Patterns of cervicofacial infections: analysis of the use of computed tomography

Admittance to the intensive care unit due to acute odontogenic cervicofacial infections; a single centre retrospective cohort study

BACKGROUND

The aim of this study is to assess the outcome of the patients who required intensive care unit (ICU) admittance after surgical drainage of an odontogenic cervicofacial infection and identify the variables that are able to predict severe infection or a high possibility of complications.

PATIENTS AND METHODS

This is a retrospective cohort study including all adult patients admitted to our hospital over the period 2011-2020 due to odontogenic cervicofacial infection and required ICU admittance. The study was approved by the hospital's scientific committee (no 814-9/8/2021).

RESULTS

51 patients were included (mean age 43.2 years). 11.7% of the patients had major comorbidities, such as diabetes or immunosuppression. At presentation, fever was recorded in 55% patients and trismus in 92.8%, with a mean delay from symptoms to hospital admission at 3 days. 23% of patients had a post-extraction infection, 61% pericoronitis and 15% other odontogenic infections. The mean duration of hospitalization was 9.16 days whereas the mean ICU length of stay was 3.76 days. 84.3% of patients showed improvement, 13.7% deteriorated with a need of reoperation and one death was reported. ICU length of stay was associated with an 89% reduced rate when positive microbe identification was feasible, whereas rate of complications was 4-fold higher in patients with prolonged ICU length of stay.

CONCLUSIONS

Patients with deep cervicofacial odontogenic infections who require ICU management have a favourable clinical outcome. A minority of these patients will not improve in a short time frame or develop complications which require further management.

The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis

OBJECTIVES

To summarise current practices in the diagnosis and management of deep neck space infections (DNSIs). To inform future studies in developing a framework in the management of DNSIs.

DESIGN

This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with two independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach.

SETTING

Secondary or tertiary care centres that undertook management of DNSIs.

PARTICIPANTS

All adult patients with a DNSI.

MAIN OUTCOME MEASURES

The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs.

RESULTS

Sixty studies were reviewed. Thirty-one studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single randomised controlled trial, all other studies were observational (n = 25) or case series (n = 36). Computer tomography (CT) was used to diagnose DNSI in 78% of patients. The mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration, respectively. Qualitative analysis identified seven major themes on DNSI.

CONCLUSIONS

There are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.

Should preoperative computed tomography be routine examination for cervicofacial space infections?

BACKGROUND

Cervicofacial space infections are potentially life-threatening, which require accurate diagnosis, early incision, and adequate drainage. The utilization of computed tomography (CT) in cervicofacial space infections has significantly increased for its advantages in the evaluation of abscesses, its availability, and low cost. However, the clinical value of preoperative CT imaging in cervicofacial space infections remains controversial for its poor specificity, radiation exposure, potential complications, and extra cost. We, therefore, investigated whether CT examination should be used as a routine examination in the treatment of patients with cervicofacial space infections.

METHODS

A retrospective study of all patients affected by cervicofacial space infections that received incision and drainage surgery from Jan 2016 to Dec 2020 was performed at West China Hospital of Stomatology at Sichuan University. Patients were divided into two groups: the group with preoperative CT and without preoperative CT. Outcomes, including reoperation rate, missed diagnosis rate, days of symptom relief, length of stay, duration of surgery, and total cost of hospitalization, were analyzed.

RESULTS

Out of n = 153 patients, 108 patients underwent surgery with preoperative CT and 45 patients without preoperative CT. The reoperation rate in the preoperative CT group (6/108, 5.6%) was significantly lower (P = 0.00) than that in the group without preoperative CT (10/45, 22.2%). Significant reduction of missed diagnosis rate (P = 0.00), days of symptom relief (P = 0.01), length of stay(P = 0.03), and duration of surgery (P = 0.01) were detected in the preoperative CT group. The results demonstrated that the utilization of preoperative CT can reduce the missed diagnosis rate and repeated surgery complications.

CONCLUSIONS

We recommend preoperative CT as a routine examination in cervicofacial space infections.