Oropharyngeal manifestations in severe toxic epidermal necrolysis: a single-center’s retrospective case series - PhDData

Access database of worldwide thesis




Oropharyngeal manifestations in severe toxic epidermal necrolysis: a single-center’s retrospective case series

The thesis was published by GLASSON, Nicolas, in January 2023, University of Lausanne.

Abstract:

Contexte :
La nĂ©crolyse Ă©pidermique toxique est une maladie cutanĂ©o-muqueuse rare et potentiellement mortelle. Bien que l’atteinte des muqueuses ORL soit frĂ©quente, on sait peu de choses sur les caractĂ©ristiques, les modalitĂ©s de traitement et les rĂ©sultats de ces lĂ©sions. L’objectif de cette Ă©tude est d’Ă©valuer les lĂ©sions des muqueuses ORL chez les patients atteints de nĂ©crolyse Ă©pidermique toxique sĂ©vère et d’analyser leurs caractĂ©ristiques, leurs modalitĂ©s de traitement et leurs rĂ©sultats, ainsi que de proposer un algorithme de prise en charge pour prĂ©venir les sĂ©quelles Ă  long terme de ces lĂ©sions.
MĂ©thodes :
Il s’agit d’une revue rĂ©trospective des cas de nĂ©crolyse Ă©pidermique toxique traitĂ©s dans le service des brĂ»lĂ©s d’un hĂ´pital tertiaire, CHUV Ă  Lausanne, Suisse, entre 2006 et 2019.
RĂ©sultats :
Sur 19 patients atteints de nĂ©crolyse Ă©pidermique toxique sĂ©vère, 17 (89%) ont bĂ©nĂ©ficiĂ© d’un examen ORL complet Ă  l’admission et 14 (82%) prĂ©sentaient une atteinte des muqueuses ORL. Cinq (26,3 %) patients sont dĂ©cĂ©dĂ©s pendant leur sĂ©jour en unitĂ© de soins intensifs. Sur les 16 patients ayant reçu des soins maximaux, 13 (81%) ont nĂ©cessitĂ© une intubation orotrachĂ©ale pendant une durĂ©e mĂ©diane de 16 (IQR 14) jours. Sur les 14 patients qui ont survĂ©cu, 4 (29%) ont eu des complications ORL Ă  long terme consistant en des synĂ©chies nĂ©cessitant des procĂ©dures endoscopiques ultĂ©rieures. Ces 4 patients ont tous eu besoin d’une ventilation mĂ©canique avec une sonde orotrachĂ©ale et ont souffert de synĂ©chies hypopharyngĂ©es ainsi que de synĂ©chies orales et endonasales dans certains cas.
Conclusion :
Cette Ă©tude suggère une prĂ©valence Ă©levĂ©e de synĂ©chies ORL chez les patients atteints de nĂ©crolyse Ă©pidermique toxique sĂ©vère et nĂ©cessitant une intubation orotrachĂ©ale. Un examen ORL pĂ©riodique pourrait prĂ©venir la formation de synĂ©chies matures chez ces patients. Nous proposons un algorithme pour prĂ©venir les sĂ©quelles Ă  long terme en cas d’atteinte des muqueuses ORL.

Background Toxic epidermal necrolysis is a rare and life-threatening mucocutaneous disease. Although mucosal ear, nose, and throat (ENT) involvement is common, little is known about the characteristics, treatment modalities, and outcomes of these lesions. The aim of this study was to evaluate ENT mucosal lesions in severe toxic epidermal necrolysis patients and analyze their characteristics, treatment modalities, and outcomes, as well as proposing a management algorithm to prevent long-term debilitating sequalae of these lesions.
Methods This is a retrospective review of toxic epidermal necrolysis cases treated at the tertiary burns unit of the Lausanne University Hospital CHUV, Switzerland, between 2006 and 2019.
Results Out of 19 patients with severe toxic epidermal necrolysis, 17 (89%) underwent a complete ENT examination at admission and 14 (82%) had ENT mucosal involvement. Five (26.3%) patients died during the stay in the intensive care unit. Of the 16 patients who received maximal care, 13 (81%) required orotracheal intubation for a median time of 16 (IQR: 14) days. Out of the 14 patients who survived, four (29%) had long-term ENT complications consisting of synechiaes necessitating subsequent endoscopic procedures. Those four patients all required mechanical ventilation with an orotracheal tube and suffered from hypopharyngeal synechiaes as well as oral and endonasal synechiaes in individual cases.
Conclusion This study suggests a high prevalence of ENT synechiaes in patients with severe toxic epidermal necrolysis and requiring orotracheal intubation. Periodic ENT examination could prevent mature synechiae formation in these patients. We propose an algorithm to prevent long-term sequalae in ENT mucosal involvement.

The full thesis can be downloaded at :
https://serval.unil.ch/notice/serval:BIB_D5C2B4C3C735


Read the last PhD tips