Cervical cellulitis with mediastinitis from an odontogenic infection complicated by diabetes mellitus: report of a case

Complications of Severe Odontogenic Infections: A Review

Severe odontogenic infections are routinely treated with little associated morbidity and mortality. Improvements in surgical techniques, antibiotic treatments, and imaging modalities have made associated complications exceedingly rare. A number of complications have been described in the literature including airway obstruction, descending necrotizing mediastinitis, orbital abscess, septic cavernous sinus thrombosis, cerebral abscess, sepsis, necrotizing fasciitis, and Lemierre's syndrome. The purpose of this article is to discuss the pathophysiology of severe odontogenic infections and the risk factors associated with the development of complications. Given the morbidity and mortality of these conditions, it is important to review the clinical features of each and the diagnostic tools that aid in early recognition.

The Sepsis Syndrome in Odontogenic Infection

Odontogenic infection is a common cause of sepsis in the head and neck. Infection frequently spreads in a predictable pattern within the fascial spaces of the neck and can result in airway compromise. Often the condition results in significant morbidity and a prolonged hospital stay. In this study, we assessed the incidence of sepsis syndrome in patients presenting to a regional maxillofacial unit with odontogenic infection. Six months of prospective data were collected, with sixty-seven patients included. The focus of infection was mandibular in 70.1% and maxillary in 29.9%. The mean length of stay was four days and 61.2% of patients were diagnosed with sepsis syndrome on admission. This group remained in hospital significantly longer than non-sepsis syndrome patients (sepsis=4.7 days, non-sepsis=2.9 days. p=0.0145.) The site of infection was not a significant factor in the development of the systemic inflammatory response syndrome (SIRS).

Risk factors for oral postoperative infection in patients with diabetes

The prevalence of diabetes mellitus in the general population has been increasing sharply. Currently, much is feared but little is known about postoperative complications of oral surgery among persons with diabetes. Existing dental education and practice guidelines cite excess infectious risk among patients with diabetes; however, empiric evidence to support such concerns is lacking. In fact, dentists commonly prescribe antibiotics when dental surgical procedures involve bone. This practice may contribute to the rising problem of microbial resistance and may increase overall healthcare costs. The growing number of dental patients with diabetes warrants strengthening the evidence base to guide their dental care and prevent possible morbid complications.

A five-year retrospective study of odontogenic maxillofacial infections in a large urban public hospital

The aim of this study was to analyze the etiology, presentation, management and outcome of odontogenic maxillofacial infections seen in an urban population that has only one major public hospital, which is also the only level I trauma center. All patients admitted to the Oral and Maxillofacial Surgery Service of San Francisco General Hospital with odontogenic infections over a 5-year period were included. Age, gender, site of infection, investigations performed, treatment carried out and outcomes were studied. Length of hospital stay and any readmissions were also noted. A total of 250 patients were admitted with maxillofacial infections, and in 157 cases the infection was odontogenic in origin. Males outnumbered females (102:55). Children had a preponderance of maxillary buccal infections whilst adults had more mandibular infections. Hospital stays ranged from 1 to 23 days, and only one patient required re-admission. A wide range of antibiotics were prescribed and 122 patients required dental extractions. Odontogenic maxillofacial infections are a public and personal health issue with potential life-threatening complications. This study identifies potential risk factors and suggests that early dental extraction, incision and drainage, coupled with intravenous antibiotic therapy, is the most effective treatment. Antibiotic therapy can be empirical since in no case where cultures were performed did this alter the antibiotic management.