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Longchamp G, Ferrari R, Essig H. Predictors of length of stay following maxillofacial abscess surgery: A 10-year retrospective cohort. J Craniomaxillofac Surg 2024; 52:931-936. [PMID: 38876956 DOI: 10.1016/j.jcms.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/23/2024] [Accepted: 05/26/2024] [Indexed: 06/16/2024] Open
Abstract
The aim of this study was to identify predictors of length of stay (LOS) after surgical therapy of maxillofacial abscess. Patients diagnosed with a maxillofacial abscess who underwent extraoral incision and drainage under general anesthesia between January 1st, 2012 and January 1st, 2022 were retrospectively reviewed Univariable and multivariable linear regressions were performed to identify the association between pre- and perioperative variables and the LOS. In total, 228 patients were included. In the forward stepwise multivariable analysis, all factors with a p-value <0.2 in the univariable model were included. Ultimately, six independent predictors of increased LOS were identified: female (coef. 0.14, 95% CI 0.03-0.25), immunosuppression (coef. 0.37, 95%CI 0.13-0.61), penicillin allergy (coef. 0.25, 95% CI 0.04-0.46), C-reactive protein (coef. 0.0008, 95% CI 0.0001-0.0014), multiple spaces involvement (coef. 0.36, 95% CI 0.13-0.59), and time to operation (coef. 0.005, 95% CI 0.002-0.008). In conclusion, our study provides new insights into predicting LOS for patients admitted with maxillofacial abscesses. The identification of these markers not only enhances the ability to forecast LOS, but also lays the groundwork for optimizing resource planning and potentially integrating them into a primary prevention algorithm.
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Affiliation(s)
- Gregoire Longchamp
- Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland.
| | - Raphael Ferrari
- Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Harald Essig
- Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
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Rasteniene R, Simenaite G, Zaleckas L, Aleksejuniene J. Non-odontogenic maxillofacial infections - a 17-years retrospective cohort study. Oral Maxillofac Surg 2024; 28:425-434. [PMID: 37289303 DOI: 10.1007/s10006-023-01162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/02/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE A retrospective 17-year review of the epidemiology, microbiological aspects, and treatment of patients hospitalized for non-odontogenic maxillofacial infections. METHODS A retrospective study reviewed 4040 medical records of patients hospitalized at Vilnius University Hospital Zalgiris Clinic during the period of 2003 to 2019. The following data were collected: patient sociodemographic characteristics, length of hospitalization, sources of infection, affected anatomical regions, treatment modalities, microbiological findings, and sensitivity to antibiotics. RESULTS The mean (sd) annual incidence of non-odontogenic maxillofacial infections over the past 17 years was 237 (49) cases, and the mean (sd) hospital stay was 7.3 (4.5) days. The male-to-female ratio was 1.9:1, while the mean (sd) patient age was 42.1 (19.0) years. The need for an additional incision and the involvement of multiple anatomical regions were the strongest predictors of longer hospitalization. A total of 139 microorganism species were identified, with Bacteroides, Prevotella, and Staphylococcus showing the highest resistance to penicillin. CONCLUSIONS Longer hospital stays were associated with older age (≥ 65 years), smoking, systemic diseases, type of treatment, involvement of multiple anatomical regions, and the need for additional surgery. Most of the cultured microorganisms were Staphylococcus species.
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Affiliation(s)
- Ruta Rasteniene
- Institute of Odontology, Faculty of Medicine, University of Vilnius, Žalgirio Str. 117, 08217, Vilnius, Lithuania.
| | - Gabriele Simenaite
- Institute of Odontology, Faculty of Medicine, University of Vilnius, Žalgirio Str. 117, 08217, Vilnius, Lithuania
| | - Linas Zaleckas
- Institute of Odontology, Faculty of Medicine, University of Vilnius, Žalgirio Str. 117, 08217, Vilnius, Lithuania
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Rasteniene R, Simenaite G, Brukiene V. Maxillofacial infections in lithuanian hospitalised children and adolescents: a 17-years retrospective study. Eur Arch Paediatr Dent 2023; 24:603-611. [PMID: 37452905 DOI: 10.1007/s40368-023-00824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To analyse the epidemiology, treatment, and microbiological findings of hospitalised Lithuanian children and adolescents admitted due to maxillofacial infections over a 17-years period. METHODS 428 medical records of paediatric (under the age of 18) patients hospitalised at Vilnius University Hospital from 2003 to 2019 due to a maxillofacial infection were reviewed. The data concerning patient sociodemographic characteristics, aspects related to a hospital stay, treatment modalities, microbiological findings, and sensitivity to antibiotics, were collected and analysed. RESULTS The most prevalent condition was odontogenic maxillofacial space infection (28.7%), followed by lymphadenitis (21.7%). The mean (sd) age was 10.86 (4.8) years and the male-to-female ratio was 1.37:1. The majority of patients (83.4%) underwent surgical treatment. The mean (sd) hospital stay was 5.49 (2.9) days. The longest hospital stay was observed in the case of odontogenic maxillofacial space infections. A longer period of hospitalisation was generally associated with the presence of anaerobes and their resistance to antibiotics as well as multiple space involvement in deep neck space infections and a permanent causative tooth in odontogenic cases. The most commonly isolated microbiological species was Staphylococcus aureus spp. CONCLUSION The most common origin of maxillofacial infection was odontogenic among investigated Lithuanian children and adolescents. In the majority of cases, a penicillin group antibiotic was prescribed. Streptococci were the predominant bacteria in the cases of odontogenic infection, while Staphylococci were the most prevalent among non-odontogenic cases. Nearly 40.0% of isolated microorganisms were resistant to penicillin. High resistance to metronidazole was identified among anaerobic bacteria.
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Affiliation(s)
- R Rasteniene
- Faculty of Medicine, Institute of Odontology, University of Vilnius, Žalgirio Str. 117, 08217, Vilnius, Lithuania.
| | - G Simenaite
- Faculty of Medicine, Institute of Odontology, University of Vilnius, Žalgirio Str. 117, 08217, Vilnius, Lithuania
| | - V Brukiene
- Faculty of Medicine, Institute of Odontology, University of Vilnius, Žalgirio Str. 117, 08217, Vilnius, Lithuania
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MRI of odontogenic maxillofacial infections: diagnostic accuracy and reliability. Oral Radiol 2023; 39:364-371. [PMID: 35943697 PMCID: PMC10017569 DOI: 10.1007/s11282-022-00646-7] [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: 05/17/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy of emergency magnetic resonance imaging (MRI) in odontogenic maxillofacial infections, the clinical and surgical significance of MRI findings, and whether MRI can identify the tooth responsible for the infection. METHODS A retrospective cohort study reviewed 106 emergency neck MRI scans of patients with neck infections of odontogenic origin. The diagnostic accuracy of MRI in identifying abscesses was studied relative to surgical findings. Correlations were analyzed between various MRI findings and clinical results and outcomes, such as the surgical approach (intraoral vs. extraoral). The ability of MRI findings to predict the causative tooth was assessed in a blinded multi-reader setting. RESULTS Of the 106 patients with odontogenic infections, 77 (73%) had one or more abscesses. Imaging showed a sensitivity, specificity, and accuracy of 0.95, 0.84, and 0.92, respectively, for MRI diagnosis of an odontogenic abscess. Among the imaging findings, mediastinal edema was the strongest predictor of extraoral surgery. MRI showed bone marrow edema in the majority of patients, and multi-reader assessment showed good reliability. MRI was also able to predict the causative tooth accurately. CONCLUSIONS Emergency neck MRI can accurately detect odontogenic abscesses and reliably point to the causative tooth. These results can increase the utility and reliance on emergency MRI in clinical decision-making.
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Zhou J, Wan T, Miao R, Tang W, Liu L, Long J, Jing W. Oral and maxillofacial emergencies: A retrospective study of 5220 cases in West China. Dent Traumatol 2023; 39:140-146. [PMID: 36366969 DOI: 10.1111/edt.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND/AIM There are no epidemiological reports focused on the oral and maxillofacial surgery emergency department in the West China Hospital of Stomatology. The aim of this study was to analyse the epidemiological characteristics of emergency patients admitted for Trauma and Plastic Surgery Department of the West China Hospital of Stomatology from 2016-2019. MATERIALS AND METHODS In this retrospective study, 5220 patients with complete medical records were evaluated. The following data were collected: gender, age, etiology, disease type distribution, anatomic injury site and treatment modality. RESULTS There were 3046 males and 2174 females (ratio 1.40:1), with an average age of 16.2 years. The largest group was children aged between 3 and 6 years old (28.3%). Maxillofacial injuries were the most common condition (87.3%), which mostly occurred on the forehead (29.7%), followed by the lips (27.8%). A fall was the leading cause of injury (59.9%), especially in patients younger than 6 years old. There were 327 cases of maxillofacial space infections (MSI), and the mandibular third molars were the most common tooth associated with odontogenic infections (36.2%). Univariable analysis identified that multiple-space infection, visit time and systemic conditions were the risk factors for being admitted to the hospital for treatment. There were 116 patients (2.2%) with bleeding as the main complaint, and most of the maxillofacial bleeding patients could be stopped by compression (52.6%). CONCLUSION Males and children aged younger than 6 years were the highest risk populations. Trauma accounted for the majority of emergency patients in maxillofacial surgery. Most maxillofacial injuries involved the forehead and were mainly caused by accidental falls. The proportion of MSI was not high, but serious cases may be life-threatening. The causes of bleeding were diverse, and the bleeding was easy to control.
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Affiliation(s)
- Jing Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou, China
| | - Ting Wan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Stomatology, Affiliated Hospital of Sichuan Nursing Vocational College, Chengdu, China
| | - Rong Miao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wei Tang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jie Long
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wei Jing
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Wang P, Huang Y, Long J. A Five-Year Retrospective Study of 746 Cases with Maxillofacial Space Infection in Western China. Infect Drug Resist 2022; 15:5099-5110. [PMID: 36068836 PMCID: PMC9441175 DOI: 10.2147/idr.s377657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To grasp the current epidemiological situation of maxillofacial space infection and investigate the risk factors contributing to the longer hospitalization of odontogenic space infection in western China. Patients and Methods This retrospective study collected the clinical characteristics from 746 hospitalized patients with maxillofacial space infection and investigated the risk factors associated with longer hospitalization. Pearson’s chi-square test and multivariable binary logistic regression were performed for statistical analysis. Results A total of 438 males and 308 females were included in this study, aging from 1 to 90 years (mean age 48.6 years). 74.9% cases resulted from odontogenic infections, with the submandibular space being the most commonly involved space (53.7%). Advanced age (OR (>60 y:19–60 y:≤18 y) = 3.784:3.416:1, p < 0.05), treatment before admission (OR = 2.271, p < 0.05) and number of involved spaces (OR (≥4:2–3:1) = 3.204:1.931:1, p < 0.05) were closely related to longer hospitalization. Streptococcus being the most frequently found aerobic bacteria (268/615, 43.6%) of all the bacteria isolated was resistant to clarithromycin (91.5%) and erythromycin (92.8%). Conclusion Hospitalization time could be longer for patients with the identified risk factors. Streptococcus, as the most common type of aerobic flora, is highly resistant to clindamycin and erythromycin.
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Affiliation(s)
- Peihan Wang
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Yanling Huang
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Jie Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Correspondence: Jie Long, Tel +86 28 85503406, Fax +86 28 85501456, Email
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