Maxillofacial Infections Research Articles

Pediatric Maxillofacial Infections During COVID-19: What Have We Learned?

BackgroundThe COVID-19 pandemic significantly affected healthcare systems worldwide, and the field of dentistry is no exception. Odontogenic infections in pediatric patients pose unique challenges to treatment and diagnosis. PurposeThe purpose of this study was to evaluate the incidence, characteristics, and treatment of pediatric maxillofacial odontogenic infections during COVID-19 compared to pre-COVID-19. Study design, setting, and sampleThis retrospective cohort study included all pediatric patients (0-18 years) who visited the emergency department (ED) at Tzafon Medical Center, Israel, between March 2020 and February 2021 (COVID-19), or between March 2018 and February 2020 (Pre-COVID-19), and were diagnosed with maxillofacial odontogenic infections. Patients with missing demographic data and patients who did not complete the medical examination were excluded. Predictor/exposure/independent variableThe exposure variable was the date of presentation, categorized as COVID-19 or pre-COVID-19. Main outcome variable(s)The main outcome variables were the proportion of patients diagnosed with odontogenic infections, hospitalization rate, treatment methods, and length of hospital stay (LOS). CovariatesCovariates included patient demographics, involved dentition and associated spaces, and the administration of antibiotics before ED arrival. AnalysesFisher exact test and Pearson's chi-squared test were applied to assess differences in categorical variables. Wilcoxon rank-sum test was used for independent variables. A logistic regression model was used to predict outcome variables. P-values were two-tailed and statistical significance was defined as p<0.05. ResultsThe study sample comprised 471 patients: 357 (76%) in the pre-COVID-19 period and 114 (24%) during COVID-19. The relative-risk of visits to the ED out of total oral and maxillofacial ED visits was lower during COVID-19 (RR=0.65, p=0.0001). The hospitalization rate increased from 72% (257 patients) pre-COVID-19 to 86.8% (99 patients) during the COVID-19 period (p=0.001). LOS during Covid-19 was significantly shorter than pre-COVID-19 (p<0.001). ConclusionsThe findings of this study reveal a significant reduction in odontogenic infection incidents referred to the ED during the pandemic. This implies that many of these incidents can be successfully treated in community healthcare settings, without referral to the ED.

Profile of Patients with Maxillofacial Space Infections and Associated Risk Factors.

To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay. We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay. A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age (P = 0.015; OR: 2.98) and evidence of bacterial culture (P = 0.001; OR:6.64) were potential predictors associated with increased hospital stay. Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.

Maxillofacial infections of dental origin

Aim: to evaluate the occurrence of maxillofacial infection cases, which were treated at local hospital, identifying the main risk factors that determine the need for hospitalization of patients and the factors associated with staying length. Methods: A retrospective review of 191 records of patients with maxillofacial infection of odontogenic origin was performed, statistically evaluated by frequency and percentage of involvement, p values (based on the chi-square test) and odds ratio with a 95% confidence interval. A p-value &lt;0.05 was considered statistically significant. Results: Among all the 191 patients, 31 had some harmful habits, such as smokers (13%) and alcoholics (1%). In addition, 39 patients reported some general health problem, such as systemic arterial hypertension (8.3%), depression (6.8%), diabetes (3.6%) and some immunosuppression (1.57%). Involvement of infection in deep facial spaces was present, with 119 patients presenting a deeper infection (62.3%) and 72 patients a superficial infection (37.7%). The most prevalent clinical signs and symptoms in the initial evaluation were pain (91.1%) and edema (90.1%), followed by erythema/hyperemia (44.5%), trismus (37.7%), abscess (30.9%), cellulitis (27.7%), f istula (16.8%), fever (16.8%), dysphagia (11%), dehydration (9.9%), odynophagia (7.9% ) and dyspnea (3.7%). Pulp necrosis was considered a risk factor for treatment in a hospital environment (0.032) and root canal treatment decreases the risk of hospitalization (p=0.002). Considering the evaluated patients, 146 (76.4%) were admitted and 45 (37.7%) were not admitted for hospitalization after initial clinical evaluation. Conclusion: there is a high occurrence of maxillofacial infection cases of dental origin, considering that involvement of infection in deeper facial spaces, as well as presence of pain, edema, erythema/hyperemia, trismus, abscess, cellulitis and pulp necrosis, represent the main risk factors for hospitalization and staying length.

Microbiological profile and antibiotic sensitivity of maxillofacial infections in an emergency hospital

Aim: To investigate the bacteriological profile of oral and maxillofacial infections and the pattern of sensitivity to a specific group of antibiotics in a reference emergency hospital in Brazil. Methods: This is a prospective cohort institutional study that studied patients affected by oral and/ or maxillofacial infections in a Brazilian emergency hospital, over a 12-month period, of different etiologies, through data collection, culture and antibiogram tests, and monitoring of the process of resolution of the infectious condition. The variables were analyzed using the chi-square and Mann-Whitney tests, using a significance level of 5%. Results: The sample consisted of 61 patients, 62.3% male. The mean age of participants was 34.3 years. Odontogenic infection was the most frequent etiology and the submandibular space was the most affected. The bacterial species Streptococcus viridans was isolated in 21.6% of cases. Levofloxacin, vancomycin and penicillin were the antibiotics with the highest frequency of bacterial sensitivity, while clindamycin and erythromycin showed the highest percentages of resistance. Conclusions: The results suggest that, among the most used antibiotics for the treatment of these infections, penicillin remains an excellent option of choice for empirical therapy.

The Global Impact on Health of Dental Infections and Antibiotic Resistance:A mini Reveiw

Dental abscesses are a common infectious process that medical professionals are aware of. The aggressiveness of the bacteria, host resistance mechanisms, and local anatomy all influence how the infection turns out. A dental abscess that spreads can have serious implications that result in a high rate of morbidity and death. Acute dental abscesses are composed of a variety of microorganisms, including facultative anaerobes like _Streptococcus anginosus_ group and _viridans_ group _streptococci_, as well as stringent anaerobes such anaerobic _cocci_, _Prevotella_, and _Fusobacterium_ species. Antibiotics are commonly prescribed to treat dental infections. The benefits of antibiotics are that they can help resolve symptoms quickly, reduce pain, and prevent systemic infections. However, antibiotics can also have negative impacts on health, such as promoting antibiotic resistance. Antibiotic resistance refers to the phenomenon where bacteria evolve to become immune to antibiotics, making them harder to treat. Bacteria can develop resistance through mutations or by acquiring resistance genes from other bacteria. The overuse and misuse of antibiotics are one of the primary causes of antibiotic resistance. Inappropriate prescribing of antibiotics for illnesses such as the common cold and flu has led to the development of antibiotic resistance. In addition, patients who do not finish a full course of antibiotics can also contribute to the evolution of resistant bacteria. This has resulted in health risks that are not just confined to treating dental infections, but also pose a significant threat to global health. MATERIALS AND METHODS: This review is based on a thorough analysis of freely accessible literature from reputable sources such as Google, Google Scholar, and PubMed. The terms used in this review include dental, oral, maxillofacial infection, resistance pattern, epidemiology, common microorganisms, nutrition components, biofilm formation, morbidity, mortality, and increased healthcare costs. Overall, this review highlights the significant impact of dental infections and resistance on global health, including increased morbidity and mortality rates and rising healthcare costs. By understanding the epidemiology and resistance patterns of common microorganisms, as well as the role of nutrition and biofilm formation in infection prevention, we can work towards developing effective strategies for managing and preventing dental infections. In CONCLUSION, the epidemiology of dental infections is an important area of study that helps us understand the prevalence, incidence, and risk factors associated with these infections. By understanding these factors, we can develop effective prevention and treatment strategies to improve oral health and overall well-being.

Reducing Hemoglobin A1C Levels in Type II Diabetes: A Retrospective Analysis of the Renew Procedure.

Periodontal disease and type 2 diabetes are interrelated, with inflammation playing a significant role in the progression of both conditions. Previous research has demonstrated the potential of various treatments, such as diet, exercise, and periodontal therapies, to improve glycemic control in diabetic patients. This study proposed a novel surgical approach, the Renew Procedure, as a potential solution to enhance glycemic control in type 2 diabetic patients with periodontal issues. The procedure involves the removal of all teeth, the elimination of oral and maxillofacial infections, the placement of dental implants, and the provision of implant-supported and implant-retained removable dentures. Preliminary findings indicated a significant reduction in HbA1c levels post-surgery, suggesting that this approach may improve overall oral health, reduce inflammation, and consequently lower HbA1c levels. Further research is necessary to confirm the efficacy of the proposed solution, but these initial results highlight the importance of addressing oral health through comprehensive strategies for diabetic and periodontitis patients.

Poorly controlled diabetes mellitus is strongly associated with descending necrotizing mediastinitis of odontogenic origin

We hypothesized that poorly controlled diabetic status may be a negative prognostic factor for acute mediastinitis of odontogenic origin, and we conducted a cohort study to verify this hypothesis. Data were collected on all consecutive patients diagnosed with maxillofacial infections of odontogenic origin who received surgical treatment in the Oral and Maxillofacial Surgery Department. All patients included in the study were divided into 4 groups based on the presence or absence of diabetes and mediastinitis. Poorly controlled diabetic status constituted our primary predictor variable, and the occurrence of descending necrotizing mediastinitis was the outcome variable. All 7 patients with poorly controlled diabetes mellitus were complicated with descending necrotizing mediastinitis. An exact Fischer test was conducted to investigate the association of poorly controlled diabetes mellitus with descending necrotizing mediastinitis in patients admitted for surgical treatment of their maxillofacial collection. The result was significant at P < .01. This study represents the first scientific attempt to associate poorly controlled diabetes mellitus with descending necrotizing mediastinitis of odontogenic origin. Our results show evidently that these patients are more susceptible to deep space infections, which subsequently spread faster and are much more difficult to control.

Maxillofacial infections in lithuanian hospitalised children and adolescents: a 17-years retrospective study.

To analyse the epidemiology, treatment, and microbiological findings of hospitalised Lithuanian children and adolescents admitted due to maxillofacial infections over a 17-years period. 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. 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. 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.

Non-odontogenic maxillofacial infections - a 17-years retrospective cohort study.

A retrospective 17-year review of the epidemiology, microbiological aspects, and treatment of patients hospitalized for non-odontogenic maxillofacial infections. 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. The mean (sd) annual incidence of non-odontogenic maxillofacial infections over the past 17years 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. Longer hospital stays were associated with older age (≥ 65years), 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.

Systemic Inflammatory Response Syndrome and Serum Procalcitonin in Odontogenic Maxillofacial Infection

INTRODUCTION: The systemic inflammatory response syndrome (SIRS) is a progressive, pathophysiological process which may be caused by a variety of clinical precursor events including local or generalized infection, or non-infective inflammatory process.&#x0D; АIM: To determine the development of systemic inflammatory response syndrome (SIRS) and serum procalcitonin level in patients with odontogenic infection of the maxillofacial area.&#x0D; MATERIALS AND METHODS: The prospective observational study evaluated on 158 medical patients from 2015 to 2018 at the Department of maxillofacial surgery, Faculty of Stomatology, Vitebsk state medical University. The patients were divided into 3 groups: 1 group (96 people) had acute purulent odontogenic osteomyelitis of mandible complicated by the cellulitis of one space cellular spaces, group 2 (36 patients) had acute purulent odontogenic osteomyelitis of mandible complicated by the cellulitis of 24 cellular spaces, group 3 (26 people) had acute purulent odontogenic osteomyelitis of the mandible complicated by Ludwig's angina. Blood tests of all patients were performed. Based on the blood test, breath rate, heart rate and body temperature SIRS was determined.&#x0D; RESULTS: Acute odontogenic osteomyelitis, complicated by cellulitis, is characterized by the development of SIRS. In case of one cellular space cellulitis SIRS developed in 9.0% of patients, in case of 24 cellular spaces cellulitis in 36.0%, in case of Ludwig's angina in 80.0%. PCT blood level in healthy group was 0.009 (0.0060.018) pg/ml. All patients groups had significantly higher PCT blood level compared with the healthy group: 1 group 0.034 (0.0190.050) pg/ml, U = 23, р = 0.01; 2 group 0.11 (0.060.24) pg/ml, U =12, р = 0.003; 3 group 0.41 (0.301.15) pg/ml, U = 17, р 0.001.&#x0D; CONCLUSION: Odontogenic maxillofacial infection is accompanied by SIRS. The search for significant diagnostic criteria for the development of life-threatening conditions should continue.

Inflammatory Markers as Predictors for Prolonged Duration of Hospitalization in Maxillofacial Infections.

Despite the progress made in diagnosing and treating maxillofacial infections, the course of infection can be unpredictable, leading to severe complications, prolonged hospitalization, and substantial financial costs to health care services. It is important to determine whether various serum inflammatory marker levels on admission may predict a prolonged hospital stay in these patients. To analyze the role of CRP, white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR) in predicting the prolonged duration of hospitalization in maxillofacial infections, we performed a retrospective study by collecting paper records data from 108 patients who met our inclusion criteria. The patients were divided into two groups according to the duration of hospitalization (group A < 5 days and group B ≥ 5 days). The predictor variables were CRP, WBC, and NLR, and the outcome variable was the duration of hospitalization. This study confirmed a positive linear correlation (p < 0.001) between the predictors and the outcome variable. The optimal cut-off values for WBC are 11,030 white blood cells/μL and 63 mg/L for CRP. Levels that exceed these optimal values predict a duration of hospitalization of over (≥) 5 days. Serum WBC and CRP on admission may predict the duration of hospitalization in patients with MFI.

Oral &amp; Maxillofacial Space Infections-A 10-Year Retrospective Study

Oral &amp; Maxillofacial Space Infections-A 10-Year Retrospective Study

Maxillofacial infections in a tertiary hospital in São Paulo, Brazil - A two-year retrospective study

Maxillofacial infections in a tertiary hospital in São Paulo, Brazil - A two-year retrospective study

Mediastenitis as a complication of maxillofacial infection: features of diagnosis and treatment

Mediastenitis as a complication of maxillofacial infection: features of diagnosis and treatment

Presepsin assessment in maxillo-facial infections: a new early biomarker of sepsis?

Odontogenic infections can cause serious inflammatory problems of the soft and hard tissues in the maxillofacial area up to, albeit in quite remote circumstances, involvement of the brain tissues. In recent years, therefore, a holistic diagnostic-therapeutic approach has been developed in the management of odontogenic infections by carrying out a careful systemic history of the patient who has an infectious condition in the oral cavity. The early detection of systemic sepsis conditions was facilitated using serum biomarkers such as PCR, Procalcitonin (PCT) and Presepsin (PSEP) in hospital emergency rooms. However, even if used in combination, their diagnostic accuracy is such as to suggest the importance of researching new, more specific, and sensitive biomarkers. A total of 9 articles was analyzed to investigate the use of the PSEP as biomarker in the maxillo-facial region infections and including only English-language articles and the electronic search of publications from 1 January 2017 to 31 December 2021. This study aimed to determine the diagnostic value of presepsin in condition of sepsis derived from an odontogenic infection and to evaluate its use in the prognostic evaluation phase of surgical interventions performed in the maxillofacial area.

Microbial Flora and Their Antibiotic Susceptibility in Oral and Maxillofacial Infections at BPKIHS: A Prospective Observational Study

Background: We aimed to find out the causative bacteria involved in oral and maxillofacial infections, and to evaluate the antibiotic susceptibility by pus culture and sensitivity test. Methods: This prospective observational study conducted over a one- year period enrolled all 41 consecutive patients with features of oral and maxillofacial infections visiting the oral and maxillofacial surgery clinic at the university hospital of B. P. Koirala Institute of Health Sciences. Pus was collected on a sterile syringe and sent to the microbiology laboratory. Pus samples were inoculated in 5% sheep blood agar and MacConkey agar and incubated at 37°C for 48 hours. Identification of the bacterial colony was done by gram staining and different biochemical tests. Antibiotic susceptibility tests were done by disc diffusion method on Mueller-Hinton agar as per CLSI guidelines. Results: Out of 41 patients, 22 were male and 19 were female patients. The average age of the patients was 41.63 years. Odontogenic infection (17, 41.46%) was found to be the most common. Submandibular space (15, 36.59%) was the most common fascial space involved. The most common organism cultured was Enterococcus faecalis (13, 31.71%). The antibiotic susceptibility pattern of the isolates showed that 50% of the cultured organisms (n = 8) were resistant to Penicillin; five of them were Enterococcus faecalis and three were Staphylococcus aureus. Conclusion: We found that Enterococcus faecalis as the common organism causing oral and maxillofacial infections with high resistance to Penicillin.

Functionalized Prussian Blue Nanozyme as Dual-Responsive Drug Therapeutic Nanoplatform Against Maxillofacial Infection via Macrophage Polarization.

Maxillofacial infection is a common disease in stomatology and is difficult to treat owing to its high potential to spread to vital anatomical structures. Excessive levels of reactive oxygen species (ROS) in infected tissues lead to cellular damage and impede tissue regeneration. However, uncontrollable strategies to remove ROS have limited therapeutic efficacy. Nanoparticle systems for scavenging ROS and remodeling the inflammatory microenvironment offer much promise in the treatment of maxillofacial inflammation. Here, a novel microenvironment-stimuli-responsive drug delivery nanoplatform (HMPB@Cur@PDA) based on a polydopamine (PDA)-functionalized hollow mesoporous Prussian blue (HMPB) nanozyme was developed for the delivery of curcumin (Cur) in the treatment of maxillofacial infection. Low pH and excess ROS in the inflammatory microenvironment cause degradation of the outer PDA layer of the nanocomplex, exposing the HMPB nanozyme and loaded Cur, which synergistically act as a ROS scavenger and anti-inflammatory agent, respectively, and induce macrophage polarization from the pro-inflammatory M1 to the anti-inflammatory M2 phenotype. Experiments in vitro provided strong evidence for the application of novel nanocomplexes in scavenging multiple ROS and inhibiting lipopolysaccharide-induced inflammation. In addition, in vivo results obtained using a mouse maxillofacial infection model demonstrated that HMPB@Cur@PDA had excellent biocompatibility, significantly attenuated the inflammatory response in periodontal tissue, and improved the repair of damaged tissue. Our results indicate that HMPB@Cur@PDA nanocomposites have great potential for ROS regulation as well as having anti-inflammatory effects, providing new insights for the development of dual-response maxillofacial infection treatments.

Relationship of Diabetes Mellitus Among The Patients Reporting With Fascial Space Infection

Objective: To determine the frequency of diabetic patients having Odontogenic Maxillofacial space infections in local population. Methodology: This cross sectional study was carried out from 1-3-2020 to August 2020 in the Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, to assess the frequency and association of diabetics with facial space infection. A total of 70 patients of both genders with Odontogenic maxillofacial infection were included in the study. Patients were stratified into three age groups; Age group 1 was from 18-30, Age group 2 from 31-45 years and Age group 3 from 46-60 years. This form includes demographic data (age, gender, contact information, address), medical history (diabetic or non-diabetic) along with sign and symptoms were noted in the Performa. The SPSS version 20.0 was used to analyze the data. Mean and standard deviation was calculated for age. Frequency and percentages were used for the gender and diabetes mellitus. Results: A total of 70 patients having Odontogenic maxillofacial space infection. Of these 70 study cases, 42 (60%) were females and 28 (40%) were males with mean age of 40.97±10.32 years. Out of 70 patients, 55 (78.57%) were diabetic and 15 (21.43%) patients were non-diabetic patients. Conclusion: Diabetic patients are more prone to Odontogenic maxillofacial space infections and due to poor diabetic control multispace infection along with severe complications may occur.

Effect of procalcitonin on the severity and prognostic value of elderly patients with a severe infection of oral and maxillofacial space.

This study aimed to investigate the effect on the severity and prognostic value of serum procalcitonin for elderly patients with oral and maxillofacial infections. We divided 163 elderly patients with severe oral and maxillofacial infection into survival and death groups according to the prognosis between June 2015 and May 2021, measured serum procalcitonin by enzyme-linked immunosorbent assay on the 1st, 2nd, 3rd, 5th, and 7th day after admission for the dynamic changes of serum procalcitonin level, collected the general physiological and biochemical indexes for the scores of acute physiology and general chronic condition, compared the correlation between serum procalcitonin, mean platelet count and APACHE score, analyzed the prognostic value of serum procalcitonin levels at different time after admission by ROC curve. The serum procalcitonin level increased significantly in both groups after admission, sharply increased at first and then rapidly decreased in the survival group, and continued to rise or declined slowly with fluctuation of high level in the death group. There was a negative correlation between serum procalcitonin level and mean platelet count (r = −0.698, P < .05) and a positive correlation between serum procalcitonin and APACHE II (R = 0.803, P < .05). The ROC curve showed that the serum procalcitonin level had little value on the first day and great value on the third day in predicting the prognosis of elderly patients with severe oral and maxillofacial infection (PCT1d = 0.539, PCT3d = 0.875, P < .05). The serum procalcitonin level is correlated with the severity of the disease in elderly patients with severe oral and maxillofacial space infection. Dynamic observation of it is helpful for the prognosis judgment of patients. After admission, serum procalcitonin level on the third day has a great value for the prognosis judgment of elderly patients with severe oral and maxillofacial space infection.

MRI of odontogenic maxillofacial infections: diagnostic accuracy and reliability

ObjectivesTo 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.MethodsA 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.ResultsOf 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.ConclusionsEmergency 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.