Ear, Nose & Throat Journal2023, Vol. 102(2) 133–135© The Author(s) 2021Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/0145561321989441journals.sagepub.com/home/ear
This is a case of an innovative method of continuous irrigation approach for wound care following surgical drainage. Compared with the traditional labor-intensive irrigation, this novel handy method is not only reducing the workload but is also less time-consuming and inexpensive. This continuous irrigation approach is an efficient alternative approach for wound care in deep infection of the head and neck.
Keywords
irrigating, device, neck, cervical, cellulitis, abscess
An 84-year-old woman presented with trismus and left cheek swelling with fever for 2 days, which then progressed to swelling and tenderness of the left zygomatic, temporal, and frontal area the next day. Computed tomography of the head and neck revealed an abscess in the left masticator space and infratemporal fossa extending to the extracranial frontotemporal region (Figure 1). These findings indicated the presence of a masticator space abscess. The patient underwent a surgical incision and drainage of the abscess (Figure 2). During the surgery, we applied an innovative continuous irrigation approach for wound care (Figure 3), which included an irrigation tube and a 6-mm Penrose draining tube. The irrigation tube was connected to a continuous normal saline irrigation cannula, and the draining tube was connected to continuous negative suction pressure. To effectively remove the deep-space pus, the irrigation tube was inserted into the neck wound approximately 5 cm deep. This double-lumen irrigation device formed using an irrigation tube and a Penrose drain was well fixed to the wound. After the surgery, continuous irrigation and suction were applied for >12 hours a day, stopping only at night while the patient slept. The wound became increasingly clean witheverypassingday,anditwassmoothlyclosedonpostoperative day 5. The patient was then discharged, and at the 3-month postoperative follow-up, the condition had not recurred.
The masticator space (one of the deep neck spaces) is a paired suprahyoid region bounded by the superficial layer of the deep cervical fascia, extending from the top of the parietal bone to the inferior mandible. This space contains mastication muscles, the posterior body and ramus of the mandible, trigeminal nerve, and maxillary artery.1 Among all the deep neck spaces, masticator space is the most prevalent site of spread of odontogenic infection.2 Deep neck infection (DNI) is a prevalent bacterial infectious disease found in all age groups3 and a common emergency condition in otorhinolaryngology.4 Deep neck infection can extend into the airway and mediastinum and potentially be life-threatening, particularly in patients with systemic diseases5-7 and elderly individuals.8,9 The traditional treatment principle of DNI includes surgical drainage, systemic antibiotics administration, and wound irrigation and dressing.10 Intensive irrigation usually needs to be implemented by trained clinicians every 4 to 8 hours each day, which increases the burden on medical manpower, and moreover, it is does not sufficiently clean deep wounds. Therefore, this is a case of an innovative method of continuous irrigation approach for wound care following surgical drainage. Compared with the traditional labor-intensive irrigation, this novel handy method is not only reducing the workload but is also less timeconsuming and inexpensive. This continuous irrigation method provides satisfactory treatment results without any complications. In conclusion, our innovative continuous irrigation approach is an efficient alternative approach for wound care in deep infection of the head and neck.
Hui-Shan Hsieh and Chih-Yuan Lee contributed equally to this work.
The authors would like to acknowledge Wallace Academic Editing for editing this manuscript.
The author(s) declare no potential conflicts of interest concerning the research, authorship, or publication of this article.
The author(s) received no financial support for the research, authorship, or publication of this article.
Hui-Shan Hsieh https://orcid.org/0000-0002-4181-9798
Geng-He Chang https://orcid.org/0000-0001-5939-9747
Ming-Shao Tsai https://orcid.org/0000-0002-9314-5940
1 Department of Otolaryngology–Head and Neck Surgery, Xiamen Chang Gung Hospital, Xiamen, China
2 Nursing Department, Chiayi Chang Gung Memorial Hospital, Chiayi
3 Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi
4 Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan
5 College of Medicine, Chang Gung University, Taoyuan
Received: December 19, 2020; accepted: January 3, 2021
Corresponding Author:
Ming-Shao Tsai, MD, Department of Otolaryngology–Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, No. 6, Sec. West, Jiapu Rd, Puzi City 61363, Chiayi County.
Email: b87401061@cgmh.org.tw
