CLINICAL CASE OF SEVERE NECK COMPLICATION IN A PATIENT WITH POOR DENTITION AND MENTAL DISORDERS

Abstract

Introduction. Deep neck infections (DNI) cause significant morbidity and mortality. The most common primary sources of DNI are inflammatory diseases of the teeth, palatine tonsils, salivary glands, foreign bodies and malignant neoplasms. Aim. Presentation of a clinical case of severe infectious neck lesions in a patient with poor dentition and paranoid schizophrenia to focus the attention of doctors of various specialties of first contact (general practitioners – family doctors, internists, pediatricians, adolescent therapists), otolaryngologists, maxillofacial surgeons, psychiatrists, doctors of all related specialties and dental teams on the prevention of formidable purulent-septic complications in such patients. Materials and methods of the study. The patient was admitted to the otolaryngology department of the Communal non-profit enterprise “Lviv Regional Clinical Hospital” with complaints of an increase in body temperature to 38°C, the presence of edema of the soft tissues of the neck on the left. The disease began acutely, a week ago, with an increase in temperature, difficulty swallowing, refusal to eat, which was associated with a psychiatric disorder. Symptomatic treatment was carried out on an outpatient basis without effect. Three days before going to the hospital, edema appeared in the supraclavicular area, redness of the neck. Results of the study and their discussion. Final diagnosis: “Phlegmon of the neck on the left. Left-sided cervical and supraclavicular lymphadenopathy. Paranoid schizophrenia”. Surgical, complex drug treatment was performed. Inpatient treatment was 18 days, the patient received outpatient treatment for 10 days, dental treatment was performed. Catamnesis of the disease after 1 month it is known that the drainage holes have healed, the consolidation of postoperative scars remains. Conclusions. Odontogenic cervical complications in a patient with immunosuppression due to malnutrition which followed paranoid schizophrenia were diagnosed late. Treatment included surgery, antibacterial and pathogenetic therapy, and was long-term inpatient and outpatient. Therefore, timely dental rehabilitation of dispensary patients is the key to preventing severe life-threatening purulent-septic complications, operations, and long-term expensive treatment. Increasing the awareness of first-line doctors of various specialties (general practitioners – family doctors, therapists, pediatricians, adolescent therapists), psychiatrists, etc. can reduce the time to seek treatment and diagnosis, and subsequently – treatment by multidisciplinary teams of specialists (otolaryngologists, maxillofacial surgeons, dental teams). Early recognition and prompt treatment of such lifethreatening complications reduces treatment time, financial costs, and improves outcomes.