Is preoperative CT imaging necessary for odontogenic fascial space infections?

Abstract

Statement of the Problem: Contrast-enhanced computed tomography has become an accepted standard for imaging odontogenic fascial space infections. The sensitivity of CT imaging for diagnosing deep neck abscesses has been quoted as high as 95%. However, when a clinical diagnosis of odontogenic infection with fascial space involvement is made, CT imaging often does not change the course of treatment. Due to the cost, radiation exposure, and potential complications of contrast media inherent in CT imaging, we propose that routine use of CT imaging is not necessary for preoperative evaluation of patients with odontogenic fascial space infections. The purpose of this study is to compare clinical outcomes of patients with odontogenic fascial space infections who had a preoperative CT with those who did not. Materials and Methods: This is a retrospective study examining the records of all patients taken to the operating room for incision and drainage of an odontogenic fascial space infection over a 30 month period. Some patients underwent CT imaging at the order of the emergency department or other service prior to consultation of oral and maxillofacial surgery. However, those patients who presented to the oral and maxillofacial surgery service with a clinical diagnosis of odontogenic fascial space infection were taken to surgery without prior CT imaging. Following surgery all patients were admitted to the hospital and placed on IV antibiotics. Patients were discharged when they were afebrile for 24 hours, had a WBC less than 11,000, had no airway compromise, and were able to take an oral diet. Method of Data Analysis: Fifty-one patients over a 24 month period were identified for the study and there were no exclusions. We compared clinical outcomes of the two groups based on the following parameters: length of hospital stay, need for re-operation, necessity of re-admission to the hospital after discharge, and other complications. A Student’s t test was used to compare length of stay among the two patient groups. Results: Forty-one patients went to surgery without prior CT imaging, while ten had a preoperative CT. The mean hospital stay for those who had a preoperative CT was 4.67 days, which was longer than those who did not have a CT prior to surgery (3.15 days). However, this was not a statistically significant difference (P = .108). In the CT imaged group, two patients needed re-operation for incision and drainage. One of those had to be taken back to the operating room twice for repeat incision and drainage. This patient was re-admitted to the hospital three days after first being discharged. In the group who did not receive preoperative CT imaging, one patient had to be taken back to surgery for a repeat incision and drainage. There were no other complications in either group. Conclusion: We conclude that preoperative contrast-enhanced CT imaging in patients with a clinical diagnosis of an odontogenic fascial space infection does not improve clinical outcomes. References Yousem DM, Chalian AA: Oral cavity and pharynx. Radiol Clin North Am 36:967, 1998 Miller WD et al: A prospective, blinded comparison of clinical examination and computed tomography in deep neck infections. Laryngoscope 109:1873, 1999