Maxillofacial Space Infection Research Articles

Rising incidence of severe maxillofacial space infections in Germany

ObjectivesSevere maxillofacial space infection (MSI) as an end stage of dentoalveolar diseases or complication of sialadenitis is a potentially life-threatening disease accompanied by complications including airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis and acute respiratory distress syndrome. The aim of this study was to analyze the incidence and time trends of severe MSI and potentially influencing factors in the German healthcare system over time.Materials and methodsNationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. A retrospective analysis of incidence and time trends of MSI-associated procedures classified with the Operation and Procedure Classification System (OPS), were statistically evaluated using Poisson regression analysis between 2005 and 2022 and were associated with different epidemiological factors.ResultsThe total standardized incidence rate of MSI-associated procedures in the observational period 2005—2022 was 9.8 (♀8.2; ♂11.4) per 100,000 person years. For all age groups a significant increase of 46.1% in severe MSI – related surgical interventions was registered within the observational period. The largest increase (120.5%) was found in elderly patients over 80 years. There were significant differences of the incidences of MSI-associated surgeries between the different federal states in Germany.ConclusionsSevere MSI are a growing challenge in German health care especially among elderly patients over 80 years.Clinical relevanceSevere MSI is a promising target for prevention. There should be more focus in primary dental and medical care especially in groups depending on social support.

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.

Neutrophil to lymphocyte ratio in odontogenic infection: a systematic review

BackgroundWe conducted this systematic review to compile the evidence for the role of neutrophil to lymphocyte ratio (NLR) in odontogenic infection (OI) and to determine whether NLR is elevated in patients with OI. This was done to aid physicians in better understanding this condition for clinical management.MethodsThe search was conducted on PubMed, Scopus, and Web of Science libraries on March 30, 2023. Two reviewers independently screened the studies using Endnote software. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the studies.ResultsA total of nine studies were included in the review. Among patients with OI, positive and statistically significant correlations of NLR were seen with more severe disease, a prolonged hospital stay, postoperative requirement of antibiotics, and total antibiotic dose needed. In the receiver operating characteristics (ROC) analysis, the optimum cut–off level of NLR was 5.19 (specificity: 81, sensitivity: 51). In addition, NLR was correlated with preoperative fever (p = 0.001). Among patients with Ludwig’s Angina, NLR could predict disease severity and length of stay in the hospital (p = 0.032 and p = 0.033, respectively). In addition, the relationship between the NLR and mortality was statistically significant (p = 0.026, specificity of 55.5%, and sensitivity of 70.8%). Among patients with severe oral and maxillofacial space infection, a positive correlation was found between IL-6 and CRP with NLR (rs = 0.773, P = 0.005 and rs = 0.556, P = 0.020, respectively). Also, a higher NLR was considered an essential predictor of organ involvement (P = 0.027) and the number of complications (P = 0.001). However, among diabetes mellitus (DM) patients afflicted with submandibular abscesses, NLR had no association with therapeutic response.ConclusionsMany people around the world suffer from OI, and a cheap and fast biomarker is needed for it. Interestingly, inflammation plays a role in this infection, and elevated NLR levels can be a good biomarker of inflammation and, as a result, for OI progression.

A retrospective study of ludwig’s angina at the maxillofacial unit of the komfo anokye teaching hospital-kumasi, Ghana.

Introduction: Ludwig’s angina is a potentially life-threatening diffuse cellulitis involving the sublingual, submental, and submandibular spaces bilaterally and causing progressive airway obstruction. The microbiology of Ludwig’s angina is polymicrobial, but commonly isolated is Streptococcal spp. Aim: The current study aimed to retrospectively evaluate the prevalence of Ludwig’s angina at the Maxillofacial Unit of the Komfo Anokye Teaching Hospital, Ghana. Materials & Methods: A 2-year retrospective analysis of patient records from January 2012 to December 2013 was undertaken. The studied variables included the aetiology, symptoms, signs, and treatment modalities. Descriptive analysis was done using charts, frequency, and tables.Results: The total number of admissions for maxillofacial space infections was 224, comprising 128 males and 96 females. The number of patients with Ludwig’s angina was 56, giving a prevalence rate of 25.0%. The commonest source of infection was of odontogenic origin (94.6%), and the teeth most involved were the first lower molars (37.5%). The predominant microorganisms isolated were E.coli, Klebsiella, and Pseudomonas spp. The majority of patients (94%) were managed medically and surgically with incision, drainage, and insertion of drains as well as extraction of affected teeth. The commonest antibiotic combination was amoxicillin/clavulanate potassium with metronidazole (65.5%), followed by crystalline penicillin with metronidazole (12.7%). Conclusion: The commonest cause of Ludwig’s angina was odontogenic, and the microorganisms cultured were E. coli, Klebsiella, and Pseudomonas. The commonest antibiotic combination used for treatment was amoxicillin/clavulanate potassium with metronidazole.

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.

Risk Factors for Maxillofacial Space Infection Complications: A Retrospective Analysis of 457 Patients.

This study was performed to determine the risk factors associated with systemic complications of maxillofacial space infection (MSI), and to propose an objective evaluation index - severity score of MSI. 457 MSI patients from Jan 2010 to Dec 2020 were reviewed retrospectively. The predictor variables included demographic, origin of infection, underlying systemic disease, pre-hospital medication history, laboratory examinations and severity scores of space infection. The severity score of space infection was proposed to evaluate the airway compromise of anatomic spaces. The primary outcome variable was the complication. The impact factors of complications were analyzed using univariate analysis and multivariate logistic regression. 457 patients were included (average age 46.3y, male to female ratio 1.43:1). Among them, 39 patients developed postoperative complications. In the complication group, there were 18 patients (46.2%) with pulmonary infection, and two patients died. We found that the history of diabetes mellitus (OR=4.74, 95% confidence interval (CI)=2.22, 10.12), high temperature (≥39°C) (OR=4.16, 95% CI=1.43, 12.06), advanced age (≥65y) (OR=2.88, 95% CI=1.37, 6.01), and severity score of space infection (OR=1.14, 95% CI=1.04, 1.25) were independent risk factors for complications of MSI. All the risk factors needed to be closely monitored. Severity score of MSI was an objective evaluation index to predict complications.

Comparison of Odontogenic Space Infection in Diabetic and Non-Diabetic Patients

Objective: This study aimed to assess and compare the etiology; odontogenic spaces involved, and associated complications between diabetic and non-diabetic patients. Methodology: A cross-sectional study was conducted at the Nishtar Institute of Dentistry, Multan, between October 2021 and March 2022. The study population included 37 participants selected through consecutive non-probability sampling. Eligible participants were individuals of both sexes, aged 18 to 60, with an odontogenic infection. Exclusion criteria comprised localized dental abscesses without fascial space involvement, infections unrelated to odontogenic origin, and unwillingness to participate. Data on demographic characteristics and clinical findings were collected using a self-structured questionnaire. Statistical analysis was performed using SPSS version 20.0, calculating the mean, standard deviation, frequency, and percentages. Statistical significance was set at p < 0.05. Results: The study enrolled 37 patients diagnosed with odontogenic maxillofacial space infections. Among them, 15 (40.5%) were female, and 22 (59.5%) were male, with a mean age of 31.51 years (SD 9.642). Of the participants, 23 (62.2%) had diabetes, while 14 (37.8%) were non-diabetic. Conclusion: The results of this research suggest that diabetic patients are more susceptible to odontogenic infections, specifically dental caries. Additionally, diabetic patients demonstrated a higher prevalence of multiple involved spaces and an increased likelihood of developing complications. Keywords: odontogenic infection, diabetes mellitus, odontogenic space, complications

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

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

Oral and maxillofacial emergencies: A retrospective study of 5220 cases in West China.

There are no epidemiological reports focused on the oral and maxillofacial surgery emergency department in the West China Hospital of Stomatology. The aim of this study was to analyse the epidemiological characteristics of emergency patients admitted for Trauma and Plastic Surgery Department of the West China Hospital of Stomatology from 2016-2019. In this retrospective study, 5220 patients with complete medical records were evaluated. The following data were collected: gender, age, etiology, disease type distribution, anatomic injury site and treatment modality. There were 3046 males and 2174 females (ratio 1.40:1), with an average age of 16.2 years. The largest group was children aged between 3 and 6 years old (28.3%). Maxillofacial injuries were the most common condition (87.3%), which mostly occurred on the forehead (29.7%), followed by the lips (27.8%). A fall was the leading cause of injury (59.9%), especially in patients younger than 6 years old. There were 327 cases of maxillofacial space infections (MSI), and the mandibular third molars were the most common tooth associated with odontogenic infections (36.2%). Univariable analysis identified that multiple-space infection, visit time and systemic conditions were the risk factors for being admitted to the hospital for treatment. There were 116 patients (2.2%) with bleeding as the main complaint, and most of the maxillofacial bleeding patients could be stopped by compression (52.6%). Males and children aged younger than 6 years were the highest risk populations. Trauma accounted for the majority of emergency patients in maxillofacial surgery. Most maxillofacial injuries involved the forehead and were mainly caused by accidental falls. The proportion of MSI was not high, but serious cases may be life-threatening. The causes of bleeding were diverse, and the bleeding was easy to control.

Metagenomic next-generation sequencing for the diagnosis of oral and maxillofacial space infections

Background/purposeMetagenomic next-generation sequencing (mNGS) has been widely used for the detection of pathogens causing infectious diseases. This study aimed to evaluate the potential ability of mNGS to detect pathogens causing oral and maxillofacial space infection (OMSI) and compare the results with those of the traditional diagnostic microbial culture method. Materials and methodsWe retrospectively reviewed the data of 218 patients diagnosed with OMSI who underwent microbial culture and mNGS at the Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, from July 2020 to January 2022. ResultsThe positivity rate of mNGS (216 cases) was significantly higher than that of microbial culture (123 cases). The most frequently detected bacteria were different between these two detection methods. Streptococcus constellatus (16.05%, 35), Streptococcus anginosus (15.69%, 34) and Klebsiella pneumoniae (6.88%, 15) were the most commonly isolated bacteria by culture. However, Peptostreptococcus stomatis (61.47%, 134), Parvimonas micra (68.35%, 149) and Streptococcus constellatus (57.34%, 125) were the most commonly detected bacteria by mNGS. mNGS also has advantages in diagnosing viral infections. The optimal numbers of diagnostic reads were 1162 and 588 for the diagnosis of Streptococcus anginosus and Streptococcus constellatus infections, respectively. Read numbers were significantly correlated with C-reactive protein (CRP), procalcitonin (PCT), and blood glucose levels and neutrophil percentage (NEUT%). ConclusionFor pathogens causing OMSI, mNGS had a higher rate of microbial pathogen detection and remarkable advantages in identifying coinfections involving viruses and fungi. The read numbers for mNGS are important for diagnostic accuracy and disease severity evaluation.

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.

A Five-Year Retrospective Study of 746 Cases with Maxillofacial Space Infection in Western China.

PurposeTo grasp the current epidemiological situation of maxillofacial space infection and investigate the risk factors contributing to the longer hospitalization of odontogenic space infection in western China.Patients and MethodsThis retrospective study collected the clinical characteristics from 746 hospitalized patients with maxillofacial space infection and investigated the risk factors associated with longer hospitalization. Pearson’s chi-square test and multivariable binary logistic regression were performed for statistical analysis.ResultsA total of 438 males and 308 females were included in this study, aging from 1 to 90 years (mean age 48.6 years). 74.9% cases resulted from odontogenic infections, with the submandibular space being the most commonly involved space (53.7%). Advanced age (OR (>60 y:19–60 y:≤18 y) = 3.784:3.416:1, p < 0.05), treatment before admission (OR = 2.271, p < 0.05) and number of involved spaces (OR (≥4:2–3:1) = 3.204:1.931:1, p < 0.05) were closely related to longer hospitalization. Streptococcus being the most frequently found aerobic bacteria (268/615, 43.6%) of all the bacteria isolated was resistant to clarithromycin (91.5%) and erythromycin (92.8%).ConclusionHospitalization time could be longer for patients with the identified risk factors. Streptococcus, as the most common type of aerobic flora, is highly resistant to clindamycin and erythromycin.

Principles of treatment for severe maxillofacial infection in pregnant women

AbstractObjectiveTo explore the principles of the surgical treatment of severe dental and maxillofacial infections in pregnant women.MethodsThere were eight pregnant women, gestational age of 20–35 weeks, diagnosed with maxillofacial cellulitis, caused by inflammation of the lower third molar. Surgeries were performed through incision and drainage intro or extraoral, systemic antibiotic treatments were also arranged, and the inflammation was cured.ResultsInfections of all patients were controlled within 1 week, Pregnancies were continued to spontaneous delivery by five patients, three patients gave birth immediately after acute inflammation control, and one patient accepted facial scar surgery 6 months after delivery.ConclusionSurgery is a good treatment method for curing severe maxillofacial space infection in pregnant women. Grasping the principle of surgery is the key to ensuring the safety of the mother and foetus.

Overlapping infection of Nocardia farcinica and Aspergillus fumigatus in a child with X-linked chronic granulomatous disease: a case report

BackgroundChronic granulomatous disease (CGD) is a rare inherited primary immunodeficiency syndrome, manifested as recurrent infections and inflammatory complications. Although prophylactic treatment with antibiotics and antifungals improved the outcome of CGD patients, infections remain the major cause of mortality.Case presentationA boy aged 3 years and 8 months was admitted to hospital complaining of lip swelling with fever for half a month and neck abscess for 11 days. After a thorough examination, severe pneumonia, respiratory failure, oral and maxillofacial space infection, and perianal abscess were confirmed. However, his condition didn’t improve after initial comprehensive therapy. Subsequently, overlapping infections of Nocardia farcinica and Aspergillus fumigatus were identified by metagenomic next-generation sequencing. He was treated with imipenem, linezolid, and voriconazole intravenously, plus taking oral compound sulfamethoxazole. Later, his condition improved. Through whole-exome sequencing, the child was ultimately diagnosed as X-linked chronic granulomatous disease (X-CGD) caused by CYBB gene mutation. Allogeneic hematopoietic stem cell transplantation was the potential sanative approach but there were no available human leukocyte antigen compatible donors for the child. The family requested to transfer to a superior hospital for further treatment. Two months later, we followed up the child’s family. Unfortunately, the child had expired due to severe infection.ConclusionTo our knowledge, this is the first case of overlapping infection of Nocardia farcinica and Aspergillus fumigatus identified by metagenomic next-generation sequencing in a child with X-CGD from China. For infectious pathogens that are hard to diagnosis by traditional detection methods, metagenomic next-generation sequencing is recommended as an adminicle or indispensable approach for microbial identification. Patients with X-CGD have poor prognosis, early diagnosis and intervention of X-CGD may reduce the mortality.

Clinical manifestations and treatment of oral and maxillofacial space infections with a third molar origin

AbstractObjectiveThis study aimed at evaluating the clinical manifestations and therapeutic options for oral and maxillofacial space infections originating from the third molar.MethodsClinical data for 60 patients with oral and maxillofacial space infections with a third molar origin who were treated between June 2016 and December 2020 in the Department of Oral and Maxillofacial Surgery of the Affiliated Hospital of Qingdao University were collected. Based on whether they were diabetic or not, patients were assigned into two groups: the diabetes mellitus (DM) group and the non‐DM group. The collected basic information included gender, age, systemic diseases, etiology and infected areas, whereas treatment information included antibiotic administration, length of hospitalisation, costs, bacteria and sensitivity tests as well as associated complications.ResultsOf the 60 patients, 36 were males while 24 were females with an age range of 21–51 years. A total of 32 patients exhibited third molar pericoronitis, whereas 26 patients had deep neck space or chest cavity infections. Compared to the non‐DM group, the length of hospital stay was relatively longer while antibiotic administration was higher in the DM group. The conformance rate of empirical antibiotic use and drug sensitivity tests was 64.9% (37/57).ConclusionDM is a risk factor for oral and maxillofacial space infections. Space infections with third molar origins are associated with serious complications. Based on patient's conditions, treatment plans should be comprehensively evaluated and personalised treatment plans formulated. Antibiotic administration by clinicians is not standardised; therefore, it is important to make adjustments depending on subsequent bacterial culture results.

Distribution of bacteria infected by metagenomic sequencing technology in maxillofacial space.

This study aimed to compare and analyze the consistency and difference between metageno-mic next-generation sequencing (mNGS) and conventional bacterial culture in the detection of pathogenic microorganisms in maxillofacial space infection, as well as to provide a new detection method for the early clinical identification of pathogenic bacteria in maxillofacial space infection. The clinical data of 16 patients with oral and maxillofacial space infections in the First Affiliated Hospital of Zhengzhou University from March 2020 to June 2020 were collected. mNGS and conventional bacterial culture methods were used to detect pus. We then analyzed and compared the test results of the two methods, including the test cycle, positive detection rate, anaerobic bacteria, facultative anaerobes and aerobic bacteria detection rates, distribution of pathogenic bacteria, relative species abundance, and resistance genes. The average inspection period of mNGS was (18.81±3.73) h, and the average inspection period of bacterial culture was (83.25±11.64) h, the former was shorter than the latter (P<0.05). The positive detection rate of mNGS was 100% (16/16), and the positive detection rate of conventional bacterial culture was 31.25% (5/16), the former was higher than the latter (P<0.05). The detection rate of mNGS anaerobic bacteria was 93.75% (15/16), the detection rate of bacterial culture anaerobes was 0 (0/16), the former was higher than the latter (P<0.05). Using mNGS, the detection rate of facultative anaerobes in bacterial culture was 75.00% (12/16), and the detection rate of facultative anaerobes in bacterial culture was 25.00% (4/16), the former was higher than the latter (P<0.05). The detection rate of aerobic bacteria in bacterial culture was 12.50% (1/16), the former was higher than the latter (P>0.05). mNGS detected 15 kinds of pathogenic bacteria, among which 3 were Gram positive, 12 were Gram negative, 49 were non-pathogenic, 16 were Gram positive, and 32 were Gram negative, 1 was fungus. Compared with conventional bacterial culture, mNGS has the characteristics of short test time, high sensitivity, and high accuracy. Thus, it is a new detection method for the early identification of pathogenic bacteria in maxillofacial space infection and is beneficial to the early clinical diagnosis and treatment of the disease.

Expert consensus on the treatment of oral and maxillofacial space infections

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts' expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig's angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Clinical analysis and countermeasures of 739 cases treated in the emergency department of stomatology in general hospital during COVID-19 epidemic

Purpose In this paper, based on the age, sex, disease type, and consultation time of dental emergency during COVID-19 epidemic, a comprehensive analysis of dental emergency management and prevention and control of COVID-19 was conducted. Methods A total of 739 emergency dental cases were collected from January 29 2020 to February 28 2020. They were divided into 3 groups，including adolescents (≤18 years), young adults (18 ~ 60 years), and elderly ( ≥60 years old). The data was analyzed using SPSS 21.0 software package. Results The ratio of male to female was 1.24∶1. There were 655 emergency cases during the day and 84 cases during the night. The types of diseases included pericoronitis (15.83%), apical periodontitis (14.21%), pulpitis (13.40%), periodontitis (12.31%), oral mucosal disease (12.18%), Oral and maxillofacial trauma (10.55%), oral and maxillofacial space infection (8.39%), dental disease in children (5.41%), oral and maxillofacial tumors (2.84%), temporomandibular joint dislocations and disorders (1.76%), and others (3.11%). Conclusions Under the epidemic situation of the new coronavirus, as one of the high-risk departments, it is of great significance to enhance the clinical emergency skills and ability of emergency treatment, improve patients' oral health awareness, address the diagnosis and treatment of essential diseases, for the improvement the quality of dental medical care and the prevention and control of COVID-19 epidemic.

The Predictive Value of Interleukin-6 and Neutrophil-Lymphocyte Ratio in Patients with Severe and Extremely Severe Oral and Maxillofacial Space Infections.

Objective To investigate the correlation between clinical manifestation and neutrophil-lymphocyte ratio, C-reactive protein (CRP), and interleukin-6 (IL-6) in the patients with severe and extremely severe oral and maxillofacial space infection (OMSI). Methods In this retrospective study, we included 18 patients with severe and extremely severe OMSI from November 2012 to October 2018. Pearson or Spearman correlation coefficients were calculated to measure the association between the number of complications and locations and the number and percentage of lymphocyte, leukocyte, neutrophil, eosinophil, basophil, monocyte, CRP, and IL-6. A multivariable regression model was used to predict the number of complications and locations from these measures. Results IL-6 was positively correlated with neutrophil-lymphocyte ratio (rs = 0.773, P = 0.005), percentage of neutrophil (rs = 0.927, P = 0.001), and the number of neutrophil (rs = 0.627, P = 0.039). It was negatively correlated with percentage of monocyte (rs = −0.773, P = 0.005). CRP was positively correlated with neutrophil-lymphocyte ratio (rs = 0.556, P = 0.020) and percentage of neutrophil (rs = 0.515, P = 0.035). It was negatively correlated with the number of lymphocyte (rs = −0.517, P = 0.017), percentage of lymphocyte (rs = −0.578, P = 0.015), number of eosinophil (rs = −0.560, P = 0.020), percentage of eosinophil (rs = −0.504, P = 0.039), number of basophil (rs = −0.504, P = 0.039), and percentage of basophil (rs = −0.548, P = 0.023). The number of the involved organs was positively correlated with neutrophil-lymphocyte ratio (rs = 0.511, P = 0.030). The number of complications was positively correlated with the percentage of neutrophils (r = 0.738, P = 0.001), the neutrophil-lymphocyte ratio (r = 0.576, P = 0.012), IL-6 (rs = 0.907, P = 0.001), and CRP (rs = 0.599, P = 0.011). Multivariable regression analysis showed that the neutrophil-lymphocyte ratio (β = 0.080) was a significant predictor of the number of the involved organs and the neutrophil-lymphocyte ratio (β = 0.099). In addition, IL-6 (β = 0.002) was a significant predictor of the number of complications. Conclusions The neutrophil-lymphocyte ratio and IL-6 contributed to the assessment of general condition in severe and profound OMSI patients. These parameters can be used as predictors to evaluate the severity of OMSI.