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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 2024:101954. [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] [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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Meisgeier A, Pienkohs S, Dürrschnabel F, Neff A, Halling F. Rising incidence of severe maxillofacial space infections in Germany. Clin Oral Investig 2024; 28:264. [PMID: 38644434 PMCID: PMC11033243 DOI: 10.1007/s00784-024-05663-w] [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: 01/23/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Severe maxillofacial space infection (MSI) as an end stage of dentoalveolar diseases or complication of sialadenitis is a potentially life-threatening disease accompanied by complications including airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis and acute respiratory distress syndrome. The aim of this study was to analyze the incidence and time trends of severe MSI and potentially influencing factors in the German healthcare system over time. MATERIALS AND METHODS Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. A retrospective analysis of incidence and time trends of MSI-associated procedures classified with the Operation and Procedure Classification System (OPS), were statistically evaluated using Poisson regression analysis between 2005 and 2022 and were associated with different epidemiological factors. RESULTS The total standardized incidence rate of MSI-associated procedures in the observational period 2005-2022 was 9.8 (♀8.2; ♂11.4) per 100,000 person years. For all age groups a significant increase of 46.1% in severe MSI - related surgical interventions was registered within the observational period. The largest increase (120.5%) was found in elderly patients over 80 years. There were significant differences of the incidences of MSI-associated surgeries between the different federal states in Germany. CONCLUSIONS Severe MSI are a growing challenge in German health care especially among elderly patients over 80 years. CLINICAL RELEVANCE Severe MSI is a promising target for prevention. There should be more focus in primary dental and medical care especially in groups depending on social support.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany.
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Florian Dürrschnabel
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Frank Halling
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
- Gesundheitszentrum Fulda, Praxis für MKG-Chirurgie, Gerloser Weg 23a, D-36039, Fulda, Germany
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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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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.
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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
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Roi CI, Roi A, Nicoară A, Nica D, Rusu LC, Soancă A, Motofelea AC, Riviș M. Impact of Treatment on Systemic Immune-Inflammatory Index and Other Inflammatory Markers in Odontogenic Cervicofacial Phlegmon Cases: A Retrospective Study. Biomedicines 2023; 11:1710. [PMID: 37371805 DOI: 10.3390/biomedicines11061710] [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: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Cervicofacial odontogenic infections can have an aggressive evolution with life-threatening complications. Management in many cases can be a challenge for clinicians, implying an extra focus on individual inflammatory parameters. The aim of this study is to evaluate the evolution of inflammatory markers for the included diagnosed odontogenic cervicofacial phlegmon cases at the moment of hospitalization and after receiving surgical and pharmaceutical treatment. MATERIALS AND METHODS A total of 39 patients diagnosed with odontogenic cervicofacial phlegmons that were admitted to the Maxillofacial Surgery Department of the Emergency Hospital from Timisoara were included in the study. The main focus was the parameters represented by the systemic immune-inflammatory index (SII) based on neutrophil, platelet, and lymphocytes count; the neutrophil-lymphocyte ratio (NLR); C-reactive protein level (CRP); and white blood cell count (WBC) before and after the treatment as potential prognosis factors. RESULTS The results of the study after analyzing the included parameters revealed a significant difference between the calculated values of the SII, NLR, CRP, and WBC at admission and at time of discharge, being directly influenced by the treatment. CONCLUSIONS SII, NLR, CRP, and WBC dynamic changes in severe cervicofacial odontogenic infections can be influenced by receiving accurate surgical and pharmacological treatment, with the potential to become future severity prognosis indexes.
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Affiliation(s)
- Ciprian Ioan Roi
- Department of Anesthesiology and Oral Surgery, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
- Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
| | - Alexandra Roi
- Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
- Department of Oral Pathology, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
| | - Adrian Nicoară
- Department of Anesthesiology and Oral Surgery, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
| | - Diana Nica
- Department of Anesthesiology and Oral Surgery, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
| | - Laura Cristina Rusu
- Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
- Department of Oral Pathology, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
| | - Andrada Soancă
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Victor Babes Street, No. 15, 40012 Cluj-Napoca, Romania
| | - Alexandru Cătălin Motofelea
- Department of Internal Medicine, Faculty of Medicine, "Victor Babeș" University of Medicine and Pharmacy, 30041 Timișoara, Romania
| | - Mircea Riviș
- Department of Anesthesiology and Oral Surgery, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
- Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 30041 Timișoara, Romania
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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.
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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
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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.
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Affiliation(s)
- Ömer EKİCİ
- AFYONKARAHİSAR SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ, KLİNİK BİLİMLER BÖLÜMÜ, AĞIZ, DİŞ VE ÇENE CERRAHİSİ ANABİLİM DALI
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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
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Eshghpour M, Sabouri M, Labafchi A, Shooshtari Z, Samieirad S. Maxillofacial Infections: A 5-Year Assessment of the Epidemiology and Etiology in an Iranian Population. J Maxillofac Oral Surg 2021. [DOI: 10.1007/s12663-021-01569-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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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.
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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.)
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Cefazolin versus ampicillin/sulbactam as an empiric antibiosis in severe odontogenic neck infection descending from the lower jaw-retrospective analysis of 350 cases. Clin Oral Investig 2020; 25:563-570. [PMID: 32779014 DOI: 10.1007/s00784-020-03492-1] [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: 03/20/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Odontogenic infections descending from the lower jaw may lead to severe health conditions. Commonly, a biphasic treatment of surgical drainage and antibiotic therapy is conducted. The choice of the administered empiric antibiotic agent remains debatable. MATERIAL AND METHODS Retrospectively, we analyzed 350 medical records of patients who were consecutively treated with odontogenic infections descending from the lower jaw. All patients received surgical drainage and either cefazolin or ampicillin/sulbactam as empiric antibiosis. In particular, the number of secondary operations, infectious parameters, and length of in-hospital stay were investigated. RESULTS The most frequently infected space was the perimandibular/buccal space for both groups followed by the submandibular space. Number of revision procedures, early recurrence, and length of stay presented no significant difference between both groups (p > 0.05). Inflammatory parameters (c-reactive protein, leukocytes) similarly decreased in both groups. CONCLUSION Cefazolin targets the majority of the pathogens detected in severe odontogenic neck infections descending from the lower jaw and reveals comparable results to AMP/S in regard to the inflammatory parameters and in-hospital stay. CLINICAL RELEVANCE Cefazolin is a feasible empiric antibiosis for odontogenic neck infections descending from the lower jaw if surgical drainage is performed.
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Qu L, Xu H, Liang X, Cai X, Zhang W, Qian W. A Retrospective Cohort Study of Risk Factors for Descending Necrotizing Mediastinitis Caused by Multispace Infection in the Maxillofacial Region. J Oral Maxillofac Surg 2019; 78:386-393. [PMID: 31862339 DOI: 10.1016/j.joms.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Descending necrotizing mediastinitis (DNM) has been the most common life-threatening complication of multispace infection (MSI) in the maxillofacial region owing to the lack of a timely diagnosis and treatment. We assessed the clinical characteristics and diagnosis of odontogenic MSI and evaluated the risk factors for DNM caused by MSI. PATIENTS AND METHODS We performed a retrospective cohort study of inpatients with MSI in the maxillofacial region from January 2012 to October 2016. The patients were classified into a non-DNM group and a secondary DNM group. The information collected included gender, age, systemic comorbidities, source of maxillofacial infection, computed tomography imaging data, and laboratory test results. Univariate analysis (t test and χ2 test, or the Fisher exact test) and logistic regression analysis were applied. RESULTS A total of 296 patients were included. The mortality was 6.3%. On univariate analysis, the following factors were statistically significant: gender (P = .001); age (P = .003); source of infection (P = .004); number of affected spaces (P < .001); involvement of the parotid space (P < .001), submandibular space (P < .001), subgingival space (P < .001), pterygomandibular space (P < .001), parapharyngeal space (P < .001), and retropharyngeal space (P < .001); and percentage of neutrophils (P < .001). On multivariate analysis, the parapharyngeal space (P = .008), source of infection (P = .037), and number of affected spaces (P < .001) were statistically significant. CONCLUSIONS Glandular infection, parapharyngeal space involvement, and the presence of multiple affected spaces were risk factors for DNM. Clinicians should vigilantly watch for these factors during clinical treatment and effective measures taken to prevent the occurrence of DNM as soon as possible.
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Affiliation(s)
- Luyao Qu
- Resident, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine National Clinical Research Center for Oral Diseases and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China
| | - Hongyuan Xu
- Master, Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine National Clinical Research Center for Oral Diseases and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China
| | - Xiang Liang
- Attending Physician, Department of Oral Surgery, Renji Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xieyi Cai
- Professor, Department of Stomatology, Meitian Dental Clinic, Shanghai, People's Republic of China
| | - Weijie Zhang
- Professor, Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine and Shanghai Key Laboratory of Stomatology, Shanghai, People's Republic of China
| | - Wentao Qian
- Attending Physician, Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine National Clinical Research Center for Oral Diseases Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, People's Republic of China.
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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
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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.
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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
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Li CM, Xie CL, Hu S, Sun Q, Li GH, Niu ZX, Sun ML. [Clinical value of vacuum sealing drainage in the treatment of oral and maxillofacial space infection]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:62-65. [PMID: 30854821 DOI: 10.7518/hxkq.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aims to observe the efficacy of vacuum sealing drainage (VSD) by continuous negative pressure drainage and saline irrigation in the treatment of oral and maxillofacial space infection. METHODS Retrospective analysis was conducted on 116 cases of maxillofacial space infection, and clinical data were collected to compare the therapeutic effects of routine incision with drainage treatment (traditional treatment group, 58 cases) and VSD treatment (VSD group, 58 cases). RESULTS The length of hospital stay, white blood cell count, scar length, frequency of dressing change, and pain degree of patients in the VSD group were all lower than those in the traditional treatment group. Moreover, the improvement degree of mouth opening in the VSD groups was better than that in the traditional treatment group (P<0.05). CONCLUSIONS VSD is a more effective method for the treatment of oral and maxillofacial space infection.
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Affiliation(s)
- Chun-Mei Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Chen-Lu Xie
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China
| | - Shuang Hu
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Qiang Sun
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Guang-Hui Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhi-Xing Niu
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ming-Lei Sun
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Delbet-Dupas C, Devoize L, Depeyre A, Mulliez A, Barthélémy I, Pham Dang N. Are routine microbiological samplings in acute dental infections justified? Our 10-year real-life experience. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:397-401. [PMID: 30836194 DOI: 10.1016/j.jormas.2019.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/26/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE Most patients with severe odontogenic infections are successfully treated with large spectrum probabilistic antibioc therapy, drainage of the collections and tooth treatment or extraction and are discharged home before antibiotic sensitivity results were available. The investigators hypothesized whether bacteriological sampling should be systematically performed in the management of patients with severe odontogenic infections. 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. The predictor variable was the results of bacteriological sampling, culture and sensitivity. The outcome variable was antibiotic therapy adaptation according to antibiotic sensitivity results. RESULTS The sample was composed of 653 patients; 386 (59%) were male and 267 (41%) female, with a mean age of 37 years (range 18-88); 378 (58%) patients had been receiving oral antibiotics before admission to hospital, for a mean duration of 4.1 days (range 1 - 30). About 535 (81.9%) patients had swabs taken during surgery. Microorganisms were observed in 477 (89.1%) patients but in 377 (70.5%) they were polymorphic oropharyngeal flora. After culture, at least one antibiogram was obtained for 91 (17%) patients and the results led to antibiotic therapy being adapted in 23 (4.3%) patients. CONCLUSION The results suggest that bacteriological analysis had an impact on evolution in less than 5% of patients. Future studies will focus on the patients for whom the bacteriological analysis is essential.
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Affiliation(s)
- C Delbet-Dupas
- Department of oral and maxillofacial surgery, NHE, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France
| | - L Devoize
- UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, université d'Auvergne, Clermont-Ferrand, 63003, France; Department of odontology, CHU de Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, 63003, France
| | - A Depeyre
- Department of oral and maxillofacial surgery, NHE, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France
| | - A Mulliez
- Délégation recherche clinique and innovation, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France
| | - I Barthélémy
- Department of oral and maxillofacial surgery, NHE, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, université d'Auvergne, Clermont-Ferrand, 63003, France
| | - N Pham Dang
- Department of oral and maxillofacial surgery, NHE, CHU de Clermont-Ferrand, université d'Auvergne, Clermont-Ferrand, 63003, France; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, université d'Auvergne, Clermont-Ferrand, 63003, France.
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A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients. J Craniomaxillofac Surg 2019; 47:334-340. [DOI: 10.1016/j.jcms.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/18/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022] Open
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Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai. J Maxillofac Oral Surg 2018; 18:345-353. [PMID: 31371872 DOI: 10.1007/s12663-018-1152-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose The aim of this study is to comprehensively review and analyse pure odontogenic maxillofacial space infections in a tertiary care hospital in Navi Mumbai over a period of 5 years. Methods A retrospective analysis of 315 patients treated at Dr. D. Y. Patil Dental College and Hospital at Nerul, Navi Mumbai, from January 2007 to December 2011 was done. Multiple variables were analysed. Localised infections like dentoalveolar infections without space involvement and infection of non-odontogenic cause were excluded from the study. Results Analysis of the records was done. Majority of patients were from lower socioeconomic background and were daily wage workers who had either consulted a general physician or a general dental practitioner or had self-medicated themselves before presenting to us with acute symptoms. Early recognition and prompt treatment involving intravenous antibiotics with extraction of involved tooth/teeth and incision and drainage helped in resolution of infections in a span of 72 h. Medically compromised patients had longer duration of hospital stay as compared to the patients who had no underlying medical condition. Majority of space infections involved multiple spaces and local anaesthesia with sedation was found to be the satisfactory mode of anaesthesia. Complications were very few. Conclusion We concurred that any form of odontogenic maxillofacial space infection should be rendered prompt and aggressive treatment and hospitalisation should be recommended wherever required.
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Is there need for technical investigations in order to predict potential length of hospital stay of oral infections? Am J Emerg Med 2018; 37:231-236. [PMID: 29898830 DOI: 10.1016/j.ajem.2018.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/13/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Oral and maxillofacial infections are generally treated by primary dental or medical caregivers. Nevertheless, because these infections are known to have life-threatening complications, there is a need of clear indicators for emergency services medical staff, particularly in determining when morbidity can be expected and when in-hospital treatment is required. This retrospective study aimed to identify variables that were observable at admission, which could indicate high complication rates, long hospital stays, and/or a need for tracheostomy. MATERIALS AND METHODS We examined data from all cases of severe oral and maxillofacial infections that were treated at the University Hospital of Leuven, between January 2013 and June 2017. 64 cases were identified after applying exclusion criteria. Uni- and multivariate analyses were performed. RESULTS A univariate analysis showed that body temperature, C-reactive protein (CRP) levels, white blood cell counts, and positive bacterial cultures were significantly associated with longer hospital stays, which indicated potential future morbidity. A multivariate analysis showed that dyspnoea, age, and CRP comprised the most significant combination for predicting the length of hospital stay. CONCLUSION Based on the statistical analysis of this population, the research group concludes that a thorough anamnesis and clinical examination should be accompanied by a blood analysis of CRP and white blood cell counts. Only then can a well-founded decision be reached on the severity of the case and the need for hospital admission. In an acute setting, radiological imaging is not required for assessing future morbidity, but it should be performed when accessible.
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Holmes CJ, Pellecchia R. Antimicrobial Therapy in Management of Odontogenic Infections in General Dentistry. Dent Clin North Am 2017; 60:497-507. [PMID: 27040298 DOI: 10.1016/j.cden.2015.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article focuses on the diagnosis and management of odontogenic infections. Current antibiotic regimens are reviewed and discussed including use of alternative antibiotics with patients known to have a penicillin allergy. Emphasis is made on proper examination of the patient with use of diagnostic aids to provide the correct treatment of choice.
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Affiliation(s)
- Curtis J Holmes
- Department of Dentistry and Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, Brooklyn, NY, USA.
| | - Robert Pellecchia
- Department of Dentistry and Oral and Maxillofacial Surgery, Geisinger Medical Center, Danville, PA, USA
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Abstract
The purpose of this study was to review the clinical features of maxillofacial space infection (MSI), and to identify the potential risk factors predisposing to life-threatening complications. A retrospective review of the medical charts of patients with MSI treated at Peking University School and Hospital of Stomatology from August 2008 to September 2013 was conducted. A total of 127 patients [75 men (59.1%) and 52 women (40.9%); mean age, 45.39 ± 21.18 years, with a range of 1–85 years] formed the study cohort. The most common cause of MSI was odontogenic infection (57.5%). The most common space involved was the submandibular space. All patients were treated by antibiotics as well as surgical incision and drainage. Sixteen patients developed life-threatening complications, and the dominant complication was respiratory obstruction. Multivariate logistic regression analysis revealed the percentage of neutrophils (NEUT%) upon hospital admission ≥85.0% to be associated with life-threatening complications (P < 0.05). Even though adequate antibiotic therapy and incision and drainage of abscess were given, MSI patients with NEUT% upon hospital admission ≥85.0% carry a higher risk of life-threatening complications. In these patients, an aggressive treatment strategy is mandatory.
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Jagadish Chandra H, Sripathi Rao BH, Muhammed Manzoor AP, Arun AB. Characterization and Antibiotic Sensitivity Profile of Bacteria in Orofacial Abscesses of Odontogenic Origin. J Maxillofac Oral Surg 2016; 16:445-452. [PMID: 29038627 DOI: 10.1007/s12663-016-0966-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/16/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Odontogenic infections range from peripheral abscess to superficial and deep infections leading to severe infections in head and neck region. This study was aimed to assess bacterial isolates responsible for orofacial infection of odontogenic origin and their drug susceptibility patterns so as to provide better perceptive for the management of odontogenic infections. METHODS The study was made in a selected cohort of patients, irrespective of age and gender having moderate and severe orofacial infections of odontogenic origin admitted to Yenepoya University Hospital. Pus samples were collected and identification of bacteria was performed by 16S rRNA gene sequencing. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. RESULT A total of 37 study subjects were included, with bacterial isolation rate of 31 (83.7 %). The mean age presented of all patients was 40.62. Of all, 24 (64.9 %) were males. Staphylococcus aureus, Enterobacter claocae subsp. dissolvens, Klebsiella quasipneumoniae subsp. similipneumoniae, Staphylococcus aureus subsp. anaerobius and Klebsiella pneumoniae subsp. ozaenae were the most prevalent isolates. Result showed that 58.6 % of the isolates were resistant to gentamicin, 52.5 % for ampicillin, 51.3 % for piperacillin; least resistant being 18.9 % for azithromycin. CONCLUSION High prevalence of bacterial isolates was found, Staphylococcus aureus being the dominant. Most of the bacteria were resistant to different classes of antibiotics. Appropriate antibiotics should be given based on the bacterial isolates, culture sensitivity and clinical course of the disease.
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Affiliation(s)
- H Jagadish Chandra
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Yenepoya University, Deralakatte, Mangalore, 575018 India
| | - B H Sripathi Rao
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Yenepoya University, Deralakatte, Mangalore, 575018 India
| | - A P Muhammed Manzoor
- Yenepoya Research Centre, Yenepoya University, Deralakatte, Mangalore, 575018 India
| | - A B Arun
- Yenepoya Research Centre, Yenepoya University, Deralakatte, Mangalore, 575018 India
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Zirk M, Buller J, Goeddertz P, Rothamel D, Dreiseidler T, Zöller JE, Kreppel M. Empiric systemic antibiotics for hospitalized patients with severe odontogenic infections. J Craniomaxillofac Surg 2016; 44:1081-8. [PMID: 27369813 DOI: 10.1016/j.jcms.2016.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/16/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Odontogenic infections may lead to severe head and neck infections with potentially great health risk. Age, location of purulent affected sites and beta-lactam allergy are some mentionable factors regarding patients' in-hospital stay and course of disease. Are there new challenges regarding bacteria' antibiotic resistance for empiric treatment and what influences do they have on patients' clinical course? METHODS We analyzed in a 4-year retrospective study the medical records of 294 in-hospital patients with severe odontogenic infections. On a routine base bacteria were identified and susceptibility testing was performed. Length of stay in-hospital was evaluated regarding patients' age, beta-lactam allergy profile, affected sites and bacteria susceptibility to empiric antibiotics. RESULTS Length of stay in-hospital was detected to be associated with affected space and penicillin allergy as well (p < 0.05). Isolates presented large amounts of aerobic gram-positive bacteria (64.2%), followed by facultative anaerobic bacteria (gram+/15.8%, gram-/12.7%). Tested ampicillin in combination with sulbactam (or without) and cephalosporins displayed high susceptibility rates, revealing distinguished results regarding clindamycin (p < 0.05). Co-trimoxazol and moxifloxacin showed high overall susceptibility rates (MOX: 94.7%, COTRIM: 92.6%). DISCUSSION This study demonstrates ampicillin/sulbactam in addition to surgical intervention is a good standard in treatment of severe odontogenic neck infections. Cephalosporins seem to be a considerable option as well. If beta-lactam allergy is diagnosed co-trimoxazol and moxifloxacin represent relevant alternatives. CONCLUSION Age, allergic profile and bacteria' resistance patterns for empiric antibiotics have an influence on patients in-hospital stay. Ampicillin/sulbactam proves itself to be good for empiric antibiosis in severe odontogenic infections. Furthermore cephalosporins could be considered as another option in treatment. However moxifloxacin and co-trimoxazol deserves further investigation as empiric antibiosis in odontogenic infections if beta-lactam allergy is diagnosed.
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Affiliation(s)
- Matthias Zirk
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany.
| | - Johannes Buller
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Peter Goeddertz
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Daniel Rothamel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Timo Dreiseidler
- Dreifaltigkeits-Krankenhaus Wesseling, University Teaching Hospital, Germany
| | - Joachim E Zöller
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery (Head: Prof. Dr. Dr. Joachim E. Zöller), University of Cologne, Germany
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Comparison of multi-space infections of the head and neck in the elderly and non-elderly people, part II: the influencing factors of the outcomes. J Craniofac Surg 2015; 26:581-4. [PMID: 25692892 DOI: 10.1097/scs.0000000000001465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aims to identify significant predictors of 3 outcomes in the aged patients and non-elderly with multi-space infections of the head and neck: the number of incisions, the length of hospital stay, and complications. PATIENTS AND METHODS A retrospective study was conducted on 242 patients receiving treatment for severe multi-space infections of the head and neck region. Study variables were categorized as demographics, clinical parameters, and laboratory values. The outcome variables were the number of incisions, length of hospital stay, and complications. Multivariate linear and logistic regression techniques were used to measure associations between study variables and the outcome variables. Statistical analyses of the results between groups were performed using the Student t test and χ. RESULTS Multivariate analyses, controlling for confounding variables, indicated that the number of spaces affected was a predictor of the number of incisions and complications in the elderly group. In the non-elderly group, the number of spaces affected was a predictor of the number of incisions and length of hospital stay. Admission blood glucose level and admission white blood cell count were the predictors of complications in the non-elderly. CONCLUSION This study identifies different study variables as predictors of outcomes in treating multi-space infections of the head and neck in the elderly and non-elderly group. The number of spaces affected is the most important predictor.
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Rastenienė R, Pūrienė A, Aleksejūnienė J, Pečiulienė V, Zaleckas L. Odontogenic Maxillofacial Infections: A Ten-Year Retrospective Analysis. Surg Infect (Larchmt) 2015; 16:305-12. [DOI: 10.1089/sur.2013.264] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Rūta Rastenienė
- Institute of Odontology, Faculty of Medicine Vilnius University, Vilnius, Lithuania
| | - Alina Pūrienė
- Institute of Odontology, Faculty of Medicine Vilnius University, Vilnius, Lithuania
| | - Jolanta Aleksejūnienė
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vytautė Pečiulienė
- Institute of Odontology, Faculty of Medicine Vilnius University, Vilnius, Lithuania
| | - Linas Zaleckas
- Institute of Odontology, Faculty of Medicine Vilnius University, Vilnius, Lithuania
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Mahmoodi B, Weusmann J, Azaripour A, Braun B, Walter C, Willershausen B. Odontogenic Infections: A 1-year Retrospective Study. J Contemp Dent Pract 2015; 16:253-8. [PMID: 26067725 DOI: 10.5005/jp-journals-10024-1671] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze the prevalence, demographic patterns and management of odontogenic infections in patients undergoing treatment in an outpatient dental emergency service of a university hospital. MATERIALS AND METHODS In a retrospective study of the year 2012, all patients suffering from odontogenic infections were included. Demographic data, diagnosis and the conducted treatment were analyzed. Odontogenic infections were defined as pulpitis, apical and marginal periodontitis, abscesses and pericoronitis. RESULTS A total of 2,058 out of 4,209 emergency patients suffered from odontogenic infections. The majority (45.0%) had an apical periodontitis, 20.8% abscesses, 17.3% a marginal periodontitis, 16.3% a pulpitis and 5.8% a pericoronitis. Mean age was 37.5 ± 17.0 years standard deviation (SD) (1.2-96.4). Most patients were 20 to 29 years (24.6%), followed by the age group of 30 to 39 year old patients (21.0%). Males were affected more frequently (55.5%) than females (45.5%). Most of the patients (64.5%) of the patients received a dental or surgical treatment. Antibiotics were prescribed in 31.7% of cases. Amoxicillin was the most common prescribed antibiotic (54.5%). CONCLUSION Odontogenic infections represent one of the main reasons for consulting the emergency service. Due to the high number of cases and the severe complications, dentists have to be familiar with the surgical management of odontogenic infections as well as the appropriate use of antibiotics. CLINICAL SIGNIFICANCE Nearly half of all patients who sought, treatment in the emergency service had an odontogenic infectious disease. This should be considered for the organization and planning of the service.
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Affiliation(s)
- Benjamin Mahmoodi
- Assistant Professor, Department of Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz Augustusplatz 2, 55131 Mainz, Germany, e-mail: benjamin.
| | - Jens Weusmann
- Department of Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz Augustusplatz, Mainz, Germany
| | - Adriano Azaripour
- Department of Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz Augustusplatz, Mainz, Germany
| | - Benedikt Braun
- Department of Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz Augustusplatz, Mainz, Germany
| | - Christian Walter
- Department of Oral and Maxillofacial and Facial Plastic Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Augustusplatz, Mainz, Germany
| | - Brita Willershausen
- Department of Operative Dentistry, University Medical Center of the Johannes Gutenberg-University Mainz Augustusplatz, Mainz, Germany
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Igoumenakis D, Giannakopoulos NN, Parara E, Mourouzis C, Rallis G. Effect of Causative Tooth Extraction on Clinical and Biological Parameters of Odontogenic Infection: A Prospective Clinical Trial. J Oral Maxillofac Surg 2015; 73:1254-8. [PMID: 25971920 DOI: 10.1016/j.joms.2015.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/19/2015] [Accepted: 02/09/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To prospectively compare changes of body temperature, white blood cell count, fibrinogen, and C-reactive protein between odontogenic infections in which the responsible tooth was removed and odontogenic infections in which the treatment included no extraction. MATERIALS AND METHODS The sample was composed of patients admitted to the authors' maxillofacial unit for odontogenic infection from 2010 through 2013. One hundred seventy-nine patients were categorized into an extraction or a non-extraction group based on whether the causative tooth was non-restorable or restorable, respectively. Non-restorable teeth were extracted at admission of the patient. Otherwise, the treatment protocol, including incision of the involved space in conjunction with intravenous antibiotics, was the same for the 2 groups. The parameters were measured and recorded at admission and 2 days later. Data records were statistically analyzed by comparing the change of the parameters studied between the extraction and non-extraction groups. P values less than .05 were regarded as statistically significant. RESULTS One hundred seventy-nine patients fulfilled the inclusion criteria and were enrolled in the study. The mean age of the patients was 39.1 years (minimum, 14 yr; maximum, 81 yr; standard deviation, 15.4 yr). One hundred nine patients (60.9%) were male, and 70 (39.1%) were female. Differences in the mean decrease of axillary temperature, white blood cell count, fibrinogven, and C-reactive protein between the 2 groups were 0.178, 2,300, 1.01, and 0.64, respectively. All these differences were statistically significant (P =.02, .001, .001, and .001, respectively). Also, the mean hospital stay in the extraction group was 1.05 days shorter than in the non-extraction group, with the difference being statistically significant (P = .006). CONCLUSIONS In odontogenic maxillofacial infections, extraction of the causative tooth is associated with a faster clinical and biological resolution of the infection.
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Affiliation(s)
- Dimosthenis Igoumenakis
- Registrar, Department of Oral and Maxillofacial Surgery, General Hospital of Attica "KAT," Athens, Greece.
| | | | - Eleni Parara
- Consultant, Department of Oral and Maxillofacial Surgery, General Hospital of Attica "KAT," Athens, Greece
| | - Constantinos Mourouzis
- Consultant, Department of Oral and Maxillofacial Surgery, General Hospital of Attica "KAT," Athens, Greece
| | - George Rallis
- Director and Head, Department of Oral and Maxillofacial Surgery, General Hospital of Attica "KAT," Athens, Greece
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Rastenienė R, Aleksejūnienė J, Pūrienė A. Determinants of length of hospitalization due to acute odontogenic maxillofacial infections: a 2009-2013 retrospective analysis. Med Princ Pract 2015; 24:129-35. [PMID: 25592626 PMCID: PMC5588211 DOI: 10.1159/000370073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/24/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the determinants of the length of hospitalization (LOH) due to acute odontogenic maxillofacial infections (AOMIs) from 2009 to 2013. MATERIALS AND METHODS Dental records of adult patients with AOMIs and related data were retrieved from the Vilnius University's dental hospital. The LOH was related to several determinants in each of the following domains: outpatient primary care, severity of AOMIs, lifestyle and disease domains. Determinants were also associated with the LOH using multivariate analysis. RESULTS A total of 285 patients were hospitalized with AOMIs, of which 166 (58.2%) were males and 119 (41.8%) were females. The mean LOH was 8.3 ± 4.9 days. The bivariate analysis did not reveal any statistically significant differences in LOH between patients with AOMIs who received urgent outpatient primary care and those who did not receive such care prior to hospitalization. All AOMI severity-related determinants were associated with the LOH. The LOH was related to coexisting systemic conditions but not to the higher severity of dental or periodontal diseases. Both bivariate and multivariate analyses revealed similar trends, where the most significant determinants of a longer LOH were related to the severity of AOMIs. CONCLUSION The most important determinants regarding longer hospitalization were indicators of infection severity such as an extension of the odontogenic infection and the need for an extraoral incision to drain the infection.
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Affiliation(s)
- Rūta Rastenienė
- Institute of Odontology, Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
- * Rūta Rastenienė, Institute of Odontology, Faculty of Medicine, University of Vilnius, Žalgirio 115, LT-08217 Vilnius (Lithuania), E-Mail
| | - Jolanta Aleksejūnienė
- Division of Preventive and Community Dentistry, Faculty of Dentistry, University of British Columbia, Vancouver, B.C., Canada
| | - Alina Pūrienė
- Institute of Odontology, Faculty of Medicine, University of Vilnius, Vilnius, Lithuania
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The value of early intraoral incisions in patients with perimandibular odontogenic maxillofacial abscesses. J Craniomaxillofac Surg 2014; 43:220-3. [PMID: 25523398 DOI: 10.1016/j.jcms.2014.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 11/21/2022] Open
Abstract
Perimandibular abscesses require drainage and removal of the underlying cause of infection. Traditionally drainage was established extraorally, but this can be associated with delay to treatment, because this is done under general anaesthesia. Between July 2008 and June 2013, 205 patients were initially either treated by immediate intraoral incision under local anaesthesia or extraoral incisions under general anaesthesia and prospectively evaluated. Predictors of treatment outcomes and complications were analysed. Fewer secondary procedures were needed for patients with primary treatment under general anaesthesia (p < 0.0001), but the overall stay in hospital was shorter after initial treatment under local anaesthesia (p < 0.0001, Odds Ratio (OR) 0.72, 95% CI 0.62-0.85). Postoperative complications occurred significantly more often under general anaesthesia (p < 0.0001, OR = 16.63, 95% CI 5.59-49.5). Significant prognostic variable was the administration of amoxicillin combined with clavulanic acid (p = 0.016, OR = 1.24, 95% CI 1.09-1.41) and adverse prognostic factors were infections with Human Immunodeficiency Virus (HIV) (p = 0.048, OR 17.45, 95% CI 1.02-298) or diabetes mellitus (p = 0.003, OR 10.39, 95% CI 2.23-48.41). Amoxicillin combined with clavulanic acid showed a significant impact on the treatment course of patients with perimandibular abscesses.
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Cachovan G, Blessmann M, Schön G, Rother U, Heiland M, Stürenburg E, Platzer U, Sobottka I. Radiography-based score indicative for the pathogenicity of bacteria in odontogenic infections. Acta Odontol Scand 2014; 72:530-6. [PMID: 24444257 DOI: 10.3109/00016357.2013.876553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To develop a new radiography-based score to assess the potential of bacteria to cause odontogenic infections derived from the occurrence of bacteria at small or large radiographical lesions. MATERIALS AND METHODS The patients analyzed were a sub-population from a large randomized clinical trial comparing moxifloxacin and clindamycin in the treatment of inflammatory infiltrates and odontogenic abscesses. Routine radiographs were used to analyze the area of the periapical radiolucent lesions. Lesions were stratified by their radiographically measured area as large (>9 mm(2)) or small (≤9 mm(2)). A risk ratio was calculated for each species from the frequency of their occurrence in large vs in small lesions. RESULTS Fifty-one patients, 19 with abscesses and 32 with infiltrates, were evaluated. Overall, the radiographical lesion areas ranged from 0.4-46.2 mm(2) (median = 9 mm(2)). An increased risk (risk ratio >1) to occur at large abscess lesions was observed for Prevotella (P.) oralis, P. buccae, P. oris, P. intermedia, Fusobacterium nucleatum and Streptococcus (Strep.) anginosus group. An increased risk to occur at large infiltrate lesions was found for Strep. salivarius, Strep. parasanguis, Strep. anginosus group, Capnocytophaga spp., Neisseria (N.) sicca, Neisseria spp., Staphylococcus (Staph.) aureus, P. intermedia, P. buccae, Prevotella spp. and P. melaninogenica. CONCLUSIONS The radiography-based score suggests that certain Prevotella spp., F. nucleatum and Strep. anginosus groups play a crucial role in the pathogenesis of odontogenic abscesses, and that various streptococci, Neisseria spp., Capnocytophaga spp., Staph. aureus and Prevotella spp. are involved in the pathogenesis of odontogenic infiltrates.
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Affiliation(s)
- Georg Cachovan
- Center for Oral and Dental Medicine, Department of Restorative and Preventive Dentistry
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Mª de Los Ángeles F, R. PG, Marcelo Mardones M, Rodrigo Bravo A. Complicaciones severas de infecciones odontogénicas. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70066-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Presentation and management of facial swellings of odontogenic origin in children. Eur Arch Paediatr Dent 2014; 15:259-68. [DOI: 10.1007/s40368-014-0110-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
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Igoumenakis D, Gkinis G, Kostakis G, Mezitis M, Rallis G. Severe Odontogenic Infections: Causes of Spread and Their Management. Surg Infect (Larchmt) 2014; 15:64-8. [DOI: 10.1089/sur.2012.178] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dimosthenis Igoumenakis
- Department of Oral and Maxillofacial Surgery, General Hospital of Attika “KAT,” Athens, Greece
| | - George Gkinis
- Department of Oral and Maxillofacial Surgery, General Hospital of Attika “KAT,” Athens, Greece
| | - George Kostakis
- Department of Oral and Maxillofacial Surgery, General Hospital of Attika “KAT,” Athens, Greece
| | - Michael Mezitis
- Department of Oral and Maxillofacial Surgery, General Hospital of Attika “KAT,” Athens, Greece
| | - George Rallis
- Department of Oral and Maxillofacial Surgery, General Hospital of Attika “KAT,” Athens, Greece
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Zheng L, Yang C, Zhang W, Cai X, Jiang B, Wang B, Pu Y, Jin J, Kim E, Wang J, Zhang Z, Zhou L, Zhou J, Guan X. Comparison of multi-space infections of the head and neck in the elderly and non-elderly: Part I the descriptive data. J Craniomaxillofac Surg 2013; 41:e208-12. [DOI: 10.1016/j.jcms.2013.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 10/29/2012] [Accepted: 01/09/2013] [Indexed: 11/26/2022] Open
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Cachovan G, Phark JH, Schön G, Pohlenz P, Platzer U. Odontogenic infections: an 8-year epidemiologic analysis in a dental emergency outpatient care unit. Acta Odontol Scand 2013; 71:518-24. [PMID: 22816380 DOI: 10.3109/00016357.2012.696694] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of this investigation was to analyze epidemiological patterns, clinical features and the management of odontogenic infections in patients undergoing treatment in a dental emergency outpatient care unit. STUDY DESIGN A retrospective analysis of 58 161 case records of patients presenting to an emergency outpatient unit in Hamburg, Germany between 2000-2007 was performed. From this pool, patients with odontogenic infections were identified using an ICD-10 code, analyzing age, gender, medical co-morbidities, duration of pain, ratio of infiltrates/abscesses, affected teeth, management of infection and administered antibiotics. RESULTS Of the 58 161 patients, 5357 (9.2%) were identified as having odontogenic infections, with 2689 (50.2%) inflammatory infiltrates and 2668 (49.8%) abscesses. Mean age was 34.8 ± 16.8 years. As the primary site of odontogenic infection, the most significantly affected teeth were the maxillary and mandibular first molars. Patients in age-group 20-29 years (25.1%) utilized the emergency care unit more frequently than other age groups. Clindamycin was the most frequently administered antibiotic. CONCLUSIONS Early recognition, diagnosis and management of odontogenic infections are requisite for avoiding or minimizing the development of potential complications. Strategies and evidence-based protocols should be developed within the dental ambulatory care sector, advancing interdisciplinary cooperation between general dentists and oral or maxillofacial surgeons.
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Affiliation(s)
- Georg Cachovan
- Center for Oral and Dental Medicine, Department of Restorative and Preventive Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bouloux GF, Wallace J, Xue W. Irrigating drains for severe odontogenic infections do not improve outcome. J Oral Maxillofac Surg 2012; 71:42-6. [PMID: 22726703 DOI: 10.1016/j.joms.2012.04.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/21/2012] [Accepted: 04/27/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The need to irrigate surgical drains in the postoperative period in patients with odontogenic infections is controversial. The purpose of this study was to evaluate the efficacy of irrigating surgical drains postoperatively in patients with severe odontogenic infections. MATERIALS AND METHODS Consecutive patients presenting with severe odontogenic infections who required incision and drainage were randomized to irrigating drains (red rubber catheters) or nonirrigating drains (Penrose drains). The primary predictor variable was the type of drain and the use of postoperative irrigation. The primary outcome variable was length of stay. Secondary outcomes included postoperative temperature, need for additional procedures, and complications. The t test was used for the primary outcome, and a P value lower than .05 was considered statistically significant. RESULTS Forty-six patients completed the study. There was no statistically significant difference in overall length of stay, length of stay after surgery, temperature, or need for additional procedures between the 2 treatment groups. CONCLUSIONS The use of nonirrigating drains appears to be equally efficacious as irrigating drains in the management of severe odontogenic infection.
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Affiliation(s)
- Gary F Bouloux
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA 30322, USA.
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The role of unfinished root canal treatment in odontogenic maxillofacial infections requiring hospital care. Clin Oral Investig 2012; 17:113-21. [DOI: 10.1007/s00784-012-0710-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 03/04/2012] [Indexed: 12/23/2022]
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Mathew GC, Ranganathan LK, Gandhi S, Jacob ME, Singh I, Solanki M, Bither S. Odontogenic maxillofacial space infections at a tertiary care center in North India: a five-year retrospective study. Int J Infect Dis 2012; 16:e296-302. [PMID: 22365137 DOI: 10.1016/j.ijid.2011.12.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 12/05/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Odontogenic infections contribute to a significant proportion of maxillofacial space infections (MSI) across the world. MSI can cause several life-threatening complications despite skillful management. The objective of this study was to review the clinical characteristics, management, and outcome of odontogenic MSI treated at a tertiary care center, and to identify the factors predisposing to life-threatening complications. METHODS A retrospective chart review of all patients treated for MSI from January 2006 to December 2010 at the Christian Medical College Hospital in Ludhiana, North India, was conducted. RESULTS Out of 137 patients identified, 66.4% were men. Mean patient age was 40 years, and 24.1% of the patients were diabetic. The most common origin was pulpal (70.8%), the most common space involved was the submandibular space, and the most common teeth responsible were the lower third molars. Twenty patients (14.6%) developed complications. Diabetes, multiple space involvement, and a total leukocyte count of ≥15×10(9)/l were associated with complications. CONCLUSIONS Patients with MSI who present with multiple space involvement, a high leukocyte count, and those with diabetes are at higher risk of developing life-threatening complications and need to be closely monitored.
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Affiliation(s)
- George C Mathew
- Department of Oral and Maxillofacial Surgery, Christian Dental College, Ludhiana, Punjab, India
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Boffano P, Roccia F, Pittoni D, Di Dio D, Forni P, Gallesio C. Management of 112 hospitalized patients with spreading odontogenic infections: correlation with DMFT and oral health impact profile 14 indexes. Oral Surg Oral Med Oral Pathol Oral Radiol 2011; 113:207-13. [PMID: 22677738 DOI: 10.1016/j.tripleo.2011.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 02/04/2011] [Accepted: 02/08/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to report our experience in treating patients affected by spreading odontogenic infections and to discuss their management and outcome. STUDY DESIGN Demographic and clinical information was collected from hospitalized patient records. Decayed, missing, and filled teeth (DMFT) index was calculated for 45 randomly selected patients. Statistical analysis was used to search for associations among multiple variables. RESULTS Statistical analysis of the variance by univariate test found significant associations between a longer hospital stay and patients >30 years old (P < .05) and patients with the presenting symptoms of dysphagia and/or dyspnea (P < .05). Statistical analysis using Fisher exact test found significant associations between patients with a DMFT index >10 and female patients (P < .05), patients >30 years old (P < .005), and a hospital stay >4 days (P < .0005). CONCLUSIONS Rapid resolution of the infection was appreciated when removal of the cause, drainage of the infection, and intravenous antibiotics were performed.
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Affiliation(s)
- Paolo Boffano
- Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
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Comparison of maxillofacial space infection in diabetic and nondiabetic patients. ACTA ACUST UNITED AC 2010; 110:e7-12. [PMID: 20656528 DOI: 10.1016/j.tripleo.2010.04.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 03/15/2010] [Accepted: 04/08/2010] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Orofacial space infections are common presentations in maxillofacial clinics even in the post-antibiotic era. One of the main factors determining the spread of infection is the host defense mechanism. Diabetes is one of the most common systemic illness suppressing the immunity of an individual and increasing their susceptibility to infections. This study was carried out to compare the spaces involved, the severity of infection, the virulent organism, the efficacy of empirical antibiotics, the length of hospital stay, and the complications encountered in the management of maxillofacial space infection of odontogenic origin in diabetic patients as compared with nondiabetic patients. METHODOLOGY A 4-year prospective study was carried out on patients with maxillofacial space infection of odontogenic origin. The patients were divided into 2 groups on the basis of presence or absence of diabetes. RESULTS A total of 111 patients were identified out of which 31 were diabetic. The organisms commonly isolated were Streptococcus species with submandibular space being the most common space involved in both the groups. The empirical antibiotic used was amoxicillin plus clavulanic acid combined with metrogyl in 70.27% cases. CONCLUSION Streptococcus species is still the most common causative pathogen irrespective of the diabetic status of the patient. The same empirical antibiotic therapy of amoxicillin plus clavulanic acid combined with metrogyl along with hyperglycemia control and surgical drainage of infection yielded satisfactory resolution of infection in the diabetic patients as well.
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