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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.
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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.
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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.
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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
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Rautaporras N, Uittamo J, Furuholm J, Marinescu Gava M, Snäll J. Deep odontogenic infections - Computed tomography imaging-based spreading routes and risk for airway obstruction. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101424. [PMID: 36781108 DOI: 10.1016/j.jormas.2023.101424] [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: 12/21/2022] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
PURPOSE This study aimed to evaluate deep odontogenic infection (DOI) spread and features utilizing head and neck computed tomography (CT) imaging. MATERIAL AND METHODS Patients with acute DOI and preoperative contrast-enhanced CT-imaging were included in the study. Infection spaces, radiological features of these infections, CT imaging-based compromised airway and patients' background factors were evaluated and associations between these and need for postoperative mechanical ventilation (MV) were reported. RESULTS Altogether 262 hospitalized patients were included in the final analysis. Typically affected spaces were submandibular (74%), mandibular buccal/vestibular (37%), and sublingual (26%). Retropharyngeal (1%), mediastinal (1%) and danger space (1%) involvements were unusual. The infections were quite evenly distributed between multispace abscesses (53%) and other infections (47%). In multivariate analysis, CT-based compromised airway (OR 5.6, CI 95%, 2.9-10.9, P <0.001), midline crossing (OR 3.3, CI 95%, 1.2-8.8, P = 0.018) and extension at the level or below hyoid body (OR 2.4, CI 95% 1.2-5.1, P = 0.016) predicted the need for MV. Other radiological findings and patients' background variables remained statistically non-significant for MV. CONCLUSION Anterolateral and superior spread to the neck is typical in DOIs, whereas caudal progression is rare. Postoperative need for MV can be well recognized from CT.
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Affiliation(s)
- Niina Rautaporras
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Johanna Uittamo
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Furuholm
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Sheikh Z, Yu B, Heywood E, Quraishi N, Quraishi S. The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis. Clin Otolaryngol 2023. [PMID: 37147934 DOI: 10.1111/coa.14064] [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: 06/30/2022] [Revised: 02/03/2023] [Accepted: 03/19/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To summarise current practices in the diagnosis and management of deep neck space infections (DNSIs). To inform future studies in developing a framework in the management of DNSIs. DESIGN This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with two independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach. SETTING Secondary or tertiary care centres that undertook management of DNSIs. PARTICIPANTS All adult patients with a DNSI. MAIN OUTCOME MEASURES The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs. RESULTS Sixty studies were reviewed. Thirty-one studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single randomised controlled trial, all other studies were observational (n = 25) or case series (n = 36). Computer tomography (CT) was used to diagnose DNSI in 78% of patients. The mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration, respectively. Qualitative analysis identified seven major themes on DNSI. CONCLUSIONS There are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.
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Affiliation(s)
- Zain Sheikh
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
- Department of Academic Clinical Training, University of Sheffield, Sheffield, UK
| | - Beverley Yu
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Emily Heywood
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Natasha Quraishi
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Shahed Quraishi
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
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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.
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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
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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.
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Computed tomography analysis of fascial space involvement demonstrates correlations with laboratory tests, length of hospital stays and admission to the intensive care unit in odontogenic infections. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S170-S176. [PMID: 35659711 DOI: 10.1016/j.bjorl.2022.04.003] [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: 01/13/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Odontogenic infections are frequent and can spread, leading to complications such as sepsis and the need for admission to an Intensive Care Unit (ICU). The purpose of this study was to perform a computed tomography analysis of the fascial space involvement and correlate with personal data, laboratory tests, length of hospital stays and admission to the ICU in patients with odontogenic infections who required hospitalization. METHODS Patients with odontogenic infections admitted between June 2017 and May 2018 were prospectively evaluated. The fascial spaces involved were studied using computed tomography with contrast. The possible correlations of tomographic findings with comorbidities, nutritional status, the causative tooth, laboratory tests, length of hospital stays and admission to the ICU were analyzed. RESULTS We identified 66 cases of odontogenic infections which were admitted in the period analyzed. The involvement of primary spaces (86.7%) predominated, followed by secondary ones (8.7%), and cervical (4.6%). The most frequently involved fascial spaces were submandibular (27.1%), buccal (20.8%), sublingual (18.3%), submental (16.7%), and others (17.1%). There were significant differences between laboratory tests (p < 0.001), mean hospital stays (p < 0.001), and admissions to the ICU (p < 0.001) depending on the number of fascial spaces involved. There was no influence of comorbidities, nutritional status, or causative tooth on fascial space involvement. CONCLUSION There was a relationship between greater involvement of fascial spaces assessed by computed tomography and higher values of laboratory tests, more extended hospitalization stays and admission to the ICU. LEVEL OF EVIDENCE Level 2b.
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Degouy G, Nicot R, Poissy J, Mathieu D, Parmentier-Decrucq E. Risk factors for difficult ventilatory weaning in intensive care patients with cervical cellulitis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e396-e401. [PMID: 35227951 DOI: 10.1016/j.jormas.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/11/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Cervical cellulitis is an infrequent but serious infection. The management of the upper airways is difficult, at the actual time of intubation but also regarding the necessity of maintaining mechanical ventilation. The objective of this study is to identify risk factors on admission to the intensive care unit for difficult ventilatory weaning in patients with cervical cellulitis. METHODS Between January 2013 and December 2018, this retrospective observational study was performed in an intensive care unit with 10 beds in a university hospital recognized as a reference center for the management of cellulitis. All intensive care patients receiving mechanical ventilation after surgery for cervical cellulitis were eligible. Difficult ventilatory weaning was defined as mechanical ventilation lasting more than 7 days or failure of extubation as established by the WIND 2017 study. RESULTS We included 120 patients with severe cervical cellulitis. The median age was 43 years. Eighteen patients (16%) presented mediastinal extension. The risk factor for difficult ventilatory weaning (n = 49) in multivariate analysis was a high level of procalcitonin on admission (OR at 1.14[1.005-1.29]; p<0.042) and the protective factor was surgery in an expert center (OR at 0.11[0.026-0.47]; p<0.003). Eight patients required a tracheotomy in our study: 3 patients during surgery and at a later time for the other 5 of our 8 patients. CONCLUSION No intensive care studies have investigated ventilatory weaning risk factors in patients with cervical cellulitis. Yet simple criteria seem to predict this risk. It is now necessary to confirm them by a multicenter prospective study.
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Affiliation(s)
- Guillaume Degouy
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital.
| | - Romain Nicot
- Service de Chirurgie Maxillo-Faciale et Stomatologie, Lille University Hospital.
| | - Julien Poissy
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital.
| | - Daniel Mathieu
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital.
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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.
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McGoldrick DM, Edwards J, Praveen P, Parmar S. Admission patterns and outcomes of patients admitted to critical care in the UK with surgically treated facial infecion: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Br J Oral Maxillofac Surg 2022; 60:1074-1079. [DOI: 10.1016/j.bjoms.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022]
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Peyton J, Fiadjoe J, Stein ML, Park R, Staffa S, Zurakowski D, Kovatsis P. Comparing standard and non-standard videolaryngoscopes in children: methodological issues. Response to Br J Anaesth 2021; 127: e52-e4. Br J Anaesth 2021; 127:e172-e173. [PMID: 34511260 DOI: 10.1016/j.bja.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- James Peyton
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
| | - John Fiadjoe
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Mary L Stein
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Raymond Park
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Steven Staffa
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Pete Kovatsis
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
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Furuholm J, Rautaporras N, Uittamo J, Saloniemi M, Snäll J. Health status in patients hospitalised for severe odontogenic infections. Acta Odontol Scand 2021; 79:436-442. [PMID: 33502919 DOI: 10.1080/00016357.2021.1876916] [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: 10/22/2022]
Abstract
OBJECTIVE Previous findings refer to certain predisposing medical conditions that compound the risk of developing severe and potentially lethal acute odontogenic infections (OI). The objective of this study was to clarify this rationale and infection severity in general. MATERIAL AND METHODS Records of patients aged ≥18 years requiring hospital care for deep OI were retrospectively investigated. The main outcome variable was need for intensive care unit (ICU) treatment. Additional outcome variable was occurrence of infection complications and/or distant infections. Several parameters describing patients' prior health and recent dental treatment were set as independent variables. RESULTS Of the 303 acute OI patients included, 71 patients (23%) required treatment in the ICU, with no significant difference between previously healthy and patients with disease history. OIs originating from teeth in the mandible compared with maxilla had 7.8-fold risk (p = .007) for ICU treatment in binary logistic regression analyses. Elevated levels of infection parameters at hospital admission predicted further ICU stay. Infection complications and/or distant infections occurred in 7.6% of patients, of which septicaemia and pneumonia were the most common. The mortality rate was 0.3%. Infection complications and/or distant infections occurred significantly more often in smokers (p = .001) and in patients with excessive consumption of alcohol or drugs (p = .025), however smoking showed 3.5-folded independent risk for infection complications and/or distant infections (p = .008) in logistic regression. CONCLUSIONS Severe OIs often occur in previously healthy patients. Smokers in particular are prone to the most serious OIs.
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Affiliation(s)
- Jussi Furuholm
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Niina Rautaporras
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Johanna Uittamo
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Mikko Saloniemi
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
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