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Pucci R, Cassoni A, Di Carlo D, Bartolucci P, Della Monaca M, Barbera G, Di Cosola M, Polimeni A, Valentini V. Odontogenic-Related Head and Neck Infections: From Abscess to Mediastinitis: Our Experience, Limits, and Perspectives-A 5-Year Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3469. [PMID: 36834169 PMCID: PMC9965740 DOI: 10.3390/ijerph20043469] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Head and neck infections are commonly caused by affections with an odontogenic origin. Untreated or non-responsive to treatment odontogenic infections can cause severe consequences such as localized abscesses, deep neck infections (DNI), and mediastinitis, conditions where emergency procedures such as tracheostomy or cervicotomy could be needed. METHODS An epidemiological retrospective observational study was performed, and the objective of the investigation was to present a single-center 5-years retrospective analysis of all patients admitted to the emergency department of the hospital Policlinico Umberto I "Sapienza" with a diagnosis of odontogenic related head and neck infection, observing the epidemiological patterns, the management and the type of surgical procedure adopted to treat the affections. RESULTS Over a 5-year period, 376,940 patients entered the emergency room of Policlinico Umberto I, "Sapienza" University of Rome, for a total of 63,632 hospitalizations. A total of 6607 patients were registered with a diagnosis of odontogenic abscess (10.38%), 151 of the patients were hospitalized, 116 of them were surgically treated (76.8%), and 6 of them (3.9%) manifested critical conditions such as sepsis and mediastinitis. CONCLUSIONS Even today, despite the improvement of dental health education, dental affections can certainly lead to acute conditions, necessitating immediate surgical intervention.
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Affiliation(s)
- Resi Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Andrea Cassoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Daniele Di Carlo
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Piero Bartolucci
- Surgical Sciences and Emergency Department, AOU Policlinico Umberto I Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marco Della Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giorgio Barbera
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Michele Di Cosola
- Department of Clinical and Experimental Medicine, Università Degli Studi di Foggia, 71122 Foggia, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Valentino Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
- Oncological and Reconstructive Maxillo-Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
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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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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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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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Li H, Luo W, Feng A, Tang ML, Kensler TB, Maldonado E, Gonzalez OA, Kessler MJ, Dechow PC, Ebersole JL, Wang Q. Odontogenic abscesses in rhesus macaques (Macaca mulatta) of Cayo Santiago. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 167:441-457. [PMID: 30129143 PMCID: PMC6764092 DOI: 10.1002/ajpa.23641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Odontogenic abscesses are one of the most common dental diseases causing maxillofacial skeletal lesions. They affect the individual's ability to maintain the dental structures necessary to obtain adequate nutrition for survival and reproduction. In this study, the prevalence and pattern of odontogenic abscesses in relation to age, sex, matriline, and living periods were investigated in adult rhesus macaque skeletons of the free-ranging colony on Cayo Santiago, Puerto Rico. MATERIALS AND METHODS The skulls used for this study were from the skeletons of 752 adult rhesus macaques, aged 8-31 years, and born between 1951 and 2000. They came from 66 matrilines ranging from 1 to 88 individuals. Fistulae or skeletal lesions caused by odontogenic abscesses drainage, carious lesions, tooth fractures, tooth loss, and alveolar resorption were evaluated visually. RESULTS Seventy-two specimens (9.57%) had odontogenic abscesses of varying severity. Males had a significantly higher prevalence than females. The prevalence of odontogenic abscesses in several matrilines was significantly higher than in the population as a whole. Animals born between 1950 and 1965 tended to have a higher prevalence of odontogenic abscesses than those born in later periods. DISCUSSION These results suggest that oral pathologies, such as dental and periodontal abscesses in rhesus macaques are fairly common, which may indicate familial effects interwoven with ecological and social factors. The closeness of the rhesus and human genomes allows insights to understand of the epidemiology of these diseases in the human population. Further assessment of the role played by environmental and familial factors on rhesus oral health and disease are warranted.
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Affiliation(s)
- Hong Li
- Department of Endodontics, School of Stomatology, Capital Medical University, Beijing 100050, P.R. China
| | - Wenjing Luo
- Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, Texas
| | - Anna Feng
- Pre-dental Scholars Program, Marquette University, Milwaukee, Wisconsin
| | - Michelle L. Tang
- Department of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia
| | - Terry B. Kensler
- Caribbean Primate Research Center, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Elizabeth Maldonado
- Caribbean Primate Research Center, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Octavio A. Gonzalez
- Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky
| | - Matthew J. Kessler
- Office of Laboratory Animal Resources, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| | - Paul C. Dechow
- Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, Texas
| | | | - Qian Wang
- Department of Biomedical Sciences, Texas A&M University Baylor College of Dentistry, Dallas, Texas
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Connors WJ, Rabie HH, Figueiredo RL, Holton DL, Parkins MD. Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications. BMC Infect Dis 2017; 17:202. [PMID: 28279155 PMCID: PMC5345191 DOI: 10.1186/s12879-017-2303-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 03/04/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center. METHODS All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care. RESULTS Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization. CONCLUSIONS ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.
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Affiliation(s)
- William J. Connors
- Department of Medicine, University of Calgary, Foothills Medical Centre, 1403, 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB T2N 2T9 Canada
- Division of Infectious Diseases, Department of Medicine, Clinical Lecturer - University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB T2N 2T9 Canada
| | - Heidi H. Rabie
- Dental Public Health Clinics, Alberta Health Services, Chumir Dental Clinic, 6th Floor, 1213 4th Street SW, Calgary, AB T2R 0X7 Canada
| | - Rafael L. Figueiredo
- Population, Public and Aboriginal Health, Alberta Health Services, Coronation Plaza 104, 14310 – 111 Avenue, Edmonton, AB T5M 3Z7 Canada
| | - Donna L. Holton
- Department of Medicine, University of Calgary, Foothills Medical Centre, 1403, 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB T2N 2T9 Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Michael D. Parkins
- Department of Medicine, University of Calgary, Foothills Medical Centre, 1403, 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB T2N 2T9 Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
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Gobbo M, Ottaviani G, Rupel K, Zoi V, Vettori E, Chermetz M, Biasotto M. Le infezioni odontogene: diagnosi, evoluzione e complicanze. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)70270-9] [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]
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