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Louizakis A, Tatsis D, Paraskevopoulos K, Antoniou A, Kyrgidis A, Vahtsevanos K. The Effect of the COVID-19 Pandemic on Odontogenic Cervicofacial Infections in a Single Center in Greece. Cureus 2024; 16:e61333. [PMID: 38947612 PMCID: PMC11213832 DOI: 10.7759/cureus.61333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION Odontogenic cervicofacial infections are still an ongoing problem, requiring immediate hospital admittance and management. The aim of this study is to reflect the number of patients with cervicofacial infections who were admitted during the coronavirus disease 2019 (COVID-19) pandemic period in a single, point of reference center in Northern Greece as well as analyze the quantitative and qualitative parameters of patient characteristics and management data. METHODS This was a retrospective cohort study that included all the patients with cervicofacial infections who were admitted to our unit during the COVID-19 pandemic, specifically between 2020 and 2021. For comparative reasons, patients admitted with cervicofacial infections between 2019 and 2020 (pre-COVID period) were analyzed. RESULTS In total, 341 patients fulfilled the criteria for this study. Specifically, the number of admitted patients was 151 in the pre-COVID era instead of 190 patients in the pandemic. The mean age of the patients was 45.3 years, with a slight male predominance (54.7% males to 45.3%). The mean duration of hospitalization was 2.5 days in the pre-COVID period instead of 3.42 days in the pandemic. Interestingly, in the pandemic, eight times more patients were admitted to the ICU post-operatively, in contrast to the pre-COVID period (23 vs 3 patients). Also in the COVID period, almost 54.9% of the patients presented with fever and 49.6% with trismus. Moreover, the submandibular space involvement was the most common space of infection in both COVID and pre-COVID groups with (58.9% and 49.7%) respectively. In one-third of all cases, a post-extraction infection of a third molar was the main cause of abscess. CONCLUSION Cervicofacial infections during the COVID-19 pandemic appeared with more severe symptoms and resulted in an increased number of patients who needed admittance to the intensive care unit, in contrast to the pre-COVID era. Also, the mean length of stay was increased for a day at the same period. This study could be used as an example for further research, in case of similar pandemic situations in the future.
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Affiliation(s)
- Alexandros Louizakis
- Department of Oral and Maxillofacial Surgery, George Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Dimitris Tatsis
- Department of Oral and Maxillofacial Surgery, George Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Konstantinos Paraskevopoulos
- Department of Oral and Maxillofacial Surgery, George Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Asterios Antoniou
- Department of Oral and Maxillofacial Surgery, George Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Athanasios Kyrgidis
- Department of Oral and Maxillofacial Surgery, George Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Konstantinos Vahtsevanos
- Department of Oral and Maxillofacial Surgery, George Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Gadicherla S, Manglani K, Pentapati KC, Kudva A, Aramanadka C, Chandravel R. Profile of Patients with Maxillofacial Space Infections and Associated Risk Factors. ScientificWorldJournal 2024; 2024:9304671. [PMID: 38633105 PMCID: PMC11022519 DOI: 10.1155/2024/9304671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
Objective To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay. Materials and Methods We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay. Results A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age (P = 0.015; OR: 2.98) and evidence of bacterial culture (P = 0.001; OR:6.64) were potential predictors associated with increased hospital stay. Conclusion Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.
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Affiliation(s)
- Srikanth Gadicherla
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Kirti Manglani
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Kalyana C. Pentapati
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Adarsh Kudva
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Chithra Aramanadka
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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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.
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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
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Ullah M, Irshad M, Yaacoub A, Carter E, Thorpe A, Zoellner H, Cox S. Dental Infection Requiring Hospitalisation Is a Public Health Problem in Australia: A Systematic Review Demonstrating an Urgent Need for Published Data. Dent J (Basel) 2023; 11:dj11040097. [PMID: 37185475 PMCID: PMC10136976 DOI: 10.3390/dj11040097] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/11/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
Background: The aim of this systematic review was to analyse the published literature on dental infections leading to hospitalisations in Australia. It was hoped that understanding the patterns and trends would form a basis for improved preventive and management policies. Methods: An electronic search was performed using Web of Science, Medline via Ovid and Google Scholar. Inclusion and exclusion criteria were applied. The included studies were analysed for demographics, aetiology, management, length of hospital stay and outcome of dental infections requiring hospitalisation. Results: Nine retrospective studies were eligible for inclusion. A total of 2196 cases of dental infections leading to hospitalisations were reported, with a male predominance (55–67%). Mental health issues, illicit substance abuse and immunosuppression were the main associated comorbidities (up to 58%). Dental caries (59–90%) and pericoronitis (10–19%) were the leading causes of dental infections. Empirical antibiotics were utilised in up to 75% of cases prior to hospital presentation. Six mortalities were reported. Conclusions: The available published data show that dental infection is a significant public health problem. However, only general conclusions were possible due to the variably small sample size and data collection that was inconsistent and incomplete across studies. Improved data collection is required to develop policies for prevention and management.
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Affiliation(s)
- Mafaz Ullah
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
| | - Muhammad Irshad
- Department of Oral Pathology, Rehman College of Dentistry, Peshawar 25000, Pakistan
- Specialised Dental Center, Ministry of Health, Sakaka Aljouf 72345, Saudi Arabia
| | - Albert Yaacoub
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Eric Carter
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
| | - Andrew Thorpe
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
| | - Hans Zoellner
- Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, NSW 2006, Australia
- Graduate School of Biomedical Engineering, University of NSW, Kensington, NSW 2052, Australia
- Strongarch Pty Ltd., Pennant Hills, NSW 2120, Australia
| | - Stephen Cox
- Discipline of Oral Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2750, Australia
- Nepean Centre for Oral Health, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, NSW 2747, Australia
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Demian N, Pearl C, Woernley T, Dallaire-Giroux C. Retrospective Cohort Study on the Management of Diffuse Deep Neck Space Infections Using a Modified Submental Approach and Placement of Wound Vacuum. J Oral Maxillofac Surg 2023; 81:337-343. [PMID: 36581313 DOI: 10.1016/j.joms.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Diffuse deep neck space infection (DDNSI) is an emergent condition that requires efficient surgical and airway management. A novel surgical approach has been developed to enhance access and improve visualization of the involved deep neck spaces, which allows for better evaluation of the extent of tissue necrosis. This study will compare the treatment of DDNSI with traditional incision and drainage with drain placement (Conventional) versus the new incision and drainage design with the use of a wound vacuum (VAC). METHODS This retrospective cohort study was performed on DDNSI cases treated with the VAC versus Conventional techniques from July 2014 to September 2020 at Memorial Hermann Hospital by the oral and maxillofacial surgery service. To be categorized as a DDNSI, the patient had to demonstrate radiographic evidence of an infection bilaterally in a minimum of four spaces, such as bilateral submandibular, sublingual, and submental spaces. Primary predictor variable was treatment method for DDNSI, Conventional versus VAC. Primary outcome variables were hospital length of stay (LOS), number of washouts, and days of intubation. Covariates were age, sex, number of spaces involved, presence of necrotic tissues, comorbidities, and mortality. Appropriate uni- and bi-variate statistics were calculated. Statistical significance was set at P < .05. RESULTS Fifty-one patients (17 female and 34 male) aged 18 to 65 years were treated for DDNSI. Twenty-eight patients were treated using the VAC approach and 23 patients were treated with the conventional approach. The average LOS 8.3 ± 0.8 days (P-value = .0001), number of days intubated 3 ± 0.3 (P-value = .0001), and number of required washouts 2 ± 0.2 (P-value = .004) were statistically lower in the VAC group compared to the Conventional group. CONCLUSIONS There were significant improvements encountered with overall length of hospital stay, number of days intubated, and the number of required wash outs. There were significant differences in outcomes between patients with comorbidities when compared to those who had none.
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Affiliation(s)
- Nagi Demian
- Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Craig Pearl
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Timothy Woernley
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX
| | - Cyndie Dallaire-Giroux
- Chief Resident, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center Houston, Houston, TX.
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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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Inflammatory Markers as Predictors for Prolonged Duration of Hospitalization in Maxillofacial Infections. J Clin Med 2023; 12:jcm12030871. [PMID: 36769517 PMCID: PMC9917481 DOI: 10.3390/jcm12030871] [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: 12/15/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Despite the progress made in diagnosing and treating maxillofacial infections, the course of infection can be unpredictable, leading to severe complications, prolonged hospitalization, and substantial financial costs to health care services. It is important to determine whether various serum inflammatory marker levels on admission may predict a prolonged hospital stay in these patients. To analyze the role of CRP, white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR) in predicting the prolonged duration of hospitalization in maxillofacial infections, we performed a retrospective study by collecting paper records data from 108 patients who met our inclusion criteria. The patients were divided into two groups according to the duration of hospitalization (group A < 5 days and group B ≥ 5 days). The predictor variables were CRP, WBC, and NLR, and the outcome variable was the duration of hospitalization. This study confirmed a positive linear correlation (p < 0.001) between the predictors and the outcome variable. The optimal cut-off values for WBC are 11,030 white blood cells/μL and 63 mg/L for CRP. Levels that exceed these optimal values predict a duration of hospitalization of over (≥) 5 days. Serum WBC and CRP on admission may predict the duration of hospitalization in patients with MFI.
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Wang P, Huang Y, Long J. A Five-Year Retrospective Study of 746 Cases with Maxillofacial Space Infection in Western China. Infect Drug Resist 2022; 15:5099-5110. [PMID: 36068836 PMCID: PMC9441175 DOI: 10.2147/idr.s377657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To grasp the current epidemiological situation of maxillofacial space infection and investigate the risk factors contributing to the longer hospitalization of odontogenic space infection in western China. Patients and Methods This retrospective study collected the clinical characteristics from 746 hospitalized patients with maxillofacial space infection and investigated the risk factors associated with longer hospitalization. Pearson’s chi-square test and multivariable binary logistic regression were performed for statistical analysis. Results A total of 438 males and 308 females were included in this study, aging from 1 to 90 years (mean age 48.6 years). 74.9% cases resulted from odontogenic infections, with the submandibular space being the most commonly involved space (53.7%). Advanced age (OR (>60 y:19–60 y:≤18 y) = 3.784:3.416:1, p < 0.05), treatment before admission (OR = 2.271, p < 0.05) and number of involved spaces (OR (≥4:2–3:1) = 3.204:1.931:1, p < 0.05) were closely related to longer hospitalization. Streptococcus being the most frequently found aerobic bacteria (268/615, 43.6%) of all the bacteria isolated was resistant to clarithromycin (91.5%) and erythromycin (92.8%). Conclusion Hospitalization time could be longer for patients with the identified risk factors. Streptococcus, as the most common type of aerobic flora, is highly resistant to clindamycin and erythromycin.
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Affiliation(s)
- Peihan Wang
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Yanling Huang
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Jie Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Correspondence: Jie Long, Tel +86 28 85503406, Fax +86 28 85501456, Email
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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.
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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
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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]
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Bègue L, Schlund M, Raoul G, Ferri J, Lauwers L, Nicot R. Biological factors predicting the length of hospital stay in odontogenic cellulitis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:303-308. [PMID: 34260983 DOI: 10.1016/j.jormas.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether common biological factors are correlated with a longer hospital stay. STUDY DESIGN All patients having odontogenic cellulitis, treated from January 2019 to December 2019 at Lille University Hospital, and requiring surgical drainage under general anesthesia, were included, retrospectively. Data, such as length of hospital stay and biological factors, namely, C-reactive protein (CRP) level, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, and bacterial samples were collected. RESULTS Significant moderate-strong correlations were found between postoperative length of stay and patients' LRINEC score (rs = 0.556) and presurgical CRP level (rs = 0.579). There was a significant moderate correlation between postoperative length of stay and presurgical procalcitonin level (rs = 0.451), and a weak correlation between postoperative length of stay and presurgical white blood cell count (rs = 0.282). Linear regression verified CRP as an independent predictor of length of hospital stay, showing a significant linear relationship between them (p < 0.0001). A significant regression equation was found (F(1,65) = 27.089; p = 0.0001), with an R2 of 0.294. CONCLUSION In this study, CRP was the key biological predictor of length of hospital stay. STATEMENT OF CLINICAL RELEVANCE The ability to predict length of hospital stay and identify patients requiring intensive care management, using simple and inexpensive biological parameters (such as CRP), will enable more cost-effective care and efficient hospital bed management.
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Affiliation(s)
- Louis Bègue
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, F-59000 Lille, France
| | - Matthias Schlund
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Gwénaël Raoul
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Joël Ferri
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Ludovic Lauwers
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, F-59000 Lille, France
| | - Romain Nicot
- University Lille, Department of Oral and Maxillofacial Surgery, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France.
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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.
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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
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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.
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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
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Rasteniene R, Vitosyte M, Jankauskaite D, Aleksejuniene J. Predictors of longer hospitalization of maxillofacial infections-a 17-year retrospective study. Oral Dis 2021; 28:1979-1986. [PMID: 33915000 DOI: 10.1111/odi.13894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To evaluate treatment outcomes in patients with severe maxillofacial infections requiring hospital care during a 17-year period. METHODS A retrospective cohort study reviewed 5,465 medical records, and the following data were collected: the reason for infection, locations of inflamed regions, treatment provided, bacteriological findings, and treatment outcomes. Other information included sociodemographic characteristics (age, gender), presence of systemic diseases, and smoking history. RESULTS The annual incidence rate of patients with acute maxillofacial infections was 206 ± 19 cases with a male to female ratio 1.4:1.0, a mean hospital stay of 7.9 ± 4.9 days. Older age (>65 years), smoking and systemic diseases (diabetes), the causative tooth (molar), and need for extraoral incision predicted longer hospitalization. Intravenous penicillin was the most common drug prescribed in 50.5% of cases. A total of 132 different microorganisms were identified. The highest microorganism resistance occurred for metronidazole and the highest sensitivity was to clindamycin. CONCLUSIONS Increased age, smoking, diabetes, causative tooth, and the occurrence of several infected spaces were associated with a longer hospital stay. Streptococcus α haemolyticus was the most common microorganism found in more than 70.0% of cases that were sensitive to intravenous penicillin.
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Affiliation(s)
- Ruta Rasteniene
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Milda Vitosyte
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Dainora Jankauskaite
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Maxillofacial space infection experience and risk factors: a retrospective study of 222 cases. Ir J Med Sci 2020; 190:1045-1053. [PMID: 33188628 DOI: 10.1007/s11845-020-02431-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/05/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Maxillofacial space infection (MSI) experience review is beneficial for its management. AIM To identify potential risk factors predisposing to the exacerbation of MSI and a prolonged length of stay (LOS). METHODS We performed a comprehensive retrospective review of medical records of 222 MSI patients admitted in Center of Stomatology during 1993-2019. RESULTS About 63.5% of 222 patients had an odontogenic infection, and submandibular space was the most involved space. Streptococcus spp. was the most common organism isolated (72.4%). Multiple-space cases had more systemic diseases, respiratory difficulty, and life-threatening complications and exhibited worse clinical characteristics (higher white-blood-cell-count, higher body temperature, and restricted mouth opening) than single-space cases (P < 0.05). No significant difference in LOS was found between multiple-space cases and single-space cases. Diabetes and hypertension both accounted for 35.1% in life-threatening cases. Multiple-space infection (60.4%), respiratory difficulty (11.7%), and systemic conditions (43.2%) were identified as critical risk factors associated with life-threatening complications in MSI patients (P < 0.001). A significantly prolonged LOS was found in cases aged ≥ 60 years or with systemic diseases. Community outpatient treatment shortened 1.9 days of LOS compared with self-medication before admission during 2010-2019 (P < 0.05). CONCLUSION Comprehensive managements are advisable for MSI patients with multiple-space infection, respiratory difficulty, systemic diseases to avoid disseminated exacerbation, and occurrence of life-threatening complications. Community outpatient treatment was beneficial to a reduced LOS. Timely access to dental outpatient management and simultaneously steady control of diabetes and hypertension was advocated. Improved coverage of insured dental outpatient treatment should be stressed.
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Zhao N, Liu Y, Yue J, Xu YX, Fu ZZ, Ding Q, Xiao WL. Negative pressure drainage-assisted irrigation for maxillofacial space infection. Oral Dis 2020; 26:1586-1591. [PMID: 32430987 DOI: 10.1111/odi.13421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/24/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In this study, the clinical effect of negative pressure drainage-assisted irrigation (NPDI) technique was evaluated in treating maxillofacial space infection (MSI) by comparing with traditional technique. METHOD A prospective study was conducted in 58 patients with MSI. The patients were randomly divided into two groups based on different treatment techniques. Thirty patients receiving NPDI were included in NPDI group, and 28 patients receiving traditional technique were included in traditional group. Case data (gender, age, etiology, concurrent illness, diabetes, involved spaces, preoperative white cell count, airway control method) and clinical effect (postoperative hospital stay, total cost of admission) for the two groups were analyzed. RESULTS Patients in both groups were cured clinically. There were no significant differences in gender, age, etiology, concurrent illness, diabetes, involved spaces, preoperative white cell count, and airway control method in NPDI group and traditional group (p > .05). The postoperative hospital stay and the total cost of admission in the NPDI group were significantly lower than the traditional group (p < .001). CONCLUSION Negative pressure drainage-assisted irrigation used in the treatment of MSI can shorten the postoperative hospital stay, reduce the total cost of admission, and show favorably clinical effect. It is a clinically recommended method for MSI.
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Affiliation(s)
- Ning Zhao
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China.,School of Stomatology, Qingdao University, Qingdao, China
| | - Yi Liu
- School of Stomatology, Qingdao University, Qingdao, China
| | - Jin Yue
- School of Stomatology, Qingdao University, Qingdao, China
| | - Yao-Xiang Xu
- School of Stomatology, Qingdao University, Qingdao, China
| | - Zhen-Zhen Fu
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Ding
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wen-Lin Xiao
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, China.,School of Stomatology, Qingdao University, Qingdao, China
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Uittamo J, Löfgren M, Hirvikangas R, Furuholm J, Snäll J. Severe odontogenic infections: focus on more effective early treatment. Br J Oral Maxillofac Surg 2020; 58:675-680. [DOI: 10.1016/j.bjoms.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/02/2020] [Indexed: 12/19/2022]
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18
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What Is the Health Care Burden of Treating Pediatric Dental Infections on an Inpatient Basis? J Oral Maxillofac Surg 2020; 78:343-349. [DOI: 10.1016/j.joms.2019.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/16/2019] [Accepted: 09/15/2019] [Indexed: 12/28/2022]
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Park J, Lee JY, Hwang DS, Kim YD, Shin SH, Kim UK, Song JM. A retrospective analysis of risk factors of oromaxillofacial infection in patients presenting to a hospital emergency ward. Maxillofac Plast Reconstr Surg 2019; 41:49. [PMID: 31815113 PMCID: PMC6872703 DOI: 10.1186/s40902-019-0238-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/25/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this study was to review the clinical features of oromaxillofacial infections in patients presenting to a hospital emergency ward, to identify the key factors affecting the requirement for hospitalization, and the potential risk factors predisposing to a prolonged length of hospital stay.
Methods
A retrospective medical record review of the 598 patients treated for oromaxillofacial infection from 2013 to 2017 at the oral and maxillofacial surgery department, Yangsan Pusan National University Hospital, was conducted. The following information was collected from each patient: sex, age, past medical history, site of infection, etiology, admission or outpatient care, level of C-reactive protein (mg/dL), fascial spaces involved, treatment method, and duration of hospitalization. Chi-squared tests were used to identify risk factors, which were further analyzed using multivariable logistic regression.
Results
A total of 606 patients were eligible for inclusion in the study, of which eight were excluded due to having incomplete charts; thus, 598 patients were included: 55% were male, mean patient age was 47.1 ± 19.9 years, and 12.9% of patients were diabetic. Furthermore, 71.2% of patients had infection originating in the mandible; the most common tooth of origin was lower posterior, and 29.8% of patients were hospitalized. Risk factors for hospital admission were elderly patients with concurrent disease, elevated C-reactive protein level, and multiple-space infection in the oromaxillofacial area. The duration of hospitalization was correlated with both diabetes and age.
Conclusions
The requirement for hospital admission is determined by the severity of the infection; even severe infections, once treated with appropriate surgery, have no relation to the length of hospital stay. The important risk factors for increased duration of hospitalization are diabetes mellitus and older age. The understanding of risk factors associated with a prolonged hospital stay during the treatment of oromaxillofacial infection will aid in treatment planning as well as highlight the importance of adequate diabetes control in patients at risk of such infection.
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Nadig K, Taylor NG. Management of odontogenic infection at a district general hospital. Br Dent J 2019; 224:962-966. [PMID: 29999002 DOI: 10.1038/sj.bdj.2018.445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/09/2022]
Affiliation(s)
- K Nadig
- Royal Surrey County Hospital, Department of Oral & Maxillofacial Surgery, Egerton Road, Guildford, GU2 7XX
| | - N G Taylor
- Royal Surrey County Hospital, Department of Oral & Maxillofacial Surgery, Egerton Road, Guildford, GU2 7XX
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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.
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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.
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Fu B, McGowan K, Sun H, Batstone M. Increasing Use of Intensive Care Unit for Odontogenic Infection Over One Decade: Incidence and Predictors. J Oral Maxillofac Surg 2018; 76:2340-2347. [PMID: 29958865 DOI: 10.1016/j.joms.2018.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/01/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine whether intensive care unit (ICU) admissions for odontogenic infections have increased during the past decade and whether certain clinical features are associated with a greater rate of ICU admission. MATERIALS AND METHODS The data from patients undergoing surgery for odontogenic infections at the Royal Brisbane and Women's Hospital in the 24 month from January 2003 to December 2004 were compared with those from patients treated from January 2013 to December 2014. A χ2 analysis was used to compare the demographic, admission, and clinical patient data in each cohort. A multiple logistic regression model was used to determine which clinical features were associated with greater rates of ICU admission. RESULTS The rate of ICU admission increased significantly from 7 to 24% during the decade (χ2 = 12.74; P = .000), although the clinical presentation of patients admitted to the ICU was similar in both cohorts. The mean number of days spent in the ICU increased significantly from 1.7 ± 0.5 to 3.24 ± 2.5 days (t = -3.63; P = .001), and the overall length of stay increased from 1.7 ± 0.5 to 3.5 ± 4.1 days (t = 2.99; P = .004). The use of preoperative computed tomography (CT) increased significantly from 42.9 to 93.3% (χ2 = 13.25; P = .000). The most significant predictors of ICU admission were lower third molar involvement (P = .026), dysphagia (P = .020), and C-reactive protein (CRP) levels exceeding 150 mg/L (P = .039). CONCLUSIONS The use of the ICU in the management of odontogenic infection has increased significantly at the Royal Brisbane and Women's Hospital over 1 decade. The demographic data and clinical presentation of the patients admitted to the ICU did not change significantly. However, the length of ICU stay and the total length of stay have both increased. A significant increase in CT usage for odontogenic infections also occurred. Third molar infections, dysphagia, and elevated CRP might be relevant clinical predictors of a more complicated course of care requiring ICU admission. More judicious use of CT scanning, combined with prompt surgical consultation and intervention, might reduce the rate of ICU admissions for odontogenic infections.
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Affiliation(s)
- Benjamin Fu
- Registrar, Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia and Masters Candidate, School of Medicine, University of Queensland, QLD, Australia.
| | - Kelly McGowan
- Associate Lecturer, School of Dentistry, University of Queensland, QLD, Australia and PhD Candidate, School of Dentistry and Oral Health, Griffith University, QLD, Australia
| | - Hansen Sun
- Adjunct Associate Professor, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Martin Batstone
- Director, Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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