1
|
Dou K, Shi Y, Yang B, Zhao Z. Risk factors for life-threatening complications of head and neck space infections: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101954. [PMID: 38908479 DOI: 10.1016/j.jormas.2024.101954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE The present systematic review was performed to identify risk factors associated with life-threatening complications of head and neck space infections (LCHNSI) within the included studies and assess the magnitude of their impact on patients. METHODS We systematically searched PubMed, Web of Science, EmBase, Scopus and CNKI for articles that reported risk factors associated with life-threatening complications of head and neck space infections from inception to 14 December 2023. Only factors reported in at least three papers were considered in the meta-analysis. Pooled odds ratio (OR) and 95 % confidence interval (CI) were calculated using fixed effects model and random effects model. The between-study heterogeneity of effect size was quantified using the Q statistic and I2. In addition, subgroup analysis stratified by study characteristics and sensitivity analysis were performed to explore the potential sources of heterogeneity and the stability of the results. RESULTS The review included a total of 29 studies. The results revealed that the risk factors which associated with LCHNSI were included diabetes mellitus (OR = 3.31, 95 % CI: 2.49-4.40), total leukocyte count(≥15 × 109/L) (OR = 1.21, 95 %CI: 1.04-1.42), multiple space involvement (OR = 4.32, 95 %CI: 3.47-5.38), combined systemic diseases (OR = 9.94, 95 %CI: 6.30-15.67), advanced age(≥60) (OR = 3.90, 95 %CI: 2.80-5.44), dyspnoea (OR = 23.39, 95 %CI: 12.41-44.10), high temperature(≥39°C) (OR = 3.23, 95 %CI: 2.02-5.17), retropharyngeal space involvement (OR = 3.62, 95 %CI: 2.06-6.35), parapharyngeal space involvement (OR = 4.62, 95 %CI: 2.27-9.42). CONCLUSIONS According to the current analysis, diabetes mellitus, total leukocyte count(≥15 × 109/L), combined systemic diseases, multiple space involvement, advanced age(≥60), dyspnoea, high temperature (≥39 °C), retropharyngeal space involvement, parapharyngeal space involvement were the risk factors for LCHNSI. To mitigate the incidence of LCHNSI, clinical staff should carefully manage these risk factors, ensure prompt diagnosis, and implement timely preventive measures.
Collapse
Affiliation(s)
- Ke Dou
- Department of Stomatology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, China
| | - Yue Shi
- School of Nursing and Rehabilitation, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Baoyi Yang
- Department of Stomatology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, China
| | - Zhiguo Zhao
- Department of Stomatology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, China.
| |
Collapse
|
2
|
Grillo R, Balel Y, Brozoski MA, Ali K, Adebayo ET, Naclério-Homem MDG. A global science mapping analysis on odontogenic infections. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101513. [PMID: 37207960 DOI: 10.1016/j.jormas.2023.101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Odontogenic infections are common and a topic of core interest for dentists, and maxillofacial surgeons. The aim of this study was to conduct a bibliometric analysis of the global literature on odontogenic infection and explore the top 100 most cited papers to identify the common causes, sequelae and management trends. METHODS Following a comprehensive literature search, a list of top 100 most cited papers was created. The VOSviewer software (Leiden University, The Netherlands) was used to create a graphical representation of the data, and statistical analyses were performed to analyze the characteristics of the top 100 most cited papers. RESULTS A total of 1,661 articles were retrieved with the first article published in 1947. There is an exponential upward trend on the number of publications (R2 = 0.919) and a majority of papers are in English language (n = 1,577, 94.94%). A total of 22,041 citations were found with a mean of 13.27 per article. The highest number of publications were recorded from developed countries. There was a male predilection in the reported cases and the most common sites included the submandibular and parapharyngeal spaces. Diabetes mellitus was identified as the commonest co-morbidity. Surgical drainage was ascertained to be the preferred method of management. CONCLUSIONS Odontogenic infections remain prevalent and have a global distribution. Although prevention of odontogenic infection through meticulous dental care is ideal, early diagnosis and prompt management of established odontogenic infections is important to avoid morbidities and mortality. Surgical drainage is the most effective management strategy. There is lack of consensus regarding the role of antibiotics in the management of odontogenic infections.
Collapse
Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Yunus Balel
- Department of Oral and Maxillofacial Surgery, Gaziosmanpasa University, Gaziosmanpasa, Turkey
| | - Mariana Aparecida Brozoski
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil
| | - Kamran Ali
- College of Dental Medicine, Qatar University, Doha, Qatar
| | - Ezekiel Taiwo Adebayo
- Department of Oral and Maxillofacial Surgery, University of Medical Sciences, Ondo, Nigeria
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil
| |
Collapse
|
3
|
Wu X, Qin N, Peng X, Wang L. Exploring odontogenic brain abscesses: a comprehensive review. Acta Neurol Belg 2024; 124:1155-1165. [PMID: 38722527 DOI: 10.1007/s13760-024-02569-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/29/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Whether in neurology or dentistry, odontogenic brain abscess stands as an ailment demanding undivided attention. The onset of this disease is insidious, with a relatively low incidence rate but a markedly high fatality rate. Moreover, its symptoms lack specificity, easily leading to misdiagnosis, oversight, and treatment delays. Hence, clinicians should maintain heightened vigilance when faced with pathogenic bacteria of dental origin in patients. AREAS COVERED This paper encapsulates the latest research findings on the clinical manifestations and essential treatment points of odontogenic brain abscess. It may offer a crucial reference for prompt diagnosis and improved therapeutic approaches. EXPERT OPINIONS Odontogenic brain abscess, an infection of the cerebral parenchyma, usually appears in immunocompromised patients with dental ailments or postdental surgeries. The main pathogenic microorganisms include Streptococcus intermedius, Fusobacterium nucleatum, Streptococcus anginosus, and Millerella. Given the undetectable and nonspecific symptoms in patients, the diagnostic process relies on microbiological methods. Therefore, clinicians should actively investigate and identify the pathogenic microorganisms of odontogenic brain abscess for early detection and selection of appropriate treatment regimens to avoid disease management delays.
Collapse
Affiliation(s)
- Xingguo Wu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ningxiang Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Peng
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Liang Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
4
|
Bond AT, Soubra YS, Aziz U, Read-Fuller AM, Reddy LV, Kesterke MJ, Amin D. Are Deep Odontogenic Infections Associated With an Increased Risk for Sepsis? J Oral Maxillofac Surg 2024; 82:852-861. [PMID: 38621664 DOI: 10.1016/j.joms.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Quick Sequential Organ Failure Assessment (qSOFA) is recommended to identify sepsis. Odontogenic infection (OI) can progress to sepsis, causing systematic inflammatory complications or organ failure. PURPOSE The purpose of the study was to measure the association between OI location and risk for sepsis at admission. STUDY DESIGN, SETTING, AND SAMPLE This retrospective cohort study included subjects treated for OI at Baylor University Medical Center in Dallas, TX, from January 9, 2019 to July 30, 2022. Subjects > 18 years old who were treated under general anesthesia were included. OI limited to periapical, vestibular, buccal, and/or canine spaces were excluded from the sample. PREDICTOR VARIABLE The primary predictor variable was OI anatomic location (superficial or deep). Superficial OI infection includes submental, submandibular, sublingual, submasseteric, and/or superficial temporal spaces. Deep OI includes pterygomandibular, deep temporal, lateral pharyngeal, retropharyngeal, pretracheal, and/or prevertebral. MAIN OUTCOME VARIABLES The primary outcome variable was risk for sepsis measured using a qSOFA score (0 to 3). A higher score (>0) indicates the patient has a high risk for sepsis. COVARIATES Covariates were demographics, clinical, laboratory, and radiological findings, antibiotic route, postoperative endotracheal intubation, tracheostomy, intensive care unit, admission, and length of stay. ANALYSES Descriptive and bivariate analyses were performed. A χ2 test was used for categorical variables. The Mann-Whitney U test was used for continuous variables. Statistical significance was P < .05. RESULTS The sample was composed of 168 subjects with a mean age of 42.8 ± 21.5 and 69 (48.6%) subjects were male. There were 11 (6.5%) subjects with a qSOFA score > 0. The relative risk of a qSOFA > 0 for a deep OI is 5.4 times greater than for a superficial OI (136 (95.8) versus 21 (80.8%): RR (95% confidence interval): 5.4 (1.51 to 19.27), P = .004). After adjusting for age, sex, American Society of Anesthesiologists score, and involved anatomical spaces, there was a significant correlation between laterality and the number of involved anatomical spaces and qSOFA score (odd ratio = 9.13, 95% confidence interval: 2.48 to 33.55, adjusted P = <.001). CONCLUSION AND RELEVANCE The study findings suggest that the OI location is associated with the qSOFA score >0.
Collapse
Affiliation(s)
- Austin T Bond
- Dental Student Researcher, Department of Oral & Maxillofacial Surgery, Texas A&M School of Dentistry, Dallas, TX
| | - Yasmine S Soubra
- Medical Student Researcher, Department of Surgery, Texas A&M School of Medicine, Dallas, TX
| | - Umaymah Aziz
- Medical Student Researcher, Department of Surgery, Texas A&M School of Medicine, Dallas, TX
| | - Andrew M Read-Fuller
- Clinical Assistant Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, Texas A&M University, Dallas, TX
| | - Likith V Reddy
- Clinical Professor, Chair of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Texas A&M University, Dallas, TX
| | - Matthew J Kesterke
- Assistant Professor, Director of Research, Department of Orthodontics, Texas A&M University School of Dentistry, Dallas, TX
| | - Dina Amin
- Associate Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, University of Rochester, Rochester, NY.
| |
Collapse
|
5
|
Wang B, Zhou Q, Qian W, He Z, Yang Z, Chen C, Zheng L, Shi H. The predictive value of laboratory tests in oro-maxillofacial infection of different severity. Oral Dis 2024; 30:1695-1701. [PMID: 37094078 DOI: 10.1111/odi.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 03/19/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE We aimed to investigate the value of individual laboratory tests and combinations of tests for predicting disease severity. METHODS We retrospectively reviewed 62 patients with space infections in the oral and maxillofacial head and neck regions. Patients were divided into three groups according to severity. Laboratory tests associated with disease severity were identified. RESULTS As the severity of infection increased, leukocytes, neutrophils, C-reactive protein (CRP), procalcitonin (PCT), soluble interleukin receptor (sILR) 2, IL6, and creatinine (CR) increased. In the ROC analysis of group 1 (moderate infection) versus group 2 (severe infection), the area under the curve (AUC) values for leukocytes (AUC = 0.724), neutrophils (AUC = 0.714), PCT (AUC = 0.762) and a combination of the 3 tests (AUC = 0.768) suggested a strong predictive value. Furthermore, in the ROC analysis of group 2 (severe infection) versus group 3 (extremely severe infection), the AUC values for CRP (AUC = 0.84), PCT (AUC = 0.799), sIL2R (AUC = 0.937), IL6 (AUC = 0.863) and a combination of the four tests (AUC = 0.943) suggested a strong predictive value. CONCLUSIONS Leukocytes, neutrophils, and PCT were associated with multispace infection and high severity. CRP, PCT, sIL2R, and/or IL6 were associated with extremely severe infections occurring in the oral and maxillofacial head and neck regions.
Collapse
Affiliation(s)
- Baoli Wang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Qin Zhou
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wentao Qian
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zhiyuan He
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zuoyi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Changyu Chen
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Lingyan Zheng
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Huan Shi
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| |
Collapse
|
6
|
Mahmoud R, Arbel S, Ianculovici C, Peleg O, Kleinman S, Shuster A. Antimicrobial therapy in the management of odontogenic infections: the penicillin-allergic patient. Int J Oral Maxillofac Surg 2024; 53:251-257. [PMID: 37758642 DOI: 10.1016/j.ijom.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
This retrospective analysis was performed to investigate whether clindamycin remains the preferred antibiotic for penicillin-allergic patients with odontogenic infections. The medical records of 311 patients admitted to the study department with odontogenic infections between 2018 and 2022 and treated with either intravenous amoxicillin-clavulanic acid (Augmentin) or intravenous clindamycin were analyzed. The Augmentin-treated group included 268 patients (86.2%) and the clindamycin-treated group included 43 patients (13.8%). Severity parameters did not differ significantly between the two groups, except for a higher prevalence of abscesses in the clindamycin-treated group (58.1% vs 41.0% in the Augmentin-treated group; P = 0.035). The clindamycin-treated group required a longer duration of intravenous antibiotics (P = 0.001) and had a higher rate of treatment failure (14.0% vs 2.2%; P = 0.002) when compared to the Augmentin-treated group, with a seven-fold increased risk of treatment failure. Moreover, significantly more isolated organisms in the clindamycin-treated group were resistant to clindamycin (P = 0.015); these were all Streptococcus anginosus group. Given the higher risk of treatment failure with clindamycin, it is necessary to choose the antibiotic treatment for penicillin-allergic patients carefully. A detailed history and allergy testing followed by combination therapy is recommended, especially in severe cases.
Collapse
Affiliation(s)
- R Mahmoud
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - S Arbel
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C Ianculovici
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - O Peleg
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Kleinman
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Shuster
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Neal TW, Carr BR, Schlieve T. Are higher odontogenic infection severity scores associated with difficult intubations? Oral Maxillofac Surg 2024; 28:435-440. [PMID: 37326786 DOI: 10.1007/s10006-023-01168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE This study aimed to determine if there is a relation between odontogenic infection severity score (OISS) and difficult intubation at the time of surgical treatment for severe odontogenic infections (SOI). A secondary goal of this study was to determine the utility of OISS as a predictor of difficult intubations. METHODS This retrospective cohort study was composed of consecutive patients admitted and surgically treated in the operating room (OR) for SOIs. Patients with an OISS ≥ 5 were designated as Group 1 and < 5 Group 2. RESULTS There was a statistically significant difference in difficult intubations between the two groups (p = 0.018). Patients with an OISS ≥ 5 were nearly four times more likely to be difficult intubations compared to patients with an OISS < 5 (OR 3.70, 95% CI 1.19-11.45). When OISS ≥ 5 was used to predict difficult intubation, the sensitivity was 69%, the specificity was 63%, the positive predictive value was 23%, and the negative predictive value was 93%. CONCLUSION OISS ≥ 5 was associated with a higher prevalence of difficult intubations compared to an OISS < 5. OISS may provide clinically relevant data that can be used with established risk factors, laboratory values, and clinical judgment.
Collapse
Affiliation(s)
- Timothy W Neal
- Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA.
| | - Brian R Carr
- Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
| | - Thomas Schlieve
- Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
| |
Collapse
|
8
|
Sklavos A, Lee K, Masood M. The association of travel distance and severity of odontogenic infections. Oral Maxillofac Surg 2024; 28:245-252. [PMID: 36585564 DOI: 10.1007/s10006-022-01135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Odontogenic infections (OI) are a preventable disease commonly managed in a tertiary hospital setting. Prevention of severe infections and hospitalisation relies on timely access to primary dental care. This study outlines the pre-hospital treatment of patients presenting to hospital with OIs and the association between travel distance from the patients' residence to a tertiary hospital oral and maxillofacial surgical (OMS) unit. METHODS This study analysed patients who initially presented hospital with an OI. Patient demographics, pre-hospital treatment, and clinical markers of severity were recorded. The travel distance from the patient's residence to the hospital was recorded in kilometers, along with any inter-hospital transfer via road/air ambulance. RESULTS Two hundred twenty-seven patients were included in this study, 17.2% required an inter-hospital transfer. Of these patients, 70.3% had prior treatment before hospitalisation, and antibiotics without source control was the most frequent treatment (83.1%). The mean travel distance for patients with more severe markers of infection significantly greater than patients with minor infections (p = < .001). Patients who required an inter-hospital transfer accounted for most cases with airway compromise requiring ICU admission. CONCLUSION This study found that most patients presenting to hospital with an OI had received antibiotics alone as treatment before hospitalisation. The travel distance from a tertiary hospital with OMS services had a significant correlation to more severe infections. This has important public health implications for the allocation of preventative dental services, and patient access to OMS services.
Collapse
Affiliation(s)
- Anton Sklavos
- Department of Dentistry and Oral Health, La Trobe University, Bendigo, VIC, Australia.
- Department of Oral and Maxillofacial Surgery, Barwon Health, Geelong, VIC, Australia.
| | - Kai Lee
- Department of Dentistry and Oral Health, La Trobe University, Bendigo, VIC, Australia
- Department of Oral and Maxillofacial Surgery, Barwon Health, Geelong, VIC, Australia
| | - Mohd Masood
- Department of Dentistry and Oral Health, La Trobe University, Bendigo, VIC, Australia
| |
Collapse
|
9
|
Chadha S, Troost JP, Shivers PL. Does thePenicillin Allergy Label Affect Outcomes of Complicated Odontogenic Infections? J Oral Maxillofac Surg 2023; 81:1301-1310. [PMID: 37507104 DOI: 10.1016/j.joms.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/31/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Penicillins are a potent antibiotic in managing odontogenic infections, but 10% of the population is labelled as allergic to these drugs. This has limited their use and resulted in increased utilization of health care resources as well as complications associated with alternative antibiotics. The purpose of the study was to measure the association between patients labeled as penicillin allergic and treatment outcomes in a sample of patients treated for complicated odontogenic infections. Additionally, we sought to investigate antibiotic resistance patterns in these patients. MATERIALS AND METHODS A retrospective cohort study was performed at the Michigan Medicine health care system to include patients who were treated for complicated odontogenic infections by oral and maxillofacial surgery between 2016 and 2020. Complicated odontogenic infection was defined as any odontogenic infection requiring admission and surgical management in the operating room. The primary predictor variable was the penicillin allergy label, which was determined by chart review and not confirmed with formal testing. Outcomes were measures of disease severity. The primary outcome variable was hospital length of stay. Secondary outcome variables were ICU admission (yes/no), repeat computed tomography scan(s), repeat surgery (yes/no), and re-admission (yes/no). Co-variates included were age, sex (male/female), tobacco use status, diabetes, immunocompromised state, number of spaces involved, white blood cell count upon admission and insurance status. For our secondary aim, the primary predictor variable was again penicillin allergy and outcome variable was antibiotic resistance as determined by wound culture results following surgical intervention. Negative binomial regression and logistic regression analyses were performed. P < .05 was considered significant. RESULTS A total of 150 patients met the inclusion criteria and of those 17.3% reported as penicillin allergic. Patients labelled as penicillin allergic did not differ significantly from patients without penicillin allergy label in terms of treatment outcomes. Age, diabetes, and immunosuppression were associated with an increased length of stay. Patients labelled as penicillin allergic were at significantly higher risk for antibiotic resistance (relative risk = 2.34; 95% confidence interval, 1.66 to 3.32; P < .001), specifically clindamycin resistance (relative risk = 3.17; 95% confidence interval, 1.93 to 5.18; P < .001). CONCLUSIONS Penicillin allergy was significantly associated with clindamycin resistance. There were similar outcomes amongst patients with and without a penicillin allergy label despite antibiotic differences. Delabeling efforts for patients with a reported penicillin allergy must be considered and local nomograms for antibiotic selection should be used by providers when seeking alternative antibiotics.
Collapse
Affiliation(s)
- Sagar Chadha
- Resident, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Jonathan P Troost
- Lead Statistician, Michigan Institute for Clinical Health and Research, Ann Arbor, MI
| | - Paul L Shivers
- Clinical Instructor, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
| |
Collapse
|
10
|
van der Merwe P, Rule R, Olorunju S, Jacobs F. The empirical use of aminoglycosides in Ludwig's angina based on bacterial analysis of 63 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101409. [PMID: 36738888 DOI: 10.1016/j.jormas.2023.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
PURPOSES To determine if the empirical use of aminoglycosides is justified in Ludwig's angina based on microscopy, culture and sensitivity results. METHODS A retrospective analysis was done on patients that presented with Ludwig's angina to the Maxillofacial and Oral surgery department at the University of Pretoria. Demographical data was extracted from patient files. Pus specimens that were submitted as part of the initial surgical intervention were analysed. RESULTS Sixty-three patients were included in the study with the majority, 76.19% (n=48/63), comprising males. The mean patient age was 38.6 years (range 6 months to 78 years). The majority of infections (87.3%) had an odontogenic aetiology (n=55/63). Forty-four percent of the patients had immunosuppressive co-morbidities (n=28/63). Streptococci contributed 71.26% (n=62/87) of the cultured bacteria. Similar bacteria were cultured in the immunocompromised and the immunocompetent patients (p=0.672). Ninety-two percent (n=57/62) of the streptococci cultured were sensitive to penicillin. The addition of aminoglycosides to the study sample would not have made a statistically significant difference (p=0.1556). CONCLUSION Based on the findings of this study, the empirical use of aminoglycosides is not warranted in either immunocompromised or immunocompetent patients with Ludwig's angina.
Collapse
Affiliation(s)
- Petrie van der Merwe
- Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, C/o Steve Biko and Dr Savage Roads, Gezina, Pretoria 0002, South Africa.
| | - Roxanne Rule
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Medical Microbiology, National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa
| | - Steve Olorunju
- Biostatistics Unit (Pretoria office), South African Medical Research Council (SAMRC), South Africa
| | - Fred Jacobs
- Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, C/o Steve Biko and Dr Savage Roads, Gezina, Pretoria 0002, South Africa
| |
Collapse
|
11
|
Jadhav D, Singh G, Mishra M, Srivastava A, Mondal S. Comparative evaluation of efficacy of C-reactive protein versus total leucocyte count as marker for monitoring patients with orofacial space infection of odontogenic origin. Natl J Maxillofac Surg 2023; 14:406-412. [PMID: 38273903 PMCID: PMC10806322 DOI: 10.4103/njms.njms_139_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 01/27/2024] Open
Abstract
Objective To compare and evaluate the efficacy of C-Reactive Protein and total leucocyte count as markers for monitoring patients of odontogenic space infection. Materials and Methods Blood samples were taken preoperatively and post-operatively at day 1, day 2, day 3 and day 7 for measuring the levels of CRP and TLC. The trends of CRP and TLC were analysed against the Clinical Severity Scale (CSS). The study was carried out on patients of odontogenic space infection, and minimum of 50 patients were selected for this study. Comparative evaluation of C-reactive protein (CRP) versus total leucocyte count (TLC) was performed. Results Data were analysed using Statistical Package for Social Sciences (SPSS) version 21. Inferential statistics were performed using Spearman Correlation. The level of statistical significance was set at 0.05. The result of the study demonstrates that the C-reactive protein (CRP) was found to be more consistent indicator for monitoring the patients of odontogenic space infection than TLC, Differential Leucocyte Count (DLC) and erythrocyte sedimentation rate (ESR). Conclusion We conclude that CRP should be incorporated as monitoring tool, and it serves as a better indicator than TLC for managing patients with orofacial space infections of odontogenic origin.
Collapse
Affiliation(s)
- Dhanashri Jadhav
- Consultant Oral and Maxillofacial Surgeon, Mumbai, Maharashtra, India
| | - Gaurav Singh
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Madan Mishra
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhinav Srivastava
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shubhamoy Mondal
- Department of Oral and Maxillofacial Surgery, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
12
|
Bigus S, Russmüller G, Starzengruber P, Reitter H, Sacher CL. Antibiotic resistance of the bacterial spectrum of deep space head and neck infections in oral and maxillofacial surgery - a retrospective study. Clin Oral Investig 2023; 27:4687-4693. [PMID: 37294354 DOI: 10.1007/s00784-023-05095-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the current resistance situation concerning routinely used antibiotics for treatment in odontogenic abscesses. MATERIALS AND METHODS This retrospective study assessed patients with deep space head and neck infections who were treated by surgical intervention under general anesthesia at our department. The target parameter was the ascertainment of the resistance rates in order to identify the bacterial spectrum, sites in the body, length of inpatient stay, and the age and sex of the patients. RESULTS A total of 539 patients, 268 (49.7%) males and 271 (50.3%) females were included in the study. The mean age was 36.5 ± 22.1 years. There was no significant difference between the two sexes with regard to the mean duration of hospitalization (p = 0.574). The predominant bacteria in the aerobic spectrum were streptococci of the viridans group and staphylococci, in the anaerobic spectrum Prevotella and Propionibacteria spp. Rates of resistance to clindamycin were between 34 and 47% in both the facultative and obligate anaerobic spectrum. Increased resistance was likewise found in the facultative anaerobic spectrum, with 94% resistance to ampicillin and 45% to erythromycin. CONCLUSION Due to the increasing levels of resistance to clindamycin, their use in empiric antibiotic treatment for deep space head and neck infections should be viewed critically. CLINICAL RELEVANCE Resistance rates continue to increase compared to previous studies. The use of these antibiotic groups in patients with a penicillin allergy needs to be called into question and alternative medications sought.
Collapse
Affiliation(s)
- Simon Bigus
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Günter Russmüller
- Department of Oral and Maxillofacial Surgery, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Starzengruber
- Department of Laboratory Medicine, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hannah Reitter
- Austrian Public Health Insurance, Wienerbergstrasse 13, 1100, Vienna, Austria
| | | |
Collapse
|
13
|
Coșarcă AS, Száva D, Bögözi B, Iacob A, Frățilă A, Sergiu G. Pediatric Cervicofacial Necrotizing Fasciitis-A Challenge for a Medical Team. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1262. [PMID: 37508759 PMCID: PMC10378044 DOI: 10.3390/children10071262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Cervical necrotizing fasciitis is a very rare complication of a bacterial infection that can have a dental cause. This type of infection typically affects fascial plane, which has a poor blood supply and can affect soft tissue and cervical fascia and can spread quickly causing infection of mediastinum. Initially, in the first stage, the overlying tissues are unaffected, and this can delay diagnosis and surgical intervention. Incidence in children is extremely rare and can be frequently associated with various other general pathologies that decrease the immune system response. We present a case of a young 12-year-old boy diagnosed with this type of infection in the head and neck as a complication of a second inferior molar pericoronitis. The treatment and the management of the case was difficult not only due to the presence of the infection but also because of the prolonged intubation.
Collapse
Affiliation(s)
- Adina Simona Coșarcă
- Department of Oral and Maxillo Facial Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Dániel Száva
- Department of Oral and Maxillo Facial Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Bálint Bögözi
- Department of Oral and Maxillo Facial Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Alina Iacob
- Department of Oral and Maxillo Facial Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Anca Frățilă
- Oral and Maxillo Facial Surgery Clinic, Emergency County Hospital Târgu Mures, Gheorghe Marinesscu Street, No. 50, 540136 Targu Mures, Romania
| | - Guzun Sergiu
- Oral and Maxillo Facial Surgery Clinic, Emergency County Hospital Târgu Mures, Gheorghe Marinesscu Street, No. 50, 540136 Targu Mures, Romania
| |
Collapse
|
14
|
Hsiao FY, Ho CY, Chan KC, Wang YC, Chin SC, Chen SL. Assessment of the Elderly Adult Patients with Deep Neck Infection: A Retrospective Study. EAR, NOSE & THROAT JOURNAL 2023:1455613231177184. [PMID: 37278212 DOI: 10.1177/01455613231177184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Background: Deep neck infection (DNI) is a potentially lethal infectious disease affecting middle-aged adults and can compromise the airway. There are limited data on the prognosis and outcomes of elderly (aged > 65 years) DNI patients, who tend to be immunocompromised. This study analyzed the clinical characteristics of elderly and adult (aged 18-65 years) DNI patients. Methods: Between November 2016 and November 2022, 398 patients with DNIs, including 113 elderly patients, were admitted to our hospital and enrolled in this study. The relevant clinical variables were investigated and compared. Results: The elderly DNI patients had longer hospital stays (P < .001), higher C-reactive protein levels (P = .021), higher blood sugar levels (P = .012), and a higher likelihood of diabetes mellitus (P = .025) than the adult patients. The higher blood sugar level is an independent risk factor for elderly (odds ratio = 1.005, 95% confidence intervals 1.002-1.008, P < .001). Moreover, the rates of intubation to protect the airway (P = .005) and surgical incision and drainage (I&D; P = .010) were higher in the elderly group. However, there were no group differences in pathogen distributions. Conclusion: The elderly DNI patients in this study had a more severe disease course, and poorer prognosis than the adult patients, as well as higher rates of intubation and I&D. However, the pathogen distributions did not differ significantly between the groups. Prompt intervention and treatment are important for elderly DNI patients.
Collapse
Affiliation(s)
- Fu-Yuan Hsiao
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kai-Chieh Chan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chien Wang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Lung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| |
Collapse
|
15
|
Furuholm J, Uittamo J, Rautaporras N, Välimaa H, Snäll J. Streptococcus anginosus: a stealthy villain in deep odontogenic abscesses. Odontology 2023; 111:522-530. [PMID: 36346473 PMCID: PMC10020309 DOI: 10.1007/s10266-022-00763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Odontogenic infections (OIs) occasionally spread to deep facial and neck tissues. Our study aimed to explore the role of Streptococcus anginous group (SAG) in these severe OIs. A retrospective study of patients aged ≥ 18 years who required hospital care for acute OI was conducted. We analysed data of OI microbial samples and recorded findings of SAG and other pathogens. These findings were compared with data regarding patients' prehospital status and variables of infection severity. In total, 290 patients were included in the analyses. The most common (49%) bacterial finding was SAG. Other common findings were Streptococcus viridans and Prevotella species, Parvimonas micra, and Fusobacterium nucleatum. Infection severity variables were strongly associated with SAG occurrence. Treatment in an intensive care unit was significantly more common in patients with SAG than in patients without SAG (p < 0.001). In addition, SAG patients expressed higher levels of C-reactive protein (p = 0.001) and white blood cell counts (p < 0.001), and their hospital stays were longer than those of non-SAG patients (p = 0.001). SAG is a typical finding in severe OIs. Clinical features of SAG-related OIs are more challenging than in other OIs. Early detection of SAG, followed by comprehensive infection care with prompt and careful surgical treatment, is necessary due to the aggressive behaviour of this dangerous pathogen.
Collapse
Affiliation(s)
- Jussi Furuholm
- Department of Oral and Maxillofacial Diseases, University of Helsinki, P.O. Box 41, 00014, Helsinki, Finland.
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, P.O. Box 447, 00029, Helsinki, Finland.
| | - Johanna Uittamo
- Department of Oral and Maxillofacial Diseases, University of Helsinki, P.O. Box 41, 00014, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, P.O. Box 447, 00029, Helsinki, Finland
| | - Niina Rautaporras
- Department of Oral and Maxillofacial Diseases, University of Helsinki, P.O. Box 41, 00014, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, P.O. Box 447, 00029, Helsinki, Finland
| | - Hanna Välimaa
- Department of Oral and Maxillofacial Diseases, University of Helsinki, P.O. Box 41, 00014, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, P.O. Box 447, 00029, Helsinki, Finland
- Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki University Hospital, P.O. Box 700, FI-00029, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki, P.O. Box 41, 00014, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, P.O. Box 447, 00029, Helsinki, Finland
| |
Collapse
|
16
|
Nagaura M, Saitoh K, Tsujimoto G, Yasuda A, Shionoya Y, Sunada K, Kawai T. Usefulness of preoperative computed tomography findings for airway management in patients with acute odontogenic infection: a retrospective study. Odontology 2023; 111:499-510. [PMID: 36279070 DOI: 10.1007/s10266-022-00756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
Odontogenic infection is more likely to affect the airway and interfere with intubation than non-odontogenic causes. Although anesthesiologists predict the difficulty of intubation and determine the method, they may encounter unexpected cases of difficult intubation. An inappropriate intubation can cause airway obstruction due to bleeding and edema by damaging the pharynx and larynx. This study was performed to determine the most important imaging findings indicating preoperative selection of an appropriate intubation method. This retrospective study included 113 patients who underwent anti-inflammatory treatment for odontogenic infection. The patients were divided into two groups according to the intubation method: a Macintosh laryngoscope (45 patients) and others (video laryngoscope and fiberscope) (68 patients). The extent of inflammation in each causative tooth, the severity of inflammation (S1-4), and their influence on the airway were evaluated by computed tomography. The causative teeth were mandibular molars in more than 90%. As the severity of inflammation increased, anesthesiologists tended to choose intubation methods other than Macintosh laryngoscopy. In the most severe cases (S4), anesthesiologists significantly preferred other intubation methods (33 cases) over Macintosh laryngoscopy (9 cases). All patients with S4 showed inflammation in the parapharyngeal space, and the airway was affected in 41 patients. The mandibular molars were the causative teeth most likely to affect the airway and surrounding region. In addition to clinical findings, the presence or absence of inflammation that has spread to the parapharyngeal space on preoperative computed tomography was considered an important indicator of the difficulty of intubation.
Collapse
Affiliation(s)
- Madoka Nagaura
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan.
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan.
| | - Keisuke Saitoh
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Gentaro Tsujimoto
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Asako Yasuda
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Yoshiki Shionoya
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Katsuhisa Sunada
- Department of Dental Anesthesiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan
| | - Taisuke Kawai
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| |
Collapse
|
17
|
Tarle M, Zubović A, Kos B, Raguž M, Lukšić I. Retrospective Longitudinal Study on Changes in Atmospheric Pressure as a Predisposing Factor for Odontogenic Abscess Formation. Dent J (Basel) 2023; 11:42. [PMID: 36826187 PMCID: PMC9955754 DOI: 10.3390/dj11020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes.
Collapse
Affiliation(s)
- Marko Tarle
- Department of Maxillofacial Surgery, Dubrava University Hospital, Gojko Šušak Avenue 6, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10000 Zagreb, Croatia
| | - Arijan Zubović
- Department of Maxillofacial Surgery, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
- The Faculty of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Boris Kos
- Department of Maxillofacial Surgery, Dubrava University Hospital, Gojko Šušak Avenue 6, 10000 Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, Gojko Šušak Avenue 6, 10000 Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Ilica 242, 10000 Zagreb, Croatia
| | - Ivica Lukšić
- Department of Maxillofacial Surgery, Dubrava University Hospital, Gojko Šušak Avenue 6, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| |
Collapse
|
18
|
Aditya NK, Lakshmi S, Bharani S. Prognostic determinants in severe odontogenic space infections: a single-center retrospective analysis. Minerva Dent Oral Sci 2023; 72:1-7. [PMID: 36197276 DOI: 10.23736/s2724-6329.22.04556-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Odontogenic space infections are a common presentation in oral and maxillofacial surgery units worldwide. Multiple patient and treatment dependent variables may be used predict the outcomes of the disease process. This study was aimed at a retrospective evaluation of significant predictors of prognosis in terms of length of hospital stay and the need for re-exploration in cases of odontogenic space infections. METHODS Patients who underwent incision and drainage of odontogenic space infections were identified from the hospital records of the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India. The variables assessed included Diabetic status, pyrexia on admission, topical rubefacient agent application, hot fomentation, recent tooth extraction, trismus, dysphagia or dyspnea on presentation, white blood cell count, number of spaces involved, antibiotics used, organisms isolated, severity of the infection and the anesthesia technique used (local anesthesia [LA], conscious sedation or general anesthesia). RESULTS The sample consisted of 259 patients (110 male, 159 female) with a mean age of 41±16.9 years. Space infections were preceded by tooth extractions in 53 (20%) cases, rubefacient balm application in 130 (40%) and hot fomentation in 58 (22%) cases. Trismus was noted in 140 patients with an average mouth opening of 21±10.3 mm. Dyspnea and dysphagia were noted in 55 (21%) and 96 (37%) patients each. Sixty-six patients were diabetic. The average length of hospital stay was 5.8±3 days and re-exploration was required in 75 (29%) patients. Significant predictors of hospital stay were severity (P<0.001), number of spaces affected (P<0.001), hot fomentation (P=0.04), trismus (P<0.001), dysphagia (P<0.001) and dyspnea (P<0.001). Predictors of re-exploration are an increased primary surgery under LA (P<0.001), white blood cell count (P<0.001), rubefacient balm application (P=0.045), dysphagia (P<0.001), dyspnea (P=0.018), and reduced mouth opening (P<0.001). No significant correlation between diabetes and length of hospital stay or the need for re-exploration were found in this study. CONCLUSIONS Poorer outcomes can be predicted based on the severity of the infection, the number of spaces involved, an increased white blood cell count as well as clinical signs and symptoms like trismus, dysphagia and dyspnea. Hot fomentation and Rubefacient agent application were identified as significant determinants of poor prognosis in this study. The presence of these indicators warrants a more aggressive approach towards management of space infections.
Collapse
Affiliation(s)
- Nagarajan K Aditya
- Department of Dentistry (OMFS), Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India -
| | - Subha Lakshmi
- Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, India
| | - Shiva Bharani
- Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, India
| |
Collapse
|
19
|
Neal TW, Schlieve T. Complications of Severe Odontogenic Infections: A Review. BIOLOGY 2022; 11:biology11121784. [PMID: 36552293 PMCID: PMC9775288 DOI: 10.3390/biology11121784] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Severe odontogenic infections are routinely treated with little associated morbidity and mortality. Improvements in surgical techniques, antibiotic treatments, and imaging modalities have made associated complications exceedingly rare. A number of complications have been described in the literature including airway obstruction, descending necrotizing mediastinitis, orbital abscess, septic cavernous sinus thrombosis, cerebral abscess, sepsis, necrotizing fasciitis, and Lemierre's syndrome. The purpose of this article is to discuss the pathophysiology of severe odontogenic infections and the risk factors associated with the development of complications. Given the morbidity and mortality of these conditions, it is important to review the clinical features of each and the diagnostic tools that aid in early recognition.
Collapse
|
20
|
Shah N, Patel S, Rupawala T, Makwana S, Mansuri S, Bhimani K. Evaluation of Efficacy of Ultrasonography as an Additional Diagnostic Tool for Deciding Management Protocol of Odontogenic Superficial Fascial Space Infections: A Prospective Clinical Study. J Maxillofac Oral Surg 2022; 21:1148-1154. [PMID: 36896083 PMCID: PMC9989102 DOI: 10.1007/s12663-021-01560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022] Open
Abstract
Objective To explore the efficacy of ultrasonography as an additional diagnostic tool in superficial odontogenic fascial space infections of maxillofacial region and modifying the treatment plan when needed. Materials and Methods Forty patients with superficial fascial space infections underwent a detailed clinical, plain radiological and ultrasonographic examination. Based on the ultrasonographic findings, final diagnosis was made and compared with clinical findings. Patients diagnosed with cellulitis were given medical line of treatment, and those with abscess were subjected to incision and drainage along with standard general supportive care and removal of etiologic agent. Results In this study, out of 40 patients (male = 22, female = 18), clinical diagnosis of cellulitis was made in 26 cases (65%) and abscess in 14 (35.0%). On USG examination, cellulitis was present in 21 cases (52.5%), while abscess in 19 (47.5%). Final diagnosis of cellulitis was made in 13 (59.1%) males and 12(66.7%) females, while abscess was confirmed in 9 (40.9%) male and 6 (33.3%) female patients. The results showed that sensitivity of the clinical examination alone was 64% with 33% specificity, and for USG, sensitivity was 84% with specificity of 100%. Conclusion The adjuvant role of ultrasonography in the diagnosis and timely management of superficial fascial space infections is promising owing to its accessibility, relative safety, repeatability and cost-effectiveness.
Collapse
Affiliation(s)
- Naiya Shah
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Shital Patel
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Taher Rupawala
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Sanjay Makwana
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Saloni Mansuri
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Kruna Bhimani
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| |
Collapse
|
21
|
EKİCİ Ö. Epidemiological Analysis and Management of Patients with Facial Space Infections of Odontogenic Origin: A Retrospective Evaluation of Two Years. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.994256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Abstract
Objective: Odontogenic infections are one of the most common pathologies in the oral and maxillofacial regions. The spread of odontogenic infections after unsuccessful or late treatment can lead to serious complications. The aim of this study is to examine the epidemiological features and treatment management of patients with odontogenic facial abscesses.
Methods: This retrospective study included 88 patients with odontogenic facial area abscesses treated at Afyonkarahisar health sciences university, faculty of dentistry’s maxillofacial surgery clinic between 2019-2021. The socio-demographic, socio-economic characteristics and clinical examination findings of the patients and treatment methods for odontogenic abscess were analyzed comprehensively. Data were
evaluated using SPSS-20 and the level of significance was set at p < .05.
Results: In the two-year period between 2019 and 2021, 88 patients (44 male and 44 female, mean age was 39.72±16.42) were treated for diffuse facial infections of odontogenic origin. The most commonly involved area was the submandibular area (38.6%), the most affected tooth was mandibular 1st molar and mandibular 3rd molars (18.2%), and the most common cause was dental caries (65.90%). Incision and drainage were performed in half of the patients (36.4% intraoral, 13.6% extraoral). The most commonly used drugs were clindamycin (36.4%), amoxicillin-clavulanate, and ornidazole combination (27.3%).
Conclusion: The results of this study confirm that odontogenic abscesses can heal without complications with timely and effective basic interventions such as incision and drainage. In this study, successful results were obtained with the parenteral clindamycin, and a combination of oral amoxicillin-clavulanate and ornidazole in the treatment of odontogenic abscesses.
Collapse
Affiliation(s)
- Ömer EKİCİ
- AFYONKARAHİSAR SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ, KLİNİK BİLİMLER BÖLÜMÜ, AĞIZ, DİŞ VE ÇENE CERRAHİSİ ANABİLİM DALI
| |
Collapse
|
22
|
Evolution of the treatment of severe odontogenic infections over 50 years: A comprehensive review. J Taibah Univ Med Sci 2022; 18:225-233. [PMID: 36817218 PMCID: PMC9926117 DOI: 10.1016/j.jtumed.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Severe odontogenic infections remain a challenge for maxillofacial surgeons. The aim of this work is to review the literature to provide an update of knowledge on the topic. Methods A comprehensive review of articles in PubMed, Web of Science and Africa Journals Online was performed through searching for "severe odontogenic infections." No language restrictions were applied. Only articles pertaining to treatment options were retrieved. Articles from the past 50 years were included. Results A total of 84 articles from 39 countries worldwide were included. Severe odontogenic infections are not unique to low- and middle-income countries but also pose challenges in developed countries. Surgical management and antibiotic therapy for this type of infection is discussed. Some immunocompromised patients have high risks of complications and mortality rates. A world map of publications on the topic is provided. Conclusions Several important aspects of managing severe odontogenic infections are discussed. Predictors of severity in addition to recommended antibiotic choice have been debated. Diabetes mellitus is a poor predictor of the prognosis of odontogenic infections.
Collapse
|
23
|
Liang J, Jiang L, Li M, Liu L, Li H. Should preoperative computed tomography be routine examination for cervicofacial space infections? BMC Infect Dis 2022; 22:566. [PMID: 35733094 PMCID: PMC9215011 DOI: 10.1186/s12879-022-07545-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/16/2022] [Indexed: 02/08/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Jiayu Liang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Linli Jiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Maoye Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hui Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| |
Collapse
|
24
|
Kang ES, Lee JH. Diagnostic value of presepsin in odontogenic infection: a retrospective study. Maxillofac Plast Reconstr Surg 2022; 44:22. [PMID: 35666350 PMCID: PMC9170860 DOI: 10.1186/s40902-022-00353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most head and neck infections originate from odontogenic causes; therefore, it is important to determine the severity of odontogenic infections. Since severe infection can cause sepsis, a systemic examination should be performed when evaluating a patient with odontogenic infection. C-reactive protein (CRP), white blood cell count (WBC), procalcitonin (PCT), and presepsin (PSEP) can be used to evaluate the severity of inflammatory status and sepsis in patients in the early stages of visiting the emergency room. Moreover, sepsis can be diagnosed based on the systemic inflammatory response syndrome (SIRS) classification. In relation to PSEP, significant study results on sepsis have been reported in other organ infections. However, there has been no progress in odontogenic infection; therefore, this study aimed to determine the diagnostic value of sepsis derived from odontogenic infection. METHODS This study was conducted from March 2021 to October 2021 on 43 patients admitted to the Department of Oral and Maxillofacial Surgery, Dankook University Hospital, in the emergency room for odontogenic infection. All patients underwent vital sign assessment and diagnostic tests (CRP, WBC, PCT, PSEP) in the emergency room. Sepsis was classified according to the SIRS criteria, and CRP, WBC, PCT, and PSEP levels were measured. The Statistical Package for the Social Sciences was used for statistical analyses. RESULTS The results of this study showed a moderately positive correlation between CRP and PCT, CRP and PSEP, and CT and PSEP levels. In addition, PCT and PSEP levels showed a positive correlation with sepsis. The odds ratios of sepsis and PCT and sepsis and PSEP were statistically significant. The optimal cut-off values obtained through the receiver operating characteristic curve were 0.24 and 671.5 for PCT and PSEP, respectively. Finally, there were positive correlations between CRP level and length of stay, WBC and Flynn scores, PCT level and Flynn scores, PCT level and length of stay, and PSEP level and length of stay. CONCLUSION WBC and CRP and PCT levels have been used in the past to determine the severity of infection and sepsis in patients with odontogenic infection, but PSEP was also found to have diagnostic value in this study. According to this study, a PSEP level of 671.5 pg/ml or higher for odontogenic infection can be considered an abnormal level.
Collapse
Affiliation(s)
- Eun-Sung Kang
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, 119 Dandae-ro, Cheonan, Chungcheongnam-do, 31116, Republic of Korea
| | - Jae-Hoon Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, 119 Dandae-ro, Cheonan, Chungcheongnam-do, 31116, Republic of Korea.
| |
Collapse
|
25
|
Hammad Y, Neal TW, Schlieve T. Admission C-reactive protein, WBC count, glucose, and body temperature in severe odontogenic infections: a retrospective study using severity scores. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 133:639-642. [PMID: 34975007 DOI: 10.1016/j.oooo.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether various serum marker levels (C-reactive protein [CRP], white blood cell [WBC] count, glucose) or body temperature at admission are associated with severity of odontogenic infections. STUDY DESIGN This retrospective chart review of patients admitted to the hospital for treatment of severe odontogenic infections (SOIs) over a 5-year period (2016-2020) assigned patients with a severity score (SS) ≥5 to group A and those with an SS <5 to group B. Serum marker levels and temperature at admission were collected, and comparisons between group A and group B were conducted for serum marker levels and body temperature at admission using 2-sample t tests. RESULTS The mean serum CRP and temperature at admission between the 2 groups was not statistically significant (P > .05). The mean WBC count and serum glucose at admission between the 2 groups was statistically significant (P = .001 and P = .036, respectively). CONCLUSIONS This study demonstrates that serum glucose and WBC at admission are significantly higher in patients with more SOIs. In addition, serum CRP and body temperature at admission are not adequate prognostic indicators of odontogenic infection severity.
Collapse
Affiliation(s)
- Yousef Hammad
- Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Timothy W Neal
- Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Thomas Schlieve
- Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| |
Collapse
|
26
|
Neal TW, Hammad Y, Carr BR, Wahidi J, Cannon S, Schlieve T. Assessment of pro re nata inpatient opioid consumption following surgical treatment of severe odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:159-162. [PMID: 35430180 DOI: 10.1016/j.oooo.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the pro re nata (PRN) opioid consumption of patients with severe odontogenic infections following operating room incision and drainage using odontogenic infection severity scores (SS). STUDY DESIGN This retrospective study reviewed consecutive charts of patients admitted for severe odontogenic infections from January 2016 to December 2020. Postoperative opioid doses were tabulated. Severity scores (SSs) were assigned based on the risk to the airway and vital structures. Patients with SS ≥5 were designated as group A and patients with SS <5 as group B. The primary predictor variable was SS, and the primary outcome variable was amount of milligram morphine equivalent consumed. RESULTS A total of 93 patients met the inclusion criteria. Group A included 40 patients, and group B included 53 patients. No statistically significant difference was found between the 2 groups in age, hospital duration, and American Society of Anesthesiologists classification. Group A consumed a significantly greater amount of PRN postoperative inpatient opioid medications (P = .02). CONCLUSIONS Patients with odontogenic infection SS ≥5 consumed more postoperative PRN opioid analgesic medications. Given that odontogenic infections are largely preventable, it is imperative to prevent progression of odontogenic infections to limit patient exposure to opioid medication.
Collapse
Affiliation(s)
- Timothy W Neal
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX.
| | - Yousef Hammad
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX
| | - Brian R Carr
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX
| | - Jason Wahidi
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX
| | - Scott Cannon
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX
| | - Thomas Schlieve
- Associate Professor, Program Director, Department of Surgery, Division of Oral and Maxillofacial Surgery, UT Southwestern/Parkland Memorial Hospital, Dallas, TX
| |
Collapse
|
27
|
Limardo A, Blanco L, Menéndez J, Ortega A. Ultrasound-guided Drainage vs Surgical Drainage of Deep Neck Space Abscesses: A Randomized Controlled Trial. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:4-10. [DOI: 10.1016/j.otoeng.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
|
28
|
Kumar N, Khare V, Jamdade A, Aggarwal A, Rathore N, Yadav S. Antibiotic susceptibility of the bacteria causing odontogenic infections: An observational study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_194_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
29
|
Neal TW, Hammad Y, Carr BR, Schlieve T. The Cost of Surgically Treated Severe Odontogenic Infections: A Retrospective Study Using Severity Scores. J Oral Maxillofac Surg 2022; 80:897-901. [DOI: 10.1016/j.joms.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/02/2022] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
|
30
|
Huang Y, Zhou P, Liu S, Duan W, Zhang Q, Lu Y, Wei X. Metabolome and microbiome of chronic periapical periodontitis in permanent anterior teeth: a pilot study. BMC Oral Health 2021; 21:599. [PMID: 34814909 PMCID: PMC8609808 DOI: 10.1186/s12903-021-01972-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background Periapical periodontitis is a common oral inflammatory disease that affects periapical tissues and is caused by bacteria in the root canal system. The relationship among the local metabolome, the inflammatory grade, and the type and abundance of microorganisms associated with periapical periodontitis is discussed in this study. Methods The inflammatory grades of periapical samples from 47 patients with chronic periapical periodontitis in permanent anterior teeth were determined based on the immune cell densities in tissues subjected to haematoxylin and eosin staining. The metabolome was evaluated using ultrahigh-performance liquid chromatography-quadrupole time-of-flight mass spectrometry, followed by principal component analysis and orthogonal partial least squares discriminant analysis. The microbiome was accessed using 16 S rRNA high-throughput sequencing. The differences in the metabolomes and microbiomes of the periapical periodontitis samples were assessed using Spearman’s correlation analysis. Result N-acetyl-D-glucosamine, L-tryptophan, L-phenylalanine, and 15 other metabolites were identified by the comparison between samples with severe inflammation and mild or moderate inflammation. Four amino acid metabolism pathways and one sugar metabolism pathway were associated with the inflammatory grade of periapical periodontitis. The abundance of Actinomycetes was negatively correlated with the abundance of glucosamine (GlcN), while the abundance of Tannerella was positively correlated with the abundance of L-methionine. Conclusions The local metabolome of periapical periodontitis is correlated with the inflammatory grade. The abundance of the local metabolites GlcN and L-methionine is correlated with the abundance of the major microorganisms Actinomycetes and Tannerella, respectively.
Collapse
Affiliation(s)
- Yun Huang
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Conservative Dentistry and Endodontics, Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Department of Operative Dentistry and Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Peng Zhou
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Conservative Dentistry and Endodontics, Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Department of Operative Dentistry and Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Siqi Liu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Conservative Dentistry and Endodontics, Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Department of Operative Dentistry and Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Wei Duan
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Conservative Dentistry and Endodontics, Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Department of Operative Dentistry and Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Qinqin Zhang
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Conservative Dentistry and Endodontics, Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Department of Operative Dentistry and Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Ying Lu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Conservative Dentistry and Endodontics, Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Department of Operative Dentistry and Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Xin Wei
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Conservative Dentistry and Endodontics, Stomatological Hospital, Nanjing Medical University, Nanjing, China. .,Department of Operative Dentistry and Endodontics, Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. .,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China.
| |
Collapse
|
31
|
Lee DW, Ryu H, Choi HJ, Heo NH. Early diagnosis of craniofacial necrotising fasciitis: Analysis of clinical risk factors. Int Wound J 2021; 19:1071-1084. [PMID: 34755456 PMCID: PMC9284621 DOI: 10.1111/iwj.13703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/25/2022] Open
Abstract
Necrotising fasciitis (NF) is a rapidly progressing fatal disease. Craniofacial necrotising fasciitis (CNF) is limited to the region above the mandibular margin, and early diagnosis is particularly difficult in the absence of related studies. Ten-year data of patients with craniofacial infection were collected from four separate hospitals. Based on the diagnostic criteria, patients were classified into abscess and CNF. The risk factors for early diagnosis were analysed by comparing the two groups. Simple abscess was found in 176 patients, and CNF was detected in 25 patients. The risk factors associated with CNF include old age, presence of odontogenic infection, elevated white blood cell count (WBC), increased C-reactive protein (CRP), high levels of creatinine (Cr) and glucose (Glu) and low levels of haemoglobin (Hb) and albumin (Alb). In addition, fever above 38°C and sinusitis at the time of admission and progressive sepsis after admission were also risk factors. Among the statistically significant risk factors, low Alb level showed the greatest association with CNF progression. Appropriate management of CNF via early diagnosis and extensive surgical intervention based on identified risk factors can reduce the mortality rate, complications and unnecessary medical expenses. Clinical question/level of evidence: Diagnostic, III.
Collapse
Affiliation(s)
- Da Woon Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Heongrae Ryu
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan, South Korea.,Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University, Cheonan, South Korea
| |
Collapse
|
32
|
Derruau S, Bogard F, Exartier-Menard G, Mauprivez C, Polidori G. Medical Infrared Thermography in Odontogenic Facial Cellulitis as a Clinical Decision Support Tool. A Technical Note. Diagnostics (Basel) 2021; 11:diagnostics11112045. [PMID: 34829390 PMCID: PMC8624025 DOI: 10.3390/diagnostics11112045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Odontogenic cellulitis are frequent infections of the head and neck fascial spaces that can sometimes spread and be life-threatening, requiring urgent hospitalization. Early diagnosis of facial cellulitis with diffuse inflammatory process is crucial in patient management but not always obvious in the field. Medical infrared thermography (MIT) is a noninvasive tool increasingly used to evaluate skin temperature maps and delineate inflammatory lesions. Objective: The aim of this work was to evaluate the use of MIT to improve the clinical examination of patients with facial cellulitis. Methods: Image processing work was carried out to highlight the thermal gradient resulting from inflammation linked to infection, in 2 patients with facial cellulitis. Results: In real-time, MIT allowed to precisely locate the inflammatory focus linked to cellulitis with no propagation to danger areas such as infraorbital space or around pharyngeal axis. Conclusions: Here, we show the first cases using MIT as a powerful complementary tool in the clinical evaluation of patients with facial cellulitis. Significance: This technology could help optimize the hospitalization decision through a facilitated assessment of infection spread in head and neck tissues and helping to incision for drainage.
Collapse
Affiliation(s)
- Stéphane Derruau
- UFR Odontologie, Université de Reims Champagne-Ardenne, 51100 Reims, France; (G.E.-M.); (C.M.)
- Pôle de Médecine Bucco-Dentaire, Service de Chirurgie Orale, Centre Hospitalier Universitaire de Reims, 51092 Reims, France
- BioSpecT EA-7506, UFR Pharmacie, Université de Reims Champagne-Ardenne, 51096 Reims, France
- Correspondence:
| | - Fabien Bogard
- MATIM EA, UFR Sciences, Université de Reims Champagne-Ardenne, 51687 Reims, France; (F.B.); (G.P.)
| | - Guillaume Exartier-Menard
- UFR Odontologie, Université de Reims Champagne-Ardenne, 51100 Reims, France; (G.E.-M.); (C.M.)
- Pôle de Médecine Bucco-Dentaire, Service de Chirurgie Orale, Centre Hospitalier Universitaire de Reims, 51092 Reims, France
| | - Cédric Mauprivez
- UFR Odontologie, Université de Reims Champagne-Ardenne, 51100 Reims, France; (G.E.-M.); (C.M.)
- Pôle de Médecine Bucco-Dentaire, Service de Chirurgie Orale, Centre Hospitalier Universitaire de Reims, 51092 Reims, France
- BIOS EA-4691, UFR Pharmacie, Université de Reims Champagne-Ardenne, 51096 Reims, France
| | - Guillaume Polidori
- MATIM EA, UFR Sciences, Université de Reims Champagne-Ardenne, 51687 Reims, France; (F.B.); (G.P.)
| |
Collapse
|
33
|
Liu W, Gu W, Jin X, Wang J. Effects of Simultaneous versus Staged VAC Placement in the Treatment of Deep Neck Multiple-Space Infections at a Tertiary Hospital Over a Four-Year Period in China. Infect Drug Resist 2021; 14:4091-4096. [PMID: 34675554 PMCID: PMC8502109 DOI: 10.2147/idr.s334203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/28/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Surgical drainage is an essential part of treatment for deep neck infections (DNIs) or deep neck multiple-space infections (DNMIs). With the emergence and application of new technologies and new materials, vacuum-assisted closure (VAC) in the treatment of DNMIs has been reported. However, reports on the timing of VAC placement are limited. Herein, we compared simultaneous versus staged VAC placement in the treatment of DNMIs. Patients and Methods Medical data from 24 patients with DNMIs who had received VAC treatment in the last five years were analyzed. The patients were classified into a simultaneous VAC placement group (11 patients) and a staged VAC placement group (13 patients) according to the timing of VAC placement when incision and drainage were performed. Results No differences in baseline characteristics were found between the two groups. All patients in the two groups survived and recovered. The hospitalization duration (days), time to wound healing (days), number of debridement procedures, and disease course (days) in the simultaneous VAC placement group and staged VAC placement group were 10 (4–18) and 22 (8–35), 21 (4–39) and 50 (9–86), one (1–2) and two (1–4), and 31.5 (11–49) and 56 (19–98), respectively. The results in the simultaneous VAC placement group were better than those in the staged VAC placement group (P = 0.001, 0.016, 0.045, and 0.016, respectively). The numbers of VAC sponge changes in the simultaneous VAC placement group and staged VAC placement group were two (1–2) and two (1–4), respectively, with no statistically significant difference (P = 0.336). Conclusion Simultaneous VAC placement during incision and drainage may shorten the wound healing time, hospitalization duration, and disease course and may reduce the number of debridement procedures.
Collapse
Affiliation(s)
- Weijiao Liu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital Pinggu Campus, Capital Medical University, Beijing, People's Republic of China
| | - Wei Gu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaofeng Jin
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian Wang
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| |
Collapse
|
34
|
Limardo A, Blanco L, Menéndez J, Ortega A. Ultrasound-guided drainage vs surgical drainage of deep neck space abscesses: A randomized controlled trial. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30167-9. [PMID: 34301374 DOI: 10.1016/j.otorri.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial. METHODS A randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0. RESULTS 128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The p-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results. DISCUSSION Surgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient's airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed. CONCLUSIONS Ultrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.
Collapse
Affiliation(s)
- Andrés Limardo
- Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina; Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Luis Blanco
- Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina; Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - José Menéndez
- Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina
| | - Adrían Ortega
- Sección de Cirugía de Cabeza y Cuello, Hospital Prof. A. Posadas, El Palomar, Argentina
| |
Collapse
|
35
|
Kim HW, Kim CH. Factors associated with treatment outcomes of patients hospitalized with severe maxillofacial infections at a tertiary center. J Korean Assoc Oral Maxillofac Surg 2021; 47:197-208. [PMID: 34187960 PMCID: PMC8249195 DOI: 10.5125/jkaoms.2021.47.3.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives The purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea. Materials and Methods A retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses. Results Average LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis. Conclusion For successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.
Collapse
Affiliation(s)
- Hye-Won Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea
| | - Chul-Hwan Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea
| |
Collapse
|
36
|
Nhongo SS, Lee K, Chan S, Sklavos A, Tocaciu S, Austin S. Redrainage in odontogenic orofacial infections: Risk factors and analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:28-33. [PMID: 34509398 DOI: 10.1016/j.oooo.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to determine the incidence of redrainage in odontogenic orofacial infections and evaluate possible risk factors. The investigators hypothesized that wait times to first surgery >48 hours and clinical risk factors may predispose patients to higher rates of redrainage. STUDY DESIGN Two hundred nineteen patients who underwent surgical drainage for odontogenic orofacial infections over an 8-year period were identified through Western Health electronic medical records. The primary outcome measure was the rate of redrainage. Secondary outcomes included total length of hospital stay and intensive care unit admission and length of stay. Stratified risk factors were analyzed using the Cochran-Mantel-Haenszel test to produce a total overall estimate risk ratio (forest plot). RESULTS Of 219 patients, 16 (7.3%) required at least 1 return to theater for redrainage. First surgery wait times >48 hours, multispace infection, C-reactive protein ≥150, trismus, and immunosuppression were associated with a significantly increased risk of redrainage (88%; combined risk ratio = 1.88; 95% confidence interval, 1.31-2.69; P = .001). CONCLUSIONS To minimize the risk of redrainage, patients with orofacial infections requiring surgery should undergo surgery within 48 hours of presentation to hospital, particularly when presenting with an elevated C-reactive protein ≥150, trismus, immunosuppression, or multispace involvement.
Collapse
Affiliation(s)
- Sipho Simon Nhongo
- Maxillofacial Registrar, Division of Maxillofacial Surgery, Western Health, Melbourne, Australia.
| | - Kai Lee
- Consultant Surgeon, Division of Maxillofacial Surgery, Western Health, Melbourne, Australia
| | - Steven Chan
- Professor of Surgery, Western Clinical School, The University of Melbourne, Melbourne, Australia
| | - Anton Sklavos
- Maxillofacial On-call Registrar, Division of Maxillofacial Surgery, Barwon Health, Geelong, Australia
| | - Shreya Tocaciu
- Consultant Surgeon, Division of Maxillofacial Surgery, Western Health, Melbourne, Australia
| | - Stephen Austin
- Head of Unit, Division of Maxillofacial Surgery, Western Health, Melbourne, Australia
| |
Collapse
|
37
|
Cole-Healy Z, Adam D, Noh K, Graham RM. Introducing the FATLIPS acronym for assessing the red flag clinical features of dental infection. Br Dent J 2021; 230:170-172. [PMID: 33574543 PMCID: PMC7877497 DOI: 10.1038/s41415-021-2602-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/09/2020] [Indexed: 11/15/2022]
Abstract
Introduction Dental infection can progress to life-threatening cervicofacial and deep space infections. Therefore, safe management requires early identification of serious infections in primary care with appropriate referral to secondary care. We have developed an acronym to aid assessment of the red flag clinical features for serious dental infection in primary care by general dental practitioners.Materials and methods Literature review and focus group discussions.Results We introduce the FATLIPS acronym for assessment of red flag features of dental infection: failed previous treatment(s), airway compromise, trismus, look (lower border mandible, orbit, oral, neck), immunosuppression, pyrexia, swallowing difficulties.Conclusion We propose the FATLIPS red flags acronym to help dentists assess the red flag features of dental infections in primary care.
Collapse
Affiliation(s)
- Zachary Cole-Healy
- ST1 in Oral and Maxillofacial Surgery, North Manchester General Hospital, Manchester, UK.
| | - Danny Adam
- ST3 in Oral and Maxillofacial Surgery, North Manchester General Hospital, Manchester, UK
| | - Kowoon Noh
- DCT1 in Oral and Maxillofacial Surgery, North Manchester General Hospital, Manchester, UK
| | - Richard M Graham
- Consultant in Oral and Maxillofacial Surgery, North Manchester General Hospital, Manchester, UK
| |
Collapse
|
38
|
Kim JK, Lee JH. Clinical utility of procalcitonin in severe odontogenic maxillofacial infection. Maxillofac Plast Reconstr Surg 2021; 43:3. [PMID: 33420845 PMCID: PMC7797011 DOI: 10.1186/s40902-020-00288-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Most of the maxillofacial infections are bacterial infections, and there is a possibility that systemic infections occur by maxillofacial infections. The aim of this study was to investigate the diagnostic value of procalcitonin in patients with odontogenic bacterial infections of the maxillofacial region. METHODS We enrolled sixty patients, who were admitted with odontogenic maxillofacial infection from September 2018 to March 2020. White blood cell counts, C-reactive protein, and procalcitonin concentrations were evaluated. Sixty patients were classified into two groups, sepsis and non-sepsis groups, based on systemic inflammatory response syndrome. A Student t test was performed to statistically analyze the difference in inflammatory markers between sepsis and non-sepsis groups. RESULTS The mean procalcitonin values on admission were 7.24 ng/mL (range, 0.09-37.15 ng/mL) and 0.40 ng/mL (range, 0.02-4.94 ng/mL) in the sepsis group and non-sepsis group, respectively. The procalcitonin values between the two groups showed a significant difference (P < 0.05). The area under the curve of procalcitonin was 0.927 (P < 0.001), and the cutoff value of procalcitonin that maximizes the area under the curve was calculated to be 0.87 ng/mL. CONCLUSIONS According to our study, routine laboratory tests have insufficient accuracy in diagnosing sepsis syndrome. Therefore, it is strongly recommended to perform the procalcitonin test in patients with maxillofacial infection in addition to the conventional laboratory tests to diagnose the systemic inflammatory condition of the patients.
Collapse
Affiliation(s)
- Ji-Kwan Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam, South Korea
| | - Jae-Hoon Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam, South Korea.
| |
Collapse
|
39
|
Delbet-Dupas C, Devoize L, Mulliez A, Barthélémy I, Pham Dang N. Does anti-inflammatory drugs modify the severe odontogenic infection prognosis? A 10-year's experience. Med Oral Patol Oral Cir Bucal 2021; 26:e28-e35. [PMID: 32851983 PMCID: PMC7806345 DOI: 10.4317/medoral.23926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/24/2020] [Indexed: 01/15/2023] Open
Abstract
Background Numerous biochemical datas support the noxious role of anti-inflammatory drugs on immune response. Those observations are often put forward for unfavorable evolution of odontogenic infection but has never been really proven in clinic. The aim of this study is to try to clarify this role based on the collection of the clinical course of odontogenic infections over a 10-year analysis period.
Material and Methods The investigators implemented a prospective observational study. The sample was composed of patients managed between January 2004 and December 2014 for severe odontogenic infection based on three criteria: hospital admission, intravenous antibiotic therapy, tooth extraction and collections drainage under general anesthesia. Clinical and pharmacological data were collected at admission, during hospitalization until discharged home. The population was first separated into two groups patients with or without anti-inflammatory drugs on admission, then on four groups (non-steroidal anti-inflammatory drugs, corticosteroids drugs, both and none on admission). Analysis were performed each time by univariate analysis, multivariate analysis and propensity score matching.
Results Six hundred and fifty-three patients were included in the study, 329 (50%) patients report orally anti-inflammatory treatment before presenting to hospital, 50 (7.6%) received corticosteroids, 242 (37%) received NSAIDs and 37 (5.6%) both. Evolution is worsening for patients under anti-inflammatory drugs in term of hospitalization in ICU (p=0.016), number of surgeries (p=0.003), risk of tracheotomy (p=0.036), duration of hospitalization (p=0.005) and spaces involved by the infection (p<0.001). When separating patients into 4 groups, dysphonia and odynophagia are more frequent for patients under corticosteroid and NSAID (35.14%, p<0.001), mediastinal erythema is more frequent for patients under corticosteroid (16%, p=0.004), fever is more frequent for patients under NSAID (35.5%, p=0.032), pain is higher for patients under corticosteroids (p=0.024). But, in order to reduce bias, linked to factors of gravity, a regression weighted by propensity scores was performed and any group of patients is different from the others.
Conclusions Patients under anti-inflammatory drugs have more severe dental infection on admission and their complex evolution seems to be linked to the severity of infection on admission. Key words:Severe odontogenic infection, anti-inflammatory drugs, corticosteroids.
Collapse
Affiliation(s)
- C Delbet-Dupas
- Department of Oral and Maxillofacial surgery Université d'Auvergne, NHE - CHU de Clermont-Ferrand 1 place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | | | | | | | | |
Collapse
|
40
|
Pham Dang N, Delbet-Dupas C, Mulliez A, Devoize L, Dallel R, Barthélémy I. Five Predictors Affecting the Prognosis of Patients with Severe Odontogenic Infections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238917. [PMID: 33266250 PMCID: PMC7730806 DOI: 10.3390/ijerph17238917] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023]
Abstract
Background: Dental cellulitis management is no longer a simple procedure, as more and more patients are needing long-time hospitalization, several surgeries and intensive care follow-up. This prospective study seeks to highlight criteria that can split patients with severe odontogenic infection into two groups: those with simple evolution and those for whom complex management is necessary. Methods: In this observational study, all patients considered with a severe odontogenic infection (which necessitated hospital admission, intravenous antibiotics and general anaesthesia) were enrolled between January 2004 and December 2014 from Clermont-Ferrand University Hospital (France). They were split into two groups: those who needed one surgical intervention with tooth extraction and collection drainage combined with probabilistic antibiotic to treat infection and those who need several surgeries, intensive care unit follow-up or tracheotomy to achieve healing. Results: 653 patients were included, of which 611 (94%) had one surgery, 42 (6%) had more than one surgery before healing. Penicillin allergy (p < 0.001), psychiatric disorders (p = 0.005), oropharyngeal oedema (p = 0.008), floor oedema (p = 0.004), fever (p = 0.04) and trismus (p = 0.018) on admission were the most relevant predictors of complex evolution. A conditional inference tree (CTREE) illustrated the association of prognostic factors and the need of multiple surgery. Conclusions: Besides clinical symptoms of severity, complications of severe odontogenic infection are predicted by measurables and objectives criteria as penicillin allergy, mandibular molar, C-reactive protein level, psychiatric disorders and alcohol abuse. Their specific association potentialize the risks. IRB number: CE-CIC-GREN-12-08.
Collapse
Affiliation(s)
- Nathalie Pham Dang
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
- Correspondence: ; Tel.: +33-473-750-102; Fax: +33-473-750-103
| | - Candice Delbet-Dupas
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation Recherche Clinique & Innovation, 63003 Clermont-Ferrand, France;
| | - Laurent Devoize
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| | - Radhouane Dallel
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| | - Isabelle Barthélémy
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| |
Collapse
|
41
|
Christensen BJ, Racha D, Hinkle R, Sahebi M. Risk Factors for Reoperation in Patients Hospitalized for Odontogenic Infections. J Oral Maxillofac Surg 2020; 79:141-151. [PMID: 32717213 DOI: 10.1016/j.joms.2020.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE One of the most common adverse events after treatment of severe odontogenic infections is the need for a second procedure. The identification of risk factors for reoperation could help surgeons predict the need for reoperation or even tailor treatment to avoid this complication altogether. The purpose of this study was to identify risk factors associated with reoperation in patients hospitalized with odontogenic infections. PATIENTS AND METHODS We designed a retrospective cohort study from an eligible population of all patients treated at our institution for an odontogenic infection with incision and drainage under general anesthesia from August 1, 2015, to June 30, 2019. The primary outcome variable was a return to the operating room because of treatment failure. The potential predictor variables included demographic characteristics, history or physical examination findings from admission, admission laboratory values, initial computed tomography results, and medications provided during treatment. Statistical analysis was performed using the χ2 test and logistic regression, and from these results, a multiple logistic regression model was created. RESULTS A total of 223 patients were included in the study. Men comprised 50.7% of the study population, and the average age was 38.9 ± 13.3 years. The mean number of involved spaces was 2.6 ± 1.7 spaces. Reoperation was performed in 25 patients (11.2%). In the adjusted model, an increased number of involved spaces (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.3 to 2.7) and increased age (OR, 1.05; 95% CI, 1.004 to 1.09) were associated with increased odds of reoperation, and antibiotic therapy with a penicillin-type antibiotic (OR, 0.1; 95% CI, 0.04 to 0.5) and dexamethasone use (OR, 0.9; 95% CI, 0.8 to 0.98) were negatively associated with reoperation. CONCLUSIONS Further studies could be directed at determining whether certain timing or dosing regimens of dexamethasone could be helpful in reducing adverse outcomes in patients with odontogenic infections or determining feasible strategies when penicillin allergies are reported.
Collapse
Affiliation(s)
- Brian J Christensen
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
| | - Dylan Racha
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Ryan Hinkle
- Chief Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Mishaun Sahebi
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| |
Collapse
|
42
|
Cao J, Liu Z, Ma D, Shen S, Wang X. Modified Usage of Negative Pressure Wound Therapy for the Management of Severe Deep Fascial Space Infections in the Head and Neck. Infect Drug Resist 2020; 13:781-788. [PMID: 32210592 PMCID: PMC7069576 DOI: 10.2147/idr.s243794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Although negative pressure wound therapy (NPWT) has been widely used in complicated wound care, there are still some obstacles regarding its use in the treatment of severe deep fascial space infections in the head and neck. The purpose of this study is to describe a new modified usage of NPWT and investigate the clinical efficacy of this system in a consecutive case series of severe deep fascial space infections. Methods The investigators implemented a new modification of NPWT for the management of severe deep fascial space infections. In this new system, the half-plugged bar-shaped foam material was arranged along with the through-and-through side-holed latex drainage tube, which could maintain negative pressure in the distal part of the spaces, and the tube was easy to remove 5–7 days after surgery. Twelve patients had severe deep fascial space infections in the head and neck with a direct threat to the airway. The median time of removal of the NPWT device, the median amount of drainage fluid and the median healing time were investigated. Results A total of 7 male and 5 female patients with an average age of 63.2 years old were included in this study. The median time of removal of the NPWT device was 6 days (ranging from 4 to 7 days). The median amount of drainage fluid within 3 days after surgery was 420 mL (ranging from 280–760 mL), and the median time for complete wound healing was 12 days (ranging from 10 to 21 days). Conclusion The results of this study suggest that the modification of NPWT provides various advantages and leads to excellent clinical outcomes in the treatment of severe deep fascial space infections. Future studies will focus on the safety verification of portable usage and the cost effectiveness analysis of NPWT.
Collapse
Affiliation(s)
- Jian Cao
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China.,Department of Oral and Maxillofacial Surgery, The 940th Hospital of People's Liberation Army, Lanzhou, People's Republic of China
| | - Zhixu Liu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China
| | - Dongyang Ma
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of People's Liberation Army, Lanzhou, People's Republic of China
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai JiaoTong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China
| |
Collapse
|
43
|
Indication for an additional postoperative antibiotic treatment after surgical incision of serious odontogenic abscesses. J Craniomaxillofac Surg 2020; 48:229-234. [PMID: 32111509 DOI: 10.1016/j.jcms.2020.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 12/03/2019] [Accepted: 01/22/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Serious abscesses of an odontogenic origin occur frequently in the oral and maxillofacial surgery departments. Rapid surgical incision and drainage constitutes the most important therapeutic action. However, additional surgical therapy and supplementary administration of antibiotics is often carried out, such that the efficiency of this supplementary therapeutic option has been questioned. METHODS All patients with severe odontogenic infections who received surgical treatment under general anaesthesia were recruited to this retrospective study. We determined whether they received additional antibiotic therapy on the ward and if it was possible to improve therapeutic outcomes using this option. RESULTS A total of 258 patients with a severe odontogenic infection between January 2008 and August 2014 were included. The most frequent infection observed was a submandibular abscess (56%), followed by a perimandibular abscess (18%) and a submental abscess (9%). About 65% of the patients were treated with antibiotics in addition to surgery. The median CRP level prior to surgical treatment was 87.8 mg/l (Q1: 40.3 mg/l; Q3: 143.5 mg/l) in patients who were administered an additional antibiotic and 83.8 mg/l (Q1: 37.3 mg/l; Q3: 135.0 mg/l) in those who received no antibiotic treatment after surgery. The postoperative median CRP levels were 116.5 mg/l (Q1: 52.1 mg/l; Q3: 159.3 mg/l) and 106.5 mg/l (Q1: 40.6 mg/l; Q3: 152.6 mg/l), respectively. Neither the preoperative CRP level (p = 0.546) nor the postoperative CRP level (p = 0.450) differed significantly between the groups. But patients who received additional antibiotic therapy had a significantly longer hospital stay (median: 6 days; range: 1-22 days) than patients who had no additional antibiotic therapy (median: 4 days; range: 1-19 days) (p = 0.002). CONCLUSIONS This study did not show an improvement in the therapeutic outcome with administration of supplementary antibiotics in addition to surgery. Thus, surgically incising an abscess is the most important therapeutic action and administration of antibiotics must be critically scrutinised.
Collapse
|
44
|
Han J, Liau I, Bayetto K, May B, Goss A, Sambrook P, Cheng A. The financial burden of acute odontogenic infections: the South Australian experience. Aust Dent J 2019; 65:39-45. [PMID: 31618789 DOI: 10.1111/adj.12726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute odontogenic infections are a common surgical emergency managed by public hospitals in Australia which cause considerable patient morbidity and occasionally, mortality. Despite posing a significant public health burden, Australian data evaluating the cost of the management of these patients are lacking. This study assessed the patient and treatment variables associated with inpatient management of deep odontogenic infections, and their respective financial impact, at a statewide Oral & Maxillofacial service. METHODS A retrospective audit was carried out of patients with deep odontogenic infections at our institution, over a 7-year period. The primary outcome was the total cost of admission. Secondary outcomes included treatment received, operating room time, return-to-theatre, length of admission (LOS), and intensive care unit (ICU) use. Cost variables were assessed against the total LOS and ICU use to determine clinical predictors affecting outcome. RESULTS Four hundred and sixty two patients met the inclusion criteria. The average cost per patient was $12 228 Australian Dollars. After multivariate analysis, variables most significantly associated with increased cost of care and LOS were high-risk infections with airway compromise, high admission white cell count and age. CONCLUSION Hospital-based management of deep-space odontogenic infections engender significant costs compared to early primary care intervention such as a dental extraction ($181/extraction).
Collapse
Affiliation(s)
- J Han
- Department of General Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - I Liau
- Oral & Maxillofacial Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - K Bayetto
- Oral & Maxillofacial Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - B May
- Oral & Maxillofacial Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A Goss
- School of Dentistry, University of Adelaide, Adelaide, South Australia, Australia
| | - P Sambrook
- Oral & Maxillofacial Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Dentistry, University of Adelaide, Adelaide, South Australia, Australia
| | - A Cheng
- Oral & Maxillofacial Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Dentistry, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
45
|
Iwanaga J, Watanabe K, Anand MK, Tubbs RS. Air dissection of the spaces of the head and neck: A new teaching and dissection method. Clin Anat 2019; 33:207-213. [DOI: 10.1002/ca.23454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation Seattle Washington USA
- Division of Gross and Clinical Anatomy, Department of AnatomyKurume University School of Medicine Kurume Fukuoka Japan
- Dental and Oral Medical CenterKurume University School of Medicine Kurume Fukuoka Japan
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of AnatomyKurume University School of Medicine Kurume Fukuoka Japan
| | | | - R. Shane Tubbs
- Seattle Science Foundation Seattle Washington USA
- Department of Anatomical SciencesSt. George's University St. George's Grenada
| |
Collapse
|
46
|
Riekert M, Kreppel M, Zöller JE, Zirk M, Annecke T, Schick VC. Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions. Oral Maxillofac Surg 2019; 23:331-336. [PMID: 31115831 DOI: 10.1007/s10006-019-00770-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate perioperative risk factors concerning difficult airway management, primary tracheostomy, and need for intensive care unit (ICU) admission in severe odontogenic space infections. METHODS Perioperative risk factors were retrospectively analyzed in 499 cases. Fisher's exact test and analysis of variance were performed to analyze associations between categorical and continuous variables. Univariate regression analysis was used for estimating predictors for ICU admission. A risk model for ICU admission was performed using multivariate regression analysis. Area-under-the-curve (AUC) was calculated by receiver-operating-characteristic (ROC) curve. RESULTS Airway securing in patients with restricted mouth opening led to significant use of the video laryngoscope (p < 0.001) or fiberoptic bronchoscope (p < 0.001). The use of fiberoptic bronchoscopy was significantly increased in patients with dysphagia (p = 0.005) and dyspnea (p = 0.04). Four patients (0.8%) needed primary tracheostomy. ICU admission was significantly associated with higher levels of C-reactive protein (CRP, p = 2.78 × 10-5), white blood cell count (WBC, p = 0.003), dyspnea (p = 9.95 × 10-6), and higher body mass index (BMI, p = 0.0003). American Society of Anesthesiologists physical status (ASA PS) class III patients (p = 0.04) and the need for the use of a video laryngoscopy (p = 0.003) or fiberoptic bronchoscopy (p = 6.58 × 10-5) resulted in a more frequent ICU admission. The AUC of the model was 0.897. CONCLUSION Difficult airway management was mainly dependent on limited mouth opening and elevated CRP. Elevated CRP, BMI, ASA PS III, and dyspnea were important risk factors for ICU admission. These predictors should be considered preoperatively for proper planning and preparation.
Collapse
Affiliation(s)
- Maximilian Riekert
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50924, Cologne, Germany
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50924, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50924, Cologne, Germany
| | - Matthias Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University Hospital of Cologne, Kerpener Straße 62, 50924, Cologne, Germany
| | - Thorsten Annecke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Volker C Schick
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| |
Collapse
|
47
|
Adamson OO, Adeyemi MO, Gbotolorun OM, Oduyebo OO, Odeniyi O, Adeyemo WL. Comparison of sensitivity of bacteria isolated in odontogenic infections to ceftriaxone and amoxicillin-clavulanate. Afr Health Sci 2019; 19:2414-2420. [PMID: 32127812 PMCID: PMC7040266 DOI: 10.4314/ahs.v19i3.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Odontogenic infections is a cause of mortality and morbidity in maxillofacial patients. This is largely due to resistance of organisms to antibiotics prescribed. OBJECTIVES To isolate organisms involved in odontogenic infections and compare the sensitivity of the organisms to Ceftriaxone and Amoxicillin-Clavulanate. METHODS The causative organisms and antibiotic sensitivity were determined by the following steps: Aspiration of pus done with needle, sample of pus or exudate collected using sterile swab if aspiration was unsuccessful and specimen were placed in transport media (thioglycolatebroth) and sent immediately to microbiology laboratory for culture of organisms and antibiotic sensitivity. RESULTS Out of a total 55 samples taken for bacteriology, 42 (76.4%) yielded positive culture for bacteria. A total number of 21 bacteria species were identified from the positive cultures. Overall, 52% of isolated organisms were sensitive to amoxicillin-clavulanate, 70% were sensitive to Ceftriaxone while 24% were resistant to both antibiotics (Table 3). Ceftriaxone was statistically significantly more potent in inhibiting bacteria growth than amoxicillin-clavulanate (P =0.009). [Table: see text].
Collapse
Affiliation(s)
- Olawale Olatunbosun Adamson
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos
| | - Michael Olayinka Adeyemi
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos
| | - Olalekan Micah Gbotolorun
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos
| | - Omoniyi Omolola Oduyebo
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos
| | - Olalekan Odeniyi
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos
| | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos
| |
Collapse
|
48
|
Tent PA, Juncar RI, Onisor F, Bran S, Harangus A, Juncar M. The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections. Drug Metab Rev 2019; 51:340-355. [PMID: 30999773 DOI: 10.1080/03602532.2019.1602630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.
Collapse
Affiliation(s)
- Paul Andrei Tent
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Raluca Iulia Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Florin Onisor
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Simion Bran
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Antonia Harangus
- Spitalul Clinic de Pneumoftiziologie Leon Daniello Cluj-Napoca , Cluj-Napoca , Romania
| | - Mihai Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| |
Collapse
|
49
|
Katoumas K, Anterriotis D, Fyrgiola M, Lianou V, Triantafylou D, Dimopoulos I. Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department. J Craniomaxillofac Surg 2019; 47:1292-1299. [PMID: 31331847 DOI: 10.1016/j.jcms.2019.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/29/2019] [Accepted: 05/04/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aims of the present study are to present the epidemiology and management of patients hospitalized with odontogenic infections in a major Greek hospital from 2015 to 2016 and to find out whether the basic principles of management of odontogenic infections were followed before referral to the emergency department of the Oral and Maxillofacial Surgery Clinic (OMFSED). METHODS A retrospective study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED. RESULTS During the two-year period from 2015 to 2016, 102 patients, 54 men (52.9%) and 48 women (47.1%) were hospitalized with severe odontogenic infections. The most common space involved in severe odontogenic infections was the submandibular (52.9%), and in 31.4% of the patients multiple spaces were involved. The lower third molars were the most common cause (36.5%). In 83 patients (81.4%) the tooth causing the infection had not received any treatment whatsoever and in all cases (100%) no decision for early incision and drainage prior to the referral to the OMFSED was made. CONCLUSION The data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.
Collapse
Affiliation(s)
- Konstantinos Katoumas
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Dimitrios Anterriotis
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Maria Fyrgiola
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Violetta Lianou
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Dimitrios Triantafylou
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Ioannis Dimopoulos
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| |
Collapse
|
50
|
Juncar M, Juncar RI, Onisor-Gligor F. Ludwig's angina, a rare complication of mandibular fractures. J Int Med Res 2019; 47:2280-2287. [PMID: 30958072 PMCID: PMC6567769 DOI: 10.1177/0300060519840128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/06/2019] [Indexed: 11/25/2022] Open
Abstract
Traumas are a major problem worldwide. A considerable proportion of traumas are located in the cephalic extremity. Neglect of these disorders by patients or those responsible for patient management may result in particularly serious consequences. This paper presents the case of a 58-year-old male patient with an intraorally open mandibular fracture, which left untreated for 3 days, was complicated by Ludwig's angina. Following aggressive surgical treatment during which the mandibular fracture was manually reduced and immobilized with a metal splint fixed with circumdental wires and effective antibiotic therapy, the septic process was terminated and the patient's fracture and infected wound were healed. The correct and rapid treatment of open mandibular fractures is mandatory in order to avoid severe septic complications.
Collapse
Affiliation(s)
- Mihai Juncar
- Oral and Maxillofacial Surgery, Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Raluca-Iulia Juncar
- Department of Prosthetics, Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Florin Onisor-Gligor
- Department of Oral and Maxillofacial Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Cluj, Romania
| |
Collapse
|