Maxillofacial Space Infection Research Articles

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.

Maxillofacial space infection experience and risk factors: a retrospective study of 222 cases.

Maxillofacial space infection (MSI) experience review is beneficial for its management. To identify potential risk factors predisposing to the exacerbation of MSI and a prolonged length of stay (LOS). We performed a comprehensive retrospective review of medical records of 222 MSI patients admitted in Center of Stomatology during 1993-2019. About 63.5% of 222 patients had an odontogenic infection, and submandibular space was the most involved space. Streptococcus spp. was the most common organism isolated (72.4%). Multiple-space cases had more systemic diseases, respiratory difficulty, and life-threatening complications and exhibited worse clinical characteristics (higher white-blood-cell-count, higher body temperature, and restricted mouth opening) than single-space cases (P< 0.05). No significant difference in LOS was found between multiple-space cases and single-space cases. Diabetes and hypertension both accounted for 35.1% in life-threatening cases. Multiple-space infection (60.4%), respiratory difficulty (11.7%), and systemic conditions (43.2%) were identified as critical risk factors associated with life-threatening complications in MSI patients (P< 0.001). A significantly prolonged LOS was found in cases aged ≥ 60years or with systemic diseases. Community outpatient treatment shortened 1.9days of LOS compared with self-medication before admission during 2010-2019 (P< 0.05). Comprehensive managements are advisable for MSI patients with multiple-space infection, respiratory difficulty, systemic diseases to avoid disseminated exacerbation, and occurrence of life-threatening complications. Community outpatient treatment was beneficial to a reduced LOS. Timely access to dental outpatient management and simultaneously steady control of diabetes and hypertension was advocated. Improved coverage of insured dental outpatient treatment should be stressed.

Negative pressure drainage‐assisted irrigation for maxillofacial space infection

In this study, the clinical effect of negative pressure drainage-assisted irrigation (NPDI) technique was evaluated in treating maxillofacial space infection (MSI) by comparing with traditional technique. A prospective study was conducted in 58 patients with MSI. The patients were randomly divided into two groups based on different treatment techniques. Thirty patients receiving NPDI were included in NPDI group, and 28 patients receiving traditional technique were included in traditional group. Case data (gender, age, etiology, concurrent illness, diabetes, involved spaces, preoperative white cell count, airway control method) and clinical effect (postoperative hospital stay, total cost of admission) for the two groups were analyzed. Patients in both groups were cured clinically. There were no significant differences in gender, age, etiology, concurrent illness, diabetes, involved spaces, preoperative white cell count, and airway control method in NPDI group and traditional group (p>.05). The postoperative hospital stay and the total cost of admission in the NPDI group were significantly lower than the traditional group (p<.001). Negative pressure drainage-assisted irrigation used in the treatment of MSI can shorten the postoperative hospital stay, reduce the total cost of admission, and show favorably clinical effect. It is a clinically recommended method for MSI.

Correlates of illness behaviour related to orofacial infections of odontogenic origin among adults in a semi urban community in Nigeria.

Infections of facial spaces in the maxillofacial region occur in most cases as a complication of odontogenic infections. It often results in substantial morbidity, with serious and potentially life threatening outcomes if allowed to progress without prompt medical attention. To identify factors that determine illness behaviour related to maxillofacial space infections. This was a descriptive cross-sectional study of adult residents of pakoto community, Ifo local government area, Ogun state. The study was conducted using an interviewer administered questionnaire which included key information about respondents' awareness of predisposing factors of maxillofacial space infections; common actions taken with regards to treatment, and the factors that influenced their utilization of the available oral health care service. A total of 187 individuals were sampled, mean age was 30.5(SD 11.7) years with majority being females (59.4%) The proportion of the total respondents who reported a history suggestive of orofacial space infection was 20.3% (n=38). Visiting a patent medicine dealer (26.3%) along with visiting a dentist (31.6%) were the illness behaviours most frequently engaged in by respondents who have had an orofacial swelling following a toothache, with majority (73.7%) indicating the action they took was based on what was most convenient. This study has revealed that engagement in unorthodox practises by individuals in a semi-urban community studied is prevalent, and influenced by factors such as age, gender, level of education and occupation. None.

Clinical value of vacuum sealing drainage in the treatment of oral and maxillofacial space infection

This study aims to observe the efficacy of vacuum sealing drainage (VSD) by continuous negative pressure drainage and saline irrigation in the treatment of oral and maxillofacial space infection. Retrospective analysis was conducted on 116 cases of maxillofacial space infection, and clinical data were collected to compare the therapeutic effects of routine incision with drainage treatment (traditional treatment group, 58 cases) and VSD treatment (VSD group, 58 cases). The length of hospital stay, white blood cell count, scar length, frequency of dressing change, and pain degree of patients in the VSD group were all lower than those in the traditional treatment group. Moreover, the improvement degree of mouth opening in the VSD groups was better than that in the traditional treatment group (P<0.05). VSD is a more effective method for the treatment of oral and maxillofacial space infection.

Investigation on the status of oral hygiene " knowledge, attitude and practice" in periodontal disease patients with maxillofacial space infection

Objective To understand the oral hygiene knowledge, attitude, of patients with oral maxillofacial space infection(OMSI), and analyze its related influencing factors. Methods According to the random sampling method, a total of 120 patients with OMSI were investigated on the status of oral hygiene knowledge, attitude and practice . Results The middle-aged and aged people were the main subjects in the survey.Male was more than female.The education level was mainly junior high school or technical secondary school.The score of attitude dimension was the highest, the score of behavior dimension was the lowest and the score of knowledge dimension was the middle.Gender, age, education level and patient's knowledge, attitude and practice scare were compared, and the differences were statistically significant (P<0.05). The professional oral health care guidance acceptance rate was low, only 24.17%, 99.17% of the respondents wanted to get professional medical help. Conclusion Among OMSI patients, the oral hygiene habits of patients with periodontal disease are generally at the lower middle level, and the behavioral dimension score is the lowest, indicating that the disease of patients with periodontal disease is related to the poor oral hygiene habits.In oral health care of China, stratified health education should be carried out according to the specific situation of gender, age and education level, and professional participations should be encouraged. Key words: Oral and maxillofacial space infection(OMSI); Periodontal disease; Oral hygiene; Knowledge, attitude,

Paediatric dento-facial infections - a potential tool for identifying children at risk of neglect?

Child neglect has a significant impact on children's physical and emotional health and development with lifelong consequences. Dental decay can lead to maxillofacial space infections which can have life-threatening complications and may indicate that a child has suffered dental neglect. In this retrospective audit, we reviewed children below sixteen years who were admitted under oral and maxillofacial surgery for incision and drainage of a dental/facial abscess, under general anaesthesia, between January 2015 and January 2017, to understand if they had experienced dental neglect. We also assessed if they were or had been known to Children's Social Services (SS) before hospital admission. Twenty-seven children were included in the study, eleven children (40%), were known to social services (SS). On average 3.2 teeth were extracted with an average hospital stay of 2.5 days. Our data indicate that a significant number of children admitted for maxillofacial space infection are already known to social services. Our recommendation is that all children admitted with dental/maxillofacial space infections, where dental neglect may be present, should be discussed with the local safeguarding team.

Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai.

The aim of this study is to comprehensively review and analyse pure odontogenic maxillofacial space infections in a tertiary care hospital in Navi Mumbai over a period of 5years. A retrospective analysis of 315 patients treated at Dr. D. Y. Patil Dental College and Hospital at Nerul, Navi Mumbai, from January 2007 to December 2011 was done. Multiple variables were analysed. Localised infections like dentoalveolar infections without space involvement and infection of non-odontogenic cause were excluded from the study. Analysis of the records was done. Majority of patients were from lower socioeconomic background and were daily wage workers who had either consulted a general physician or a general dental practitioner or had self-medicated themselves before presenting to us with acute symptoms. Early recognition and prompt treatment involving intravenous antibiotics with extraction of involved tooth/teeth and incision and drainage helped in resolution of infections in a span of 72h. Medically compromised patients had longer duration of hospital stay as compared to the patients who had no underlying medical condition. Majority of space infections involved multiple spaces and local anaesthesia with sedation was found to be the satisfactory mode of anaesthesia. Complications were very few. We concurred that any form of odontogenic maxillofacial space infection should be rendered prompt and aggressive treatment and hospitalisation should be recommended wherever required.

Indirect pulp therapy for deciduous teeth with deep caries lesions

Deciduous teeth are the first dentition of humans and play an important role in children's physical and mental development. Dental caries are one of the most common oral diseases in children. According to the data of the World Health Organization, 60%-90% of school children worldwide develop dental caries. In China, dental caries of primary teeth feature high incidence and low rate of visits. Without timely treatment, the deep caries lesions of primary teeth can lead to teeth defect, pulpitis, apical periodontitis, and maxillofacial space infection. Moreover, the premature loss of deciduous teeth can cause malocclusion and eruption disorder of subsequent permanent teeth. These conditions all cause considerable effects on children's oral health and physical and mental development. Performing active and effective measures to treat deciduous teeth with deep caries lesions is important to maintain the integrity and normal physiological function of dentition and facilitate normal eruption of permanent teeth. The current situation of indirect pulp therapy in China was studied in this paper. Basic concepts, including indirect pulp capping, interim therapeutic restoration, partial caries removal, stepwise caries removal, and atraumatic restorative therapy, have been defined by consulting domestic and foreign literature. A theoretical basis for improving the clinical pathway of deciduous teeth with deep caries lesions is provided by explaining the technical connotation and therapeutic importance of indirect pulp therapy in primary teeth.

The clinical and bacteriological analysis of the diabetic with oral and maxillofacial space infections

The clinical and bacteriological analysis of the diabetic with oral and maxillofacial space infections

A Prospective Comparison of Computed Tomography and Magnetic Resonance Imaging as a Diagnostic tool for Maxillofacial Space Infections.

Aims and Objectives:The aim of this work was to assess the advantages and disadvantages of magnetic resonance imaging (MRI) versus computed tomography (CT) in the initial evaluation of maxillofacial space infections by comparing various parameters of the imaging studies and comparing them on a three-point scale.Materials and Methods:We prospectively evaluated 15 patients with head and neck space infections. All patients underwent CT and MRI using similar slice thickness. We reviewed all imaging studies with special attention to location, extension, source of infection, extent of bone involvement, odontogenic or nonodontogenic, and presence of gas/calcium in the lesions. All the parameters were graded based on a three-point scale and were compared statistically by paired t-test.Results:According to the results we arrived at, MRI was superior to CT in regard to lesion conspicuity, extension, number of anatomic spaces involved, and source on infection. Although not significant, MRI detected a greater number of abscess collections. However, in the aspects of detection of intralesional gas and calcium and motion artifacts, CT was superior to MRI. However, these advantages of CT over MRI are not significantly better than those of MRI.Conclusion:MRI was considered superior to CT in the initial evaluation of head and neck space infections. Our study thus concludes that MRI may be used as the primary modality to evaluate patients with head and neck infections when clinically feasible.

Is the routine practice of antibiotic prescription and microbial culture and antibiotic sensitivity testing justified in primary maxillofacial space infection patients? A prospective, randomized clinical study

PurposeThe purpose of this prospective, randomized, comparative clinical study was to compare treatment outcome of removal of foci and incision and drainage, with or without oral antibiotic therapy, in the management of single primary maxillofacial space infection with a known focus. Materials and methodsA total of 40 patients with single primary maxillofacial space infection with a known infectious focus were divided into two groups, one treated with incision and drainage only, and the other with incision and drainage along with oral antibiotics. The focus of infection was addressed in both groups. Parameters evaluated included pain score, maximum mouth opening, swelling, purulent discharge and return to normal life, which were assessed on days 1, 2, 3, 5 and 7. The patients were followed up until they reported return to normal life as assessed by a questionnaire. ResultsAll of the patients rapidly responded to treatment as observed by a reduction in pain, swelling, discharge, and improvement in mouth opening. Pus discharge stopped within first 3 days in 75% of patients. The patients who underwent immediate extraction showed a faster resolution of infection (mean return to normal life = 9 days) than others (mean = 11.2 days). There was no statistically significant difference between the two groups for the five study parameters (p < 0.05). Of the total pus specimens, 75% had no significant bacterial growth, or grew ‘oral flora’/contaminants, while only 25% grew specific bacteria. ConclusionThis study questions the conventional practice by dental practitioners and surgeons of prescribing antibiotics to all patients with odontogenic infection. Microbial culture and antibiotic sensitivity is of little therapeutic value in selected patient groups.

Steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Objectives: To report a series of MSI managed with antibiotics, surgical intervention and exogenous steroids as an adjunct, highlighting functional improvement following steroid administration. Methods: A retrospective cohort study was carried out from December 2013 to September 2016, involving 30 patients (n = 30, 22 males, 8 females) diagnosed with MSI. All patients were initially managed with intravenous empirical antibiotics, analgesics and removal of potential source of infection. A course of 3 doses of IV Dexamethasone 8 mg at an interval of 8 hours was started during the first day of hospital admission. Results: This series reports 30 patients presenting with MSI, who received prompt antibiotics and 3 doses of steroids as inpatients. Significant clinical improvement was noted in the form of amelioration of pain, rapid reduction in edema, and improved trismus, shortening hospital stay to an average of 3.5 days, and omission of surgical intervention in 50% of our cases. No adverse effects or drug reaction was noted. Conclusion: In conclusion, the value of synergistic use of corticosteroids with antibiotics in management of MSI is significant. Despite these promising findings, there is scarce evidence in the literature to fully support the use of corticosteroids in abscess management. The role of corticosteroids in treatment of MSI should be explored further.

"Risk Factors" for Life Threatening Complications Associated with Maxillofacial Space Infections: A Clinical Study

"Risk Factors" for Life Threatening Complications Associated with Maxillofacial Space Infections: A Clinical Study

The clinical effect and cost analysis of patients of oral and maxillofacial space infection treated with improved closed negative pressure drainage

Objective To explore the clinical effect of patients of oral and maxillofacial space infection treated with improved closed negative pressure drainage combined with hyperbaric oxygen, and the possibility of using this method to decrease the hospital expenses. Methods 156 patients with oral and maxillofacial space infection were divided into control group, closed negative pressure drainage group and improved closed negative pressure drainage combined with hyperbaric oxygen group by random number table. 52 patients in each group. The granulation tissue growth time, the healing of wound, clinical effect of the 8thday, hospitalization days, wound healing time, antibiotic cost, average cost in hospital were recorded after treatment. Results The average wound healing time of patients in improved closed negative pressure drainage combined with hyperbaric oxygen group was (6.06±0.23)days, while the granulation tissue growth time was (16.13±2.89) days, both of them were much shorter than the control group[(15.46±4.68)days and (28.60±3.50)days respectively],as well as the closed negative pressure drainage group [(7.43±0.75) days and (22.67±4.34) days respectively], and the differences were statistically significant which the F values equaled to 6.213 and 8.451, P values all less than 0.05. The total healing rate of patients in closed negative pressure drainage group and improved closed negative pressure drainage combined with hyperbaric oxygen group were both 100.00% (52/52), the difference was statistically significant compared with control group (χ2=6.89, P < 0.05). The average hospitalization days of the patients in the closed negative pressure drainage group and improved closed negative pressure drainage combined with hyperbaric oxygen group were (8.20±1.49) days and (7.45±0.42)days, the antibiotic cost were(5 068.34±1 074.68)RMB and (5 001.00±456.00) RMB, the average total cost were(9 457.43±647.23)RMB and (9 249.00±367.00)RMB, all these indexes were much lower that which in control group[(18.40±5.89)days,(21 000.43±2 036.48) RMB and (31 000.66±2 711.36) RMB], and the differences were statistically significant, F values equaled to 15.221, 29.434 and 81.220 each, P values were all less than 0.01. Conclusions Improved closed negative pressure drainage combined with hyperbaric oxygen method could improve the clinical effect of patients with oral and maxillofacial space infection, speed up the granulation tissue, shorten the in-hospital time as well as reduce the medical cost. Key words: Oral and maxillofacial space infection; Improved closed negative pressure drainage; Hyperbaric oxygen treatment; Cure rate; Hospital costs

Risk Factors for Life-Threatening Complications of Maxillofacial Space Infection.

The purpose of this study was to review the clinical features of maxillofacial space infection (MSI), and to identify the potential risk factors predisposing to life-threatening complications. A retrospective review of the medical charts of patients with MSI treated at Peking University School and Hospital of Stomatology from August 2008 to September 2013 was conducted. A total of 127 patients [75 men (59.1%) and 52 women (40.9%); mean age, 45.39 ± 21.18 years, with a range of 1–85 years] formed the study cohort. The most common cause of MSI was odontogenic infection (57.5%). The most common space involved was the submandibular space. All patients were treated by antibiotics as well as surgical incision and drainage. Sixteen patients developed life-threatening complications, and the dominant complication was respiratory obstruction. Multivariate logistic regression analysis revealed the percentage of neutrophils (NEUT%) upon hospital admission ≥85.0% to be associated with life-threatening complications (P < 0.05). Even though adequate antibiotic therapy and incision and drainage of abscess were given, MSI patients with NEUT% upon hospital admission ≥85.0% carry a higher risk of life-threatening complications. In these patients, an aggressive treatment strategy is mandatory.

Analysis of 20 cases of patients with diabetes merged oral and maxillofacial space infection

Objective To discuss the methods of treating diabetes merged oral and maxillofacial space infec-tion and their effects. Methods Clinical data of 20 patients with diabetes merged oral and maxillofacial space infec-tion were retrosepectively analyzed. Results All 20 cases of patients with diabetes merged oral and maxillofacial space infection were cured. The mean length of treatment was(18.4±2.8)days. There were 20 cases of positive results of bacterial culture, the positive rate was 100%, and there were 15 cases of streptococcal infection,4 cases of klebsiella pneumoniae infection,1 case of candida albicans infection. 20 cases of patients was given incision and drainage,4 cases given incision of trachea. Conclusion It was easier for patients with diabetes having maxillofacial space infection, and more serious illness, more difficult for treating. Local infection should be treated, and systemic conditions should be improved as well. The risks of occurrence of serious complications should be reduced. Key words: Diabetes; Infection; Comprehensive modality therapy

A comparative analysis of odontogenic maxillofacial infections in diabetic and nondiabetic patients: an institutional study.

ObjectivesThe increased prevalence of antibiotic resistance is an outcome of evolution. Most patients presenting with odontogenic space infections also have associated systemic co-morbidities such as diabetes mellitus resulting in impaired host defense. The present study aims to compare the odontogenic spaces involved, antibiotic susceptibility of microorganisms, length of hospital stay, and the infl uence of systemic comorbidities on treatment outcome in diabetic patients.Materials and MethodsA 2-year prospective study from January 2012 to January 2014 was conducted on patients with odontogenic maxillofacial space infections. The patients were divided into two groups based on their glycemic levels. The data were compiled and statistically analyzed.ResultsA total of 188 patients were included in the study that underwent surgical incision and drainage, removal of infection source, specimen collection for culture-sensitivity, and evaluation of diabetic status. Sixty-one out of 188 patients were found to be diabetic. The submandibular space was the most commonly involved space, and the most prevalent microorganism was Klebsiella pneumoniae in diabetics and group D Streptococcus in the nondiabetic group.ConclusionThe submandibular space was found to be the most commonly involved space, irrespective of glycemic control. Empiric antibiotic therapy with amoxicillin plus clavulanic acid combined with metronidazole with optimal glycemic control and surgical drainage of infection led to resolution of infection in diabetic as well as nondiabetic patients. The average length of hospital stay was found to be relatively longer in diabetic individuals.