Cervicofacial Infections Research Articles

EVALUATION OF ANTIBIOTIC SENSITIVITY OF ODONTOGENIC BACTERIA IN CERVICOFACIAL CELLULITIS IN THE CITY OF SANGMELIMA, CAMEROON

Aim and objective: Cervicofacial cellulitis of dental origin is a polymicrobial infection characterized by inflammation of the deep spaces of the neck and face. These conditions can be life-threatening, as the bacteria can spread throughout the body, leading to descending necrotizing mediastinitis, sepsis and death. Management is greatly challenging because of microbial polymorphism, probabilistic antibiotic selection treatment sometimes being hesitant and inappropriate because of lack of consensus. The aim of this study was to evaluate the antibiotic susceptibility of odontogenic bacteria in cervicofacial infections. Material and methods: This was a cross-sectional, descriptive study conducted from May 2019 to August 2020 in the odontostomatology and bacteriology departments of the Sangmelima District and Reference Hospitals in Cameroon. Thirty five samples were collected by swabbing or puncture. Specific culture media were used to inoculate samples. Sensitivity of isolated bacteria was assessed using the Kirby-Bauer diffusion disk method. Data analysis was performed using SPSS 23.0. Results: Thirty samples were positive (85.7%). Bacteria isolated were Streptococcus (40%), Staphylococcus (30%), Pseudomonas (20%), Escherichia coli (6.7%) and Lactobacillus (3.3%). Sensitivity testing was performed with amoxicillin/clavulanic acid, metronidazole, gentamicin, ciprofloxacin, imipenem and clindamycin. Bacteria were more sensitive to amoxicillin/clavulanic acid, ciprofloxacin and imipenem. Conclusion: Bacteria identified in purulent secretions from cervicofacial cellulitis are much more sensitive to amoxicillin/clavulanic acid, ciprofloxacin and imipenem. Peer Review History: Received 25 March 2024; Revised 4 May 2024; Accepted 27 June; Available online 15 July 2024 Academic Editor: Prof. Dr. Gorkem Dulger, Duzce University, Turkey, gorkemdulger@yandex.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com Prof. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye

The Effect of the COVID-19 Pandemic on Odontogenic Cervicofacial Infections in a Single Center in Greece.

Odontogenic cervicofacial infections are still an ongoing problem, requiring immediate hospital admittance and management. The aim of this studyis to reflect the number of patients with cervicofacial infections who were admitted during the coronavirus disease 2019 (COVID-19) pandemic period in a single, point of reference center in Northern Greeceas well as analyze the quantitative and qualitative parameters of patient characteristics and management data. This was a retrospective cohort study that included all the patients with cervicofacial infections who were admitted to our unit during the COVID-19 pandemic, specificallybetween 2020 and 2021. For comparative reasons, patients admitted with cervicofacial infections between 2019 and 2020 (pre-COVID period) were analyzed. In total, 341 patients fulfilled the criteria for this study. Specifically, the number of admitted patients was 151 in the pre-COVID era instead of 190 patients in the pandemic. The mean age of the patients was 45.3 years, with a slight male predominance (54.7% males to 45.3%). The mean duration of hospitalization was 2.5 days in the pre-COVID period instead of 3.42 days in the pandemic. Interestingly, in the pandemic, eight times more patients were admitted to the ICU post-operatively, in contrast to the pre-COVID period (23 vs 3 patients). Also in the COVID period, almost 54.9% of the patients presented with fever and 49.6% with trismus. Moreover, the submandibular space involvement was the most common space of infection in both COVID and pre-COVID groups with (58.9% and 49.7%) respectively.In one-third of all cases, a post-extraction infection of a third molar was the main cause of abscess. Cervicofacial infections during the COVID-19 pandemic appeared with more severe symptoms and resulted in an increased number of patients who needed admittance to the intensive care unit, in contrast to the pre-COVID era. Also, the mean length of stay was increased for a day at the same period. This study could be used as an example for further research, in case of similar pandemic situations in the future.

Efficacy/Safety of the Use of Glucocorticoids in Oral and Maxillofacial Surgery.

Glucocorticoids, also known as corticosteroids or steroids, are drugs derived from cholesterol. They are synthesized by the adrenal cortex, along with other hormones, such as cortisol and aldosterone. Glucocorticoids are drugs recommended for patients undergoing surgery on the oral cavity, facial skeleton, and related cervical structures due to their high efficacy against inflammatory and immune processes. However, these drugs are restricted due to their multiple and serious adverse effects. The objective of this study was to verify the efficacy of corticosteroids administered in major surgeries of the oral cavity, as well as of the cervical and facial structures, based on the characteristics of the patient so as to select the best therapeutic strategy. Articles in the databases of PubMed, Nature Portfolio, Medline, Cochrane Library, and Google Scholar were thoroughly examined. A total of 54 articles were selected to address the proposed objectives. The results obtained show that it is effective and safe to use glucocorticoids as pre- or postsurgical therapy in oral and maxillofacial surgery to control the processes of inflammation, pain, lockjaw, and edema. However, when referring to the use of these drugs, one must proceed with caution and pay particular attention when handling them. The concentration of the glucocorticoids used must be individualized, as well as the selection of the route of administration. Various studies show that, although the oral route is the most used route, the most effective route is the intramuscular route due to its easy absorption. However, for patients who have recurrent inflammatory and vesiculobullous ulcerative lesions, the topical route should be chosen to mitigate side effects, considering that recurrent applications must be made to prevent the worsening of the lesion and to avoid having to use medications enterally. In patients with cervicofacial infections, antibiotics continue to be the main drugs used to manage the condition in conjunction with corticosteroids. It is important to know the possible interactions of glucocorticoids with other medicines or food: it has been described that the interaction between Ritonavir, an antiretroviral drug that inhibits human immunodeficiency virus (HIV) proteases, and prednisone causes an increase in the concentration of prednisone, leading to possible toxicity in normally safe doses and, in many cases, iatrogenic Cushing's syndrome. It is also important to know the systemic or topical adverse effects of the chronic or high-dose use of glucocorticoids. It can be concluded that by making adequate use of glucocorticoid therapy in oral and maxillofacial surgery to manage clinical manifestations, it is possible to attenuate the morbidities of treatment and intervention.

Current management of cervicofacial nontuberculous mycobacterial infections in the pediatric population.

The purpose of this review is to analyze and consolidate recently published literature to provide updated guidelines on the diagnosis and management of nontuberculous mycobacterial lymphadenitis (NTM LAD) in the pediatric population and to suggest areas of further research. Diagnosis of NTM LAD relies on a detailed clinical history, physical examination, laboratory tests, and imaging techniques. Treatment strategies vary widely, with a shift towards complete surgical excision being observed due to its higher cure rate, improved aesthetic outcomes, and lower recurrence rates. However, patient-specific factors must be considered. The role of genetic factors, such as Mendelian susceptibility to mycobacterial disease (MSMD), is being increasingly recognized and could lead to targeted therapies. Despite strides in the understanding and management of NTM LAD, substantial gaps remain in key areas such as the role of diagnostic imaging, optimal treatment parameters, postoperative care, and surveillance strategies. In this article, we explain our approach to NTM using the most relevant evidence-based medicine while offering directions for future work.

Impact of Treatment on Systemic Immune-Inflammatory Index and Other Inflammatory Markers in Odontogenic Cervicofacial Phlegmon Cases: A Retrospective Study.

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. 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. 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.

Coexistence of COVID-19, Pseudomonas, and thoracic actinomycosis in a cystic bronchiectasis case

Actinomycosis often leads to cervicofacial infections, but thoracic involvement may also occur. However, the development of empyema is rare. While being followed up with the diagnosis of asthma and bronchiectasis, our case was hospitalized for infected bronchiectasis. As empyema developed in the follow-up, the pleural effusion was drained by tube thoracostomy. Actinomycosis was diagnosed through pleural effusion cytology. Growth of Pseudomonas aeruginosa was observed in sputum culture, and SARS-CoV2 RT-PCR was also positive in nasopharyngeal sampling. Polymicrobial agents can often be detected in actinomycosis. Actinomycosis cases have also been reported in the post-COVID period. Our case is presented since it would be the first in the literature regarding the coexistence of COVID-19, Pseudomonas, and thoracic Actinomycosis (empyema).

1861. The Spectrum and Clinical Significance of Actinomyces Blood Stream Infection

Abstract Background Actinomyces species are Gram-positive anaerobic branching bacilli which are commensal of oropharynx, urogenital and gastrointestinal tracts that is associated with infrequent chronic granulomatous diseases including cervicofacial, intrabdominal and genital infections. Actinomyces Blood Stream Infections (BSIs) are usually rare but becoming more frequent with advanced modern diagnostic techniques. The presented study aims to evaluate the spectrum and clinical relevance of Actinomyces BSI at Hamad Medical Corporation (HMC), Qatar. Methods A retrospective observational study was conducted for all reported Actinomyces species BSI at HMC between January 2016 to November 2020. Isolates were identified using modern automated BD PhoenixTM and MALDI-TOF microbiological methods. Results Over the five years study period, 37 episodes of Actinomyces BSIs were recorded the majority of which identified as Actinomyces odontolyticus (40.5 %, 15/37). The mean age was 32 years (range 1 month – 81 years), 62.2 % were females (23/37), 64.8 % had chronic medical conditions while 78.4 % developed fever as presenting illness. Out of the total cases, cultures were considered significant in only 48.6 % of cases (18/37), in which primary source of infection was oropharyngeal (10) followed by genitourinary (4), gastrointestinal (2) and 2 infected diabetic foot. However, 86.5 % (32/37) received antimicrobial therapy mainly as βlactam antibiotics or cephalosporins ranging between 3 days to 6 months. Antimicrobial therapy was given for a short duration in 87.5% (28/32) of cases for less than 14 days with no long-term complications while only four cases received prolonged therapy. The remaining Five patients did not receive any antibiotics as the cultures were considered contaminants by the primary provider. Conclusion Actinomyces species blood stream infection is becoming more frequent with advanced diagnostic techniques affecting all age groups. Females and patients with chronic comorbidities are more commonly affected while A. odontolyticus is the predominant isolated species. Almost half of the cases were not clinically relevant, but most cases received short courses of antimicrobial therapy with no long-term complications. Disclosures All Authors: No reported disclosures.

27. The microbiology of cervicofacial infections presenting to a regional maxillofacial unit

Cervicofacial infections commonly present to maxillofacial units and form a large proportion of emergency activity. Treatment with antibiotics is the standard and there are growing concerns regarding antimicrobial resistance. The aim of this audit is to assess for changes in the microbiology of infections.

60. To Swab or not to swab? A review of the value of pus swabs in the management of cervico-facial infections

At present, the majority of inpatients who undergo incision and drainage of cervico-facial infections at the Queen Elizabeth university Hospital have pus swabs sent routinely for culture and sensitivity tests. We aim to explore if there is evidence to support this practice, and whether pus swabs had any influence on the patient’s definitive antibiotic regimen.

Predictors and risk factors for admission to critical care in cervicofacial infections: a Maxillofacial Trainee Research Collaborative (MTReC) study

Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care. Prospective data were captured on 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared with those who received ward-level care. Multivariate and receiver operating characteristic curve analyses were used to identify predictors for critical care admission. Our results show that the best predictor for critical care admission is the presence of three or more features of airway compromise (AUC 0.779), followed by C-reactive protein (CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement (OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 109/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care is multifactorial, however, the presence of three or more features of airway compromise is the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow for the early recognition of patients who may require escalation to critical care.

A RARE CASE OF ACTINOMYCES EMPYEMA

A RARE CASE OF ACTINOMYCES EMPYEMA

COVID-19 and Limited Dental Resources. The Impact of Odontogenic Infections on Emergency Room and Intensive Care Unit Admissions: The Wexner Medical Center at The Ohio State University Experience

Many dental procedures generate a significant number of droplets and aerosols, thus posing a potential risk of transmission of the COVID-19 virus and forcing many dental offices to close in an attempt to protect their providers, staff, and patients. The purpose of this study is to assess whether the barrier to dental care in Ohio during the height of the COVID-19 pandemic contributed to an increase in hospital admissions, length of stay, and severity of odontogenic infections extending to the deep neck spaces. This retrospective study included all patients admitted to the Wexner Medical Center at the Ohio State University (OSUWMC) for management of a deep space neck abscess of odontogenic origin requiring an extraoral incision and drainage +/- dental extraction between the timeframe of March 2017 and January 2021. Data, such as age and sex of patient, length of hospital stay, number of deep neck spaces involved, ASA status, subsequent need for a surgical washout, and need for ICU transfer, were collected from a chart review of 212 patients (Image 1). We used a Fisher exact test to look for differences in categorical variables both before and after the start of the COVID-19 pandemic. We used a Wilcox signed rank test to look for differences in continuous variables both before and after the COVID-19 pandemic. Based on these tests, we see that there is a marginally significant difference in the total number of spaces before/after COVID-19 (P value = 0.0784 < 0.1). We also see marginally significant difference in whether there were complications before/after COVID-19 (P value = 0.0973 < 0.1). While these results are not significant under the usual significance level of α = 0.05, they are marginally significant. The P values are greater than 0.05, however, not by much. We did not see additional significant differences in variables before/after COVID-19 (Image 2). The authors proposed that the barrier to dental care during the global COVID-19 pandemic would lead to a significant increase in the number of odontogenic infections seen, treated, and admitted to OSUWMC. While the data show only marginal significance, the fact remains that, at a baseline, an endemic exists in patients with odontogenic disease leading to severe cervicofacial infections requiring invasive surgical treatment and lengthy hospital stays.Tabled 1Summary TableSummary statistics of dataXLevelOveralln211Sex (%)F102 (48.3)M109 (51.7)Washout needed? (%)No188 (89.1)Yes23 (10.9)ICU TransferNo192 (91)Yes19 (9)Complications?No171 (81)Yes40 (19)ASA (mean (SD))2.36 (0.75)Age (mean (SD))41.10 (17.4)Length of Stay (Days) (mean (SD))6.64 (7.29)Total # of Spaces (mean (SD))2.39 (1.34)during covid (%)No139 (65.9)Yes72 (34.1) Open table in a new tab Tabled 1Stratified by before/during covidSummary statistics of data stratified by before and after covidVariableLevelBefore COVID-19After COVID-19P valuen13972Sex (%)F62 (44.6)40 (55.6)0.1476M77 (55.4)32 (44.4)Washout needed? (%)No124 (89.2)64 (88.9)1.0000Yes15 (10.8)8 (11.1)ICU Transfer? (%)No124 (89.2)68 (94.4)0.3103Yes15 (10.8)4 (5.6)Complications? (%)No108 (77.7)63 (87.5)0.0973Yes31 (22.3)9 (12.5)ASA (mean (SD))2.33 (0.79)2.42 (0.64)0.2796Age (mean (SD))42.20 (18.39)38.99 (15.2)0.3329Length of Stay (Days) (mean (SD))6.99 (8.64)5.96 (3.27)0.5646Total # of Spaces (mean (SD))2.28 (1.33)2.59 (1.34)0.0784We used a Fisher exact test to test for differences in categorical variables between before/after COVID-19 (sex, washout needed, etc.). We used a Wilcox signed mak test to test for differences in continuous variables between before/after COVID (ASA, Age. etc). Based on the test, we see that there is a marginally significant difference in total number of spaces before/after COVID (P value = 0.0784 < 0.1). We also see marginally significant difference in whether there are complications before/after COVID-19 (P value = 0.0973 < 0.1). These results are not significant under the usual significance level of α = 0.05 but they are marginally significant. The P values are greater than 0.05 but not by much.We do not see additional significant differences in variables before/after COVID-19. Open table in a new tab

Should preoperative computed tomography be routine examination for cervicofacial space infections?

BackgroundCervicofacial space infections are potentially life-threatening, which require accurate diagnosis, early incision, and adequate drainage. The utilization of computed tomography (CT) in cervicofacial space infections has significantly increased for its advantages in the evaluation of abscesses, its availability, and low cost. However, the clinical value of preoperative CT imaging in cervicofacial space infections remains controversial for its poor specificity, radiation exposure, potential complications, and extra cost. We, therefore, investigated whether CT examination should be used as a routine examination in the treatment of patients with cervicofacial space infections.MethodsA retrospective study of all patients affected by cervicofacial space infections that received incision and drainage surgery from Jan 2016 to Dec 2020 was performed at West China Hospital of Stomatology at Sichuan University. Patients were divided into two groups: the group with preoperative CT and without preoperative CT. Outcomes, including reoperation rate, missed diagnosis rate, days of symptom relief, length of stay, duration of surgery, and total cost of hospitalization, were analyzed.ResultsOut of n = 153 patients, 108 patients underwent surgery with preoperative CT and 45 patients without preoperative CT. The reoperation rate in the preoperative CT group (6/108, 5.6%) was significantly lower (P = 0.00) than that in the group without preoperative CT (10/45, 22.2%). Significant reduction of missed diagnosis rate (P = 0.00), days of symptom relief (P = 0.01), length of stay(P = 0.03), and duration of surgery (P = 0.01) were detected in the preoperative CT group. The results demonstrated that the utilization of preoperative CT can reduce the missed diagnosis rate and repeated surgery complications.ConclusionsWe recommend preoperative CT as a routine examination in cervicofacial space infections.

HAS THE COVID-19 PANDEMIC INFLUENCED THE NUMBER OF PATIENTS WITH CERVICOFACIAL INFECTIONS? A SINGLE CENTRE STUDY

Objectives The aim of the present study was to assess whether the current COVID-19 pandemic affect the prevalence of patients with cervicofacial infections in a major tertiary hospital in Greece. Materials and Methods A retrospective comparative study was performed, assessing the hospitalization of patients with cervicofacial infections in a university-affiliated Department of Oral and Maxillofacial Surgery. Patients were recorded in two periods, the COVID period, from March 2020 to February 2021, and the pre-COVID period, from March 2019 to February 2020. All patients admitted with any form of cervicofacial infection during these periods were included in the study. Results In total, 341 patients were recorded. Of those, 151 were admitted in the pre-COVID period and 190 in the COVID period (P=0,03). The mean age was 45.3 years in total. A slight male predominance was observed (54.7% males). Mean length of stay was 3.42 days in the COVID period, whereas it as 2.5 in the pre-COVID period. 23 patients had severe deep neck infections the COVID period, requiring admittance to the intensive care unit, compared to the 3 patients in the previous period (P&lt;0,001). Conclusions The high surge of patients with cervicofacial infections with increased severity during the COVID period is merely attributed to the inability of these patients to attend primary care facilities and prevent the infections in an initial stage in order to minimize hospitalizations.

Imaging of descending necrotizing mediastinitis: A report of 11 cases and review of the literature

Introduction: Descending necrotizing mediastinitis is a rare and fatal condition that results from the spread of cervicofacial infections to the mediastinum. Early and appropriate management is needed to reduce mortality and morbidity rates. Imaging, especially CT, plays a central role in the diagnosis, treatment, and monitoring of patients. This study is aimed at assessing the role of computed tomography in diagnosing and planning the management of DNM. Material and methods: This is an 8-year retrospective study on 11 patients who fulfilled the ESTRERA criteria. All the patients underwent thoracic radiography along with an enhanced cervicothoracic CT scan. Results: Median age was 34 years with a sex-ratio of 1.75. 4 patients had diabetes. The primary oropharyngeal infection was an odontogenic abscess in most cases. The reported symptoms were mainly thoracic pain and fever. Thoracic radiography and cervicothoracic CT scan confirmed the diagnosis and showed different findings. 7 patients were diagnosed with type I DNM, 1 patient with type IIA and 3 patients with type IIB. Conclusion: DNM is a medico-surgical emergency where imaging, in particular CT, plays an essential role in establishing the diagnosis and guiding the surgical approach to ensure optimal patient care.

Surgical and Non-Surgical Maxillofacial Infections

One of the most common infectious processes known to ancient and modern medicine alike, the majority of these illnesses are odontogenic in identity. The majority of these infections can be treated surgically, including drainage, endodontic treatment, and exodontia in order to be controlled without resorting to antimicrobials. Due to the intricate anatomy involved and the potential for catastrophic medical problems even with expert therapy, severe space infections pose a difficult dilemma for maxillofacial surgeons. Because of the proximity of the submandibular and submental areas, infections can also affect several spaces. Streptococcus pyogenes, a Gram-positive aerobic pathogen, was found to be the most frequent organism linked to orofacial infection. Possibly deadly consequences that may appear after MSI include septicemia, airway compromise, cavernous sinus thrombosis, necrotizing fasciitis, and mediastinitis. Deep space maxillofacial and cervicofacial infections should be managed according to certain principles, including immediate and prompt evaluation of the infection's extent based on anatomical location, rate of development, and possibility for airway impairment. Penicillin is still the preferred empiric medication, at least for outpatients, according to recent data on the antibiotic sensitivity of the most frequently identified bacteria of odontogenic infections. With respect to surgical intervention, many surgeons have been shown to favor tracheotomy to endotracheal intubation for maintaining the airway in patients with airway blockage. In contrast to those who receive endotracheal intubation, patients with severe cervicofacial infections who receive tracheotomy for airway support have been shown to have a shorter stay in critical care, experience fewer problems, and pay less overall. After assessing the host immunity, early definite operative therapy is essential for halting the infection's spread.

Long-Term Outcome of Surgical Treatments for Nontuberculous Mycobacterial Cervicofacial Lymphadenitis in Children

Information on long-term treatment outcome for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis in children is scarce. The purpose of this study is to evaluate long-term outcome for surgical treatment, which is the mainstay treatment modality. This case series describes recurrence rates of surgically treated NTM cervicofacial lymphadenitis patients with a follow-up of at least 10 years. The current study data were partially collected from a randomized, prospective, multicenter, multidisciplinary trial (CHIMED study), which was conducted between 2000 and 2006 to determine the optimal treatment for NTM cervicofacial lymphadenitis in children. After the CHIMED trial inclusion ended, our institute continued to serve as a referral center. This enabled us to enlarge the surgical CHIMED cohort by adding patients who were treated during 2007 to 2010 in our center and collect the rest of the current study data. About 427 children with chronic cervicofacial lymphadenopathy were analyzed. Among these, 290 had microbiologically confirmed cervicofacial mycobacterial infections (n=3 Mycobacterium tuberculosis, n=1 Mycobacterium bovis, n=286 NTM). Of these 286 children with NTM cervicofacial lymphadenitis, 189 were treated surgically (median age: 41 months, range: 9-144, 46.0% males). The affected lymph nodes were excised in 151 children (79.9%), and curettage was performed in 38 children (20.1%). One patient (0.07%) experienced a reactivation/recurrence 2 years after surgical excision and required another surgical excision. Three children (7.9%) experienced infection reactivation/recurrences after curettage, confirmed by redness or a draining fistula, within the first year after healing. Two of these 3 patients were treated with additional surgical excisions. The long-term outcome of surgical excision for NTM cervicofacial lymphadenitis is favorable with a low recurrence rate. Curettage or a conservative wait-and-see approach can be considered an alternative in advanced and surgically challenging cases. However, healing will take longer, and late recurrences are possible.

Analysis of 10 Cases of Orbital Infections Arising from Odontogenic Cervicofacial Infections

Orbital cellulitis, also called postseptal cellulitis, is an infection of contents of the orbit (periorbital fat, neurovascular bundle, and the extraocular muscles). It should be differentiated from preseptal (periorbital) cellulitis which is a lesion of the anterior portion of the eyelid. However, both preseptal and postseptal cellulitis could present in a similar way with eye pain, edema, and erythema. The aim of the study was to review patients with orbital cellulitis as a complication of odontogenic cervicofacial infections seen in a Nigerian tertiary care facility. A retrospective analysis of cases of odontogenic cervicofacial infections complicated by orbital infections that presented at a Nigerian tertiary health facility between January 2006 and September 2019 was conducted. A total of 10 patients with cervicofacial infections who presented with 11 orbital infections as a complication were retrieved for this study. They were six males and four females; male to female ratio was 1.5:1. Median age was 33.5 years (mean age was 34.3 years, range was 22-47 years). Based on clinical features and results of available imaging, orbital infections using the classification by Chandler et al., (1970), were one cases of type I (9.1%), seven cases (63.6%) of type II and two cases (18.2%) of type IV and one case (9.1%) of type V. There was no case of type III. Cervicofacial infections could arise from upper posterior teeth. These infections could spread into the orbit causing cellulitis especially type II.

Stress hyperglycaemia or diabetes mellitus in cervicofacial infections? A Maxillofacial Surgery Trainee Research Collaborative (MTReC) study

Diabetes mellitus (DM) is thought to be associated with poor outcomes in cervicofacial infections (CFI), yet little is known about the prevalence of DM in these cases. Stress hyperglycaemia (SHG), a normal physiological response to inflammation, is distinct from DM, though they overlap and may be conflated. We aimed to establish the prevalence of DM and SHG in CFI, and to determine the effect of each on severity of disease and outcome measures. The Maxillofacial Surgery Trainee Research Collaborative (MTReC) carried out an audit of all patients with CFI admitted to 25 hospitals between May and October 2017. To the best of our knowledge this created the largest prospective database on CFI, with information collected on presentation, source of infection, biological data, and outcomes. We recorded 1002 admissions, of which 78 (7.8%) had DM. Random blood glucose was measured on admission in 401 patients (40%), of which 45 (11%) displayed SHG. Patients diagnosed with DM were more likely to have infections arising from a salivary source (13% vs 4%, p<0.00), more returns to theatre (9% vs 2%, p<0.00), and a longer hospital stay (median (range) 2 (0-34) vs 1 (0-139) day, p=0.01) than non-DM patients. In contrast, patients with SHG had more severe disease (multiple fascial spaces involved in 59% vs 19%, p=0.01, and systemic inflammatory response syndrome present in 66% vs 45% p=0.03), but did not have significantly more returns to theatre (2% vs 3%, p=0.91) or longer stays in hospital (median (range) 1 (0-63) vs 1 (0-6), p=0.55) than normoglycaemic patients. The prevalence of DM in our cohort was only marginally higher than in the general population, despite previous retrospective case reviews suggesting a significantly higher prevalence. SHG was not associated with poor outcomes in our cohort, but is likely to be associated with a small increased risk of subsequent diagnosis of DM, which can be quantified using a calculator tool. On discharge, it is important to give appropriate advice about diet, lifestyle, exercise, and weight loss to all patients with CFI.

Gender differences in patients with severe dental infections presenting to hospital.

Introduction Gender differences have been documented in prevalence and morbidity of caries, gingivitis and oral health, but not previously in cervicofacial infection. Identification and minimisation of gender inequalities is a World Health Organisation priority, and there are physiological, behavioural and cultural reasons to suspect that sex and gender differences may be present.Methods Analysis was carried out of the MTReC National Snapshot audit of cervicofacial infections. This database was created by oral and maxillofacial surgery trainees in 2017 and records over 400 variables in 1,002 individual patients admitted to hospital with severe odontogenic infection.Results Records were available for 1,002 patients with cervicofacial infection (456 females and 546 males). There were significant differences between recorded gender in those presenting with airway compromise (male 7% vs female 2%, p = 0.001), severe inflammatory response syndrome (male 60% vs female 39%, p = 0.007) and requirement for awake fibre-optic intubation on admission (male 4% vs female 1%, p = 0.014).Discussion These results suggest that male patients access healthcare later in their disease than female patients, and with more severe systemic compromise. This may be due to prevalent cultural and behavioural norms. As equality of access is the responsibility of the administrator, we discuss methods which might improve timely presentation in males with cervicofacial infections.