Fascial Space Infections Research Articles

Multifunctional Irrigation-Assisted Vacuum Drainage versus Traditional Drainage in the Treatment of Odontogenic Deep Fascial Infection: A Retrospective Cohort Study

PurposeOdontogenic deep fascial space infection in the head and neck is a common potentially fatal clinical problem. Traditional drainage method is considered laborious and gravity-dependent. In this study, we aimed to evaluate the clinical effect of a modified multifunctional irrigation-assisted vacuum drainage (MIVD) by comparing it with the traditional drainage method in the treatment of odontogenic deep fascial infection.Patients and MethodsPatients diagnosed with odontogenic deep fascial space infection in the Second Affiliated Hospital, Zhejiang University School of Medicine, China between March 2018 and March 2021 were studied. We divided the patients into two groups based on the drainage method they received: patients with the MIVD device were included in the MIVD group, patients with traditional drainage were included in the traditional group. Data were collected retrospectively including baseline characteristics and treatment outcome variables.ResultsA total of 65 patients were included. All the patients were eventually cured. There were no significant differences in age, gender, diabetes, end stage renal disease, autoimmune diseases, other systemic diseases, tobacco use, number of the infected spaces, preoperative white blood cell count and C-reactive protein between the two groups. The number and frequency of manual irrigation by clinicians (MIC), time required for white blood cell count to return to normal levels (TWBC), time required for C-reactive protein to return to normal levels (TCRP), the length of hospitalization and the length and total cost of antibiotics use were significantly less in the MIVD group. There was no significant difference in the cost of hospitalization between the 2 groups.ConclusionThe MIVD device significantly reduced the number and frequency of MIC, TWBC, TCRP, the length of hospitalization and the length and total cost of antibiotics use in comparison with the traditional drainage method. It provided a favorable treatment method for patients with odontogenic deep fascial space infection in the head and neck.

Can oral surgery be performed safely when COVID-19 status is unknown?

Design Cross-sectional study/special report.Study population This paper presents the early experience of the oral and maxillofacial surgery department at Hadassah University Medical Centre in Jerusalem during the first wave of the COVID-19 pandemic in 2020. The study involved both medical staff and patients.Data analysis A retrospective analysis of an eight-week period (February-April 2020) collated 1,471 patient records and examined diagnoses, procedures performed and COVID-19 status of patients and staff. Any attempts made to access routine dental care before presentation in secondary care were recorded.Results In the study period, one member of staff was confirmed as COVID-19-positive. Sixty-three patients had formal COVID-19 tests; all were negative. Forty-three patients were admitted for drainage of odontogenic fascial space infections; 53% reported delayed or failed attempts to access dental care before their infection. Additionally, the authors describe a screening process, personal protective equipment (PPE) allocation and staff/patient testing protocols employed in their surgical unit throughout this period.Conclusions The authors suggest a series of triage and screening measures to limit the risk of unknowingly exposing clinical staff to the COVID-19 virus and offer advice on safely delaying non-emergency treatment where necessary. Recommendations for use of PPE for aerosol and non-aerosol generating procedures are made, but it is important to recognise that the efficacy of these measures cannot be determined by the methodology employed. This paper demonstrates an early example of complications developing from absent or delayed routine dental services resulting from lockdowns. This 'excess morbidity' is likely to have an impact on healthcare services as the pandemic recovery unfolds and services begin to return to normal.

Evaluation of Efficacy of Ultrasonography as an Additional Diagnostic Tool for Deciding Management Protocol of Odontogenic Superficial Fascial Space Infections: A Prospective Clinical Study.

To explore the efficacy of ultrasonography as an additional diagnostic tool in superficial odontogenic fascial space infections of maxillofacial region and modifying the treatment plan when needed. Forty patients with superficial fascial space infections underwent a detailed clinical, plain radiological and ultrasonographic examination. Based on the ultrasonographic findings, final diagnosis was made and compared with clinical findings. Patients diagnosed with cellulitis were given medical line of treatment, and those with abscess were subjected to incision and drainage along with standard general supportive care and removal of etiologic agent. In this study, out of 40 patients (male = 22, female = 18), clinical diagnosis of cellulitis was made in 26 cases (65%) and abscess in 14 (35.0%). On USG examination, cellulitis was present in 21 cases (52.5%), while abscess in 19 (47.5%). Final diagnosis of cellulitis was made in 13 (59.1%) males and 12(66.7%) females, while abscess was confirmed in 9 (40.9%) male and 6 (33.3%) female patients. The results showed that sensitivity of the clinical examination alone was 64% with 33% specificity, and for USG, sensitivity was 84% with specificity of 100%. The adjuvant role of ultrasonography in the diagnosis and timely management of superficial fascial space infections is promising owing to its accessibility, relative safety, repeatability and cost-effectiveness.

TEMPORAL SPACE INFECTION SECONDARY TO RECURRENT BUCCAL SPACE INFECTION FROM MANDIBULAR DECIDUOUS MOLAR IN 7-YEAR-OLD CHILD: A CASE REPORT

Head and neck space infections are usually secondary to odontogenic infec­tions due to translocation of oral microbes to fascial space via odontogenic route resulting in progression by enzymatic degradation of connective tissue. Various factors like microbiological, host, nutritional and socioeconomic fac­tors are responsible for progression of fascial space infection that might take fatal course if not treated in time. The present case report describes a child with fascial space infection of oral and maxillofacial region who was treated by incision and drainage in department of oral and maxillofacial surgery of this hospital. Fascial space infections are one of the surgical emergencies and need to be addressed in early stage as it has rapid regional and systemic progression leading to fatal outcome. It is multifactorial and all need to be addressed. Incision and drainage with removal of cause with antimicrobial therapy is treatment modality of space infection. Inadequate drainage might lead to recurrence of infection and progression to distant secondary spaces.

Microbiological profile of aerobic and anaerobic bacteria and its clinical significance in antibiotic sensitivity of odontogenic space infection: A prospective study of 5 years.

Introduction:Odontogenic infections are mixed aerobic-anaerobic microbial flora. Infections caused by anaerobic bacteria are serious and life-threatening. The microbial specificity in odontogenic infections is technique sensitive depending on the sampling and culturing of specimens.Materials and Methods:A prospective study was carried out on 100 consecutive cases of odontogenic infections treated at our institute over a period of 5 years by surgical intervention and intravenous antibiotics. This study evaluates the pathogenic potential and virulence factors of aerobes and anaerobes as well as its synergistic interrelations with other infectious flora, by culturing of specimens and testing antibiotic sensitivity in standard microbiological methodology in correlation with patient demographic factors.Results:Of the 100 patients of odontogenic space infection, males were more affected, between third and fourth decades. Caries is the most common etiology with involvement of mandibular molars. Submandibular and buccal space is commonly involved. The most common microorganisms isolated being Staphylococcus aureus and Streptococcus viridans are facultative anaerobes which belong to aerobes and Peptostreptococcus predominated among obligate anaerobes. The empirical antibiotic regimen followed is amoxicillin plus clavulanic acid with Metronidazole, followed by surgical treatment. Clindamycin was preferred as the second line of choice in patients resistance to penicillin drugs with comparable efficacy in it.Conclusion:Our study expanded the knowledge base of the microbial flora associated with odontogenic infections, with special reference to anaerobes. Successful management of odontogenic space infection lies in decompression, removal of etiological factors, and also in selecting appropriate antimicrobial therapy depending on microbial flora isolated, for recovery of patients and preventing complications associated with fascial space infection.

Efficacy of C-Reactive protein as a marker in patients with odontogenic fascial space infection: A prospective analytical study

Efficacy of C-Reactive protein as a marker in patients with odontogenic fascial space infection: A prospective analytical study

Fascial space infections: think twice before extubation with a CRP more than 200!

Fascial space infections: think twice before extubation with a CRP more than 200!

A Case Report of a Submental and Submandibular Space Infection

In most of the cases of space infections are secondary to an odontogenic infection. In space infection,spread occurs through the fascial plane because of the degradation of connective tissue by action of differentenzymes produced by microorganisms. Different factors like age, nutritional status of the host, host defense,virulence of the microorganism play an important role in the spread of the infection. Sometimes it may takethe fetal course if not treated on time because of its local and systemic complications. It should be treatedas an emergency condition to prevent its rapid progression leading to fatal outcome. Here the case reportdescribes an old lady suffering from fascial space infection and treated by incision and drainage. Incompleteremoval of any odontogenic infection may cause the recurrence of the infection or infection that may spreadto fascial spaces.

Can CRP Predict the Need for a CT Scan, NG Tube, and Tracheostomy in Fascial Space Infections of the Head and Neck? A Review of Cases at a Single Regional Center Covering the West of Scotland

Around the world, admission due to dental sepsis in public hospitals is rising. The issues behind this are diverse. There can be significant sequelae to these infections, including ICU admission, prolonged intubation, tracheostomy, scarring, tooth loss and oral rehabilitation as well as short- and long-term swallowing issues. We wanted to identify if there was any way to identify those who may need a CT scan, NG tube and tracheostomy in our patient group to help with decision-making processes in the future.

Microflora in odontogenic infections

Purpose: This study was intended to evaluate the various causative microorganisms responsible for fascial space infections. Materials and Methods: A total of 88 patients who reported with an orofacial space infection of odontogenic origin were included in the study. Following a thorough evaluation, using a disposable syringe, pus sample was obtained and sent for culture and sensitivity test. Offending teeth were extracted under antibiotic coverage, and incision and drainage was done as and when indicated. The results of the culture and sensitivity along with the effective antibiotic were tabulated. Results: The results of this study show that submandibular space (38.8%) is the frequently involved fascial space. Majority of the patients are in the second and third decades of life (53.9%). Staphylococcus species (41.1%) is the most commonly isolated microorganism. Penicillin remains to be the drug of choice. Extraction of the offending tooth under antibiotic coverage and incision and drainage remains to be a treatment option. Conclusion: Based on the results of this study, it can be concluded that the causative microorganisms for odontogenic infections involved mixed aerobic–anaerobic bacteria. Anaerobic as well as aerobic cultures were necessary to isolate all pathogens.

Modified Usage of Negative Pressure Wound Therapy for the Management of Severe Deep Fascial Space Infections in the Head and Neck.

PurposeAlthough negative pressure wound therapy (NPWT) has been widely used in complicated wound care, there are still some obstacles regarding its use in the treatment of severe deep fascial space infections in the head and neck. The purpose of this study is to describe a new modified usage of NPWT and investigate the clinical efficacy of this system in a consecutive case series of severe deep fascial space infections.MethodsThe investigators implemented a new modification of NPWT for the management of severe deep fascial space infections. In this new system, the half-plugged bar-shaped foam material was arranged along with the through-and-through side-holed latex drainage tube, which could maintain negative pressure in the distal part of the spaces, and the tube was easy to remove 5–7 days after surgery. Twelve patients had severe deep fascial space infections in the head and neck with a direct threat to the airway. The median time of removal of the NPWT device, the median amount of drainage fluid and the median healing time were investigated.ResultsA total of 7 male and 5 female patients with an average age of 63.2 years old were included in this study. The median time of removal of the NPWT device was 6 days (ranging from 4 to 7 days). The median amount of drainage fluid within 3 days after surgery was 420 mL (ranging from 280–760 mL), and the median time for complete wound healing was 12 days (ranging from 10 to 21 days).ConclusionThe results of this study suggest that the modification of NPWT provides various advantages and leads to excellent clinical outcomes in the treatment of severe deep fascial space infections. Future studies will focus on the safety verification of portable usage and the cost effectiveness analysis of NPWT.

The clinico-microbiological pattern of orofacial space infections in patients attending a tertiary hospital in Tanzania

Background: Fascial space infections in the orofacial region have plagued humans for centuries. The majority of these infections are of odontogenic origin and are polymicrobial in nature. This study aimed at determining the clinical and microbiological pattern of orofacial space infections in patients attending a tertiary hospital in Tanzania. Methods: This was a cross-sectional hospital-based study that included patients with pyogenic orofacial space infections. Data on the demographic pattern of the patients, clinical presentations of the disease, and results of culture and sensitivity tests were collected. For analysis, when more than two spaces were involved, the case was classified as multiple space infection. The number of microbial isolates was grouped into no isolate, monomicrobial, and polymicrobial. The significance level was set at p

Predictive factors of lethality and complications of deep fascial space infections of the neck.

to identify predictive factors for lethality and complications of deep fascial space infections of the neck (DFSIN), establishing an early and aggressive treatment in the neck before the progression to descending mediastinitis. we retrospectively analyzed 133 cases of DFSIN treated at Discipline of Head and Neck Surgery of the Medicine School of Santa Casa de Misericórdia de São Paulo. We accessed demographic characteristics, associated diseases, clinical presentation, laboratorial tests, length of hospital stay, number of involved anatomic neck spaces, intra-operative and microbiology findings. We analyzed these data using logistic regression to predict DFSIN lethality and life threatening complications (mediastinitis, septic shock, pneumonia, pleural empyema, skin necrosis). lethality and complication ratios were 9% and 50.3%, respectively. The logistic regression model showed that patients with septic shock were more likely to have progression to death (p < 0.001) and, the presence of more than two involved neck spaces (p < 0.001) and older individuals (p = 0.017) were more likely to have complicated deep neck infections. Descending necrotizing mediatinitis increased the lethality ratio by 50%, and was associated to necrotizing fasciitis (p=0.012) and pleural empyema (p<0.001). septic shock is a lethal predictive factor and age as well as more than two involved neck spaces are the predictive factors for complications. Necrotizing fasciitis is an important factor for complications and death. Therefore, its surgical treatment must be more aggressive. Descending mediastinitis has a high lethal rate and the successful treatment is based on early diagnosis and aggressive surgical approach.

Mediastinal Access for Oral and Maxillofacial Surgeons

Introduction Cardiothoracic surgical access to the mediastinum may rarely be required in the management of Oral and Maxillofacial surgical cases. Examples of such cases include of mediastinal extension of odontogenic fascial space infection and neoplastic neck disease, e.g. ectopic parathyroid adenoma, mediastinal cystic hygroma and retrosternal goitre. We present a series of cases where median sternotomy and thoracoscopic approach were required for mediastinal dissection.

The Clinical and Pathological Features of Fascial Space Infections of the Head and Neck in Patients with Diabetes Mellitus Compared to Non-diabetic Patients

The Clinical and Pathological Features of Fascial Space Infections of the Head and Neck in Patients with Diabetes Mellitus Compared to Non-diabetic Patients

Epidemiologic evaluation of maxillofacial infections and their risk factors and associated complications in a one year period in Shariati hospital in 2013-2014

Purpose: Maxillofacial infections (MIs) commonly occur in patients of all ages, representing a life-threatening challenge when reaching deep facial spaces. The epidemiologic studies of MIs and their characteristics are very important and beneficial for both patients and clinicians. Therefore, the aim of this prospective study was to determine the annual incidence, etiology, risk factors and complications of MIs in all patients who were admitted to the department of oral and maxillofacial surgery of the Shariati hospital during a 1-year period. Material and methods: The demographic data, levels of some serum markers on day of admission, such aserythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), bandemia, serum albumin, predisposing factors for each patient referred for treatment of MI were recorded by one researcher in November 2013 to November 2014. The linear regression test was used to evaluate whether there was a relationship between the amount of changes in ESR, CRP and albumin levels and age of the patients, pregnancy, gender and severity of infection. Panoramic radiography as well as axial and coronal CT scans with soft tissue window were performed for all cases, except pregnant participants. The origin of MIs, including odontogenic, pathologic and foreign body, was identified for each patient. Results:During the study period, a total of 157 patients (87 female, 70 male), with an age range of 3 to 74 years (mean, 23.5±13.2 years), were admitted to the department of maxillofacial surgery. Regardless of the gender, the most frequent cause of MIs was odontogenic sources (128 cases, 81.5%). The most common affected area was the buccal space with 106 positive cases (67.5%). The most common teeth responsible for maxillofacial fascial space infection were mandibular third molars. A positive association was found between CRP and ESR levels and the severity of infections. Serum albumin and ESR levels were significantly reduced and increased in the patients with severe infection and pregnant patients, respectively. Conclusion: The results of this study indicated that odontogenic origins were the main cause of MIs and the most common involved space was the buccal space. Diabetes mellitus was the most commonly found systemic disease among the participants of this study. The findings of this study suggest that dentists should consider that the most appropriate treatment of odontogenic infections involves surgical intervention and selection of a suitable antibiotic as an adjunct.

Outcome of Odontogenic Infections in Rural Setup: Our Experience in Management.

This study was intended to evaluate the various predisposing factors and to assess the causative microorganisms responsible for fascial space infections. A total of 124 patients who reported with an orofacial space infection of odontogenic origin were included. Following thorough evaluation, using a disposable syringe, pus sample was obtained and sent for culture and sensitivity test. Offending teeth were extracted under antibiotic coverage, and incision and drainage was done as and when indicated. The results of this study show that submandibular space (34.6%) is the frequently involved fascial space. Majority of the patients are in the second and third decade of life (46.7%). Staphylococcus species (43.7%) is the most commonly isolated microorganism. Majority of the subject gives a history of hot fomentation (64.5%). Penicillin remains to be the drug of choice. Extraction of the offending tooth under antibiotic coverage and incision and drainage as indicated remains to be treatment option when the scenario is tackled in the initial stages. Since the study was conducted in a semi-urban/rural setup, poor oral hygiene and lack of awareness for the dental health in addition to the delay in reporting to the clinician may have been the causes for the development of such fascial space infections from a small carious tooth.

Treatment of severe odontogenic infection: antibiotic management preferences of oral surgeons

Background: Severe odontogenic infections are defined as fascial space infections that require incision and drainage in an operating room setting. Appropriate antimicrobial therapy is crucial in the treatment of severe OIs. Although there is a data published on the appropriate use of antibiotics to treat these infections, prescriptions patterns seem to vary widely.

Temporal space infection secondary to recurrent buccal space infection from mandibular deciduous molar in 7-year-old child: a case report

Head and neck space infections are usually secondary to odontogenic infections due to translocation of oral microbes to fascial space via odontogenic route resulting in progression by enzymatic degradation of connective tissue. Various factors like microbiological, host, nutritional and socioeconomic factors are responsible for progression of fascial space infection that might take fatal course if not treated in time. The present case report describes a child with fascial space infection of oral and maxillofacial region who was treated by incision and drainage in department of oral and maxillofacial surgery of this hospital. Fascial space infections are one of the surgical emergencies and need to be addressed in early stage as it has rapid regional and systemic progression leading to fatal outcome. It is multifactorial and all need to be addressed. Incision and drainage with removal of cause with antimicrobial therapy is treatment modality of space infection. Inadequate drainage might lead to recurrence of infection and progression to distant secondary spaces.

Institutional microbial analysis of odontogenic infections and their empirical antibiotic sensitivity

Most purulent orofacial infections are of odontogenic origin. It is well established that odontogenic infections are polymicrobial in nature. Empiric antibiotics were administered before the culture and sensitivity test results were obtained and specific antibiotics were administered based on the culture and sensitivity test results. But resistance was a challenging problem all throughout along with development of more virulent strains of microorganisms which were more infectious and resistant to many known antibiotics. ObjectiveTo identify the causative aerobic and anaerobic micro-organisms responsible for orofacial infections and to evaluate the resistance against empirical antibiotics used in the treatment of space infections. Method142 patients with head and neck fascial space infections of odontogenic origin were randomly taken, the pus samples and aspirates were collected aseptically from patients for aerobic and anaerobic microbiological study. ResultsIn this study the most common aerobic organism isolated was streptococcus viridians (34.49%), most common anaerobe was peptostreptococci, (61.11%) and the most common mixed organism was streptococcus with peptostreptococci (30%). Amoxicillin was the most commonly used empirical drug in all cases and showed highest resistance (96.55%) for all the organisms. But linezolid (100%) was sensitive to all the aerobic, anaerobic and mixed group of organisms. Metronidazole (100%) turned out to be sensitive to the entire anaerobic group. Clindamycin (100%) appeared sensitive to the entire aerobic group. ConclusionKnowledge about the pathologic flora involved in head and neck infection in a locality and their sensitivity and resistance to commonly used antibiotics will help the clinician in administering appropriate antibiotics.