibular de agravamento progressivoassociada a obstrução da via aérea e necessidade de ventilação mecânica invasiva. Imagiologicamente, apresentava extenso processo fleimonoso dos tecidos moles do pescoço, com ponto de partida em cáries dentárias homolaterais. Foi instituída a drenagem do abcesso e antibioterapia, sem evidência de melhoria. Careceu de intervenção cirúrgica, com evolução paulatina, mas favorável. Este caso demonstra que o diagnóstico e tratamento precoces são fundamentais para o sucesso terapêutico.

Abstract Ludwig’s angina is a severe cellulitis involving the submandibular space, with acute onset and rapidly progressive evolution. We describe the case of a 33-year-old man with a progressive submandibular swelling associated with an airway obstruction that required mechanical ventilation. Radiologically, the patient presented with an extensive phlegmonous process of the soft tissues of the neck, originating from homolateral dental caries. Abscess drainage and antibiotic therapy were performed, without evidence of improvement. Surgical intervention was required, resulting in slow but favorable evolution. This case shows that successful treatment depends on early diagnosis and treatment.

Resumen La fascitis necrotizante es una infección rara y de tejidos blandos caracterizada por una infección de rápida propagación del tejido subcutáneo y, en particular, de la fascia. La fascitis necrotizante tiene un origen polimicrobiano y una necrosis extensa que exhibe formación gaseosa en el tejido subcutáneo y la fascia superficial. El manejo de los tejidos infectados requiere un diagnóstico rápido, una intervención quirúrgica inmediata acompañada de un desbridamiento prolongado y una terapia antibiótica sistémica. El objetivo de este trabajo es relatar un caso raro de fascitis necrotizante de la región cervical-fascial, haciendo hincapié en la importancia del diagnóstico y el tratamiento temprano.

Abstract Necrotizing fasciitis is characterized as a subset of aggressive infections of the skin and soft tissues that cause necrosis of the muscular fascia and subcutaneous tissues. It has a polymicrobial origin and presents an extensive necrosis that exhibits gas formation in the subcutaneous tissue and superficial fascia. The management of infected tissues requires rapid diagnosis, immediate surgical intervention accompanied by extensive debridement and systemic antibiotic therapy. The aim of this paper is to relate a case of an odontogenic necrotizing fasciitis of the cervico-facial region emphasizing the importance of early diagnosis and treatment.

Resumo A fasceite necrotizante é caracterizada como um subconjunto das infecções agressivas da pele e tecidos moles que causam necrose da fáscia muscular e dos tecidos subcutâneos. Tem origem polimicrobiana e apresenta extensa necrose que exibe uma formação gasosa no tecido subcutâneo e fáscia superficial. É fundamental um rápido diagnóstico, seguido de intervenção cirúrgica imediata e antibioticoterapia sistêmica para que se consiga sucesso no tratamento. O objetivo desse artigo é relatar um caso de fasceíte necrotizante em região cérvico-facial com origem odontogênica, ressaltando a importância do diagnóstico e tratamento precoce.