Space Infections Of Odontogenic Origin Research Articles

Serum Biomarkers in Fascial Space Infections of Odontogenic Origin and Their Role in Prognosis of Sepsis: A Systematic Review

Serum Biomarkers in Fascial Space Infections of Odontogenic Origin and Their Role in Prognosis of Sepsis: A Systematic Review

Epidemiological Analysis and Management of Patients with Facial Space Infections of Odontogenic Origin: A Retrospective Evaluation of Two Years

Objective: Odontogenic infections are one of the most common pathologies in the oral and maxillofacial regions. The spread of odontogenic infections after unsuccessful or late treatment can lead to serious complications. The aim of this study is to examine the epidemiological features and treatment management of patients with odontogenic facial abscesses.
 Methods: This retrospective study included 88 patients with odontogenic facial area abscesses treated at Afyonkarahisar health sciences university, faculty of dentistry’s maxillofacial surgery clinic between 2019-2021. The socio-demographic, socio-economic characteristics and clinical examination findings of the patients and treatment methods for odontogenic abscess were analyzed comprehensively. Data were
 evaluated using SPSS-20 and the level of significance was set at p < .05.
 Results: In the two-year period between 2019 and 2021, 88 patients (44 male and 44 female, mean age was 39.72±16.42) were treated for diffuse facial infections of odontogenic origin. The most commonly involved area was the submandibular area (38.6%), the most affected tooth was mandibular 1st molar and mandibular 3rd molars (18.2%), and the most common cause was dental caries (65.90%). Incision and drainage were performed in half of the patients (36.4% intraoral, 13.6% extraoral). The most commonly used drugs were clindamycin (36.4%), amoxicillin-clavulanate, and ornidazole combination (27.3%).
 Conclusion: The results of this study confirm that odontogenic abscesses can heal without complications with timely and effective basic interventions such as incision and drainage. In this study, successful results were obtained with the parenteral clindamycin, and a combination of oral amoxicillin-clavulanate and ornidazole in the treatment of odontogenic abscesses.

Comparative evaluation of efficacy of C-reactive protein versus total leucocyte count as marker for monitoring patients with orofacial space infection of odontogenic origin.

To compare and evaluate the efficacy of C-Reactive Protein and total leucocyte count as markers for monitoring patients of odontogenic space infection. Blood samples were taken preoperatively and post-operatively at day 1, day 2, day 3 and day 7 for measuring the levels of CRP and TLC. The trends of CRP and TLC were analysed against the Clinical Severity Scale (CSS). The study was carried out on patients of odontogenic space infection, and minimum of 50 patients were selected for this study. Comparative evaluation of C-reactive protein (CRP) versus total leucocyte count (TLC) was performed. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21. Inferential statistics were performed using Spearman Correlation. The level of statistical significance was set at 0.05. The result of the study demonstrates that the C-reactive protein (CRP) was found to be more consistent indicator for monitoring the patients of odontogenic space infection than TLC, Differential Leucocyte Count (DLC) and erythrocyte sedimentation rate (ESR). We conclude that CRP should be incorporated as monitoring tool, and it serves as a better indicator than TLC for managing patients with orofacial space infections of odontogenic origin.

To Evaluate the Efficacy of Biomarkers as Monitoring Tool in Patients with Fascial Space Infections of Odontogenic Origin: A Clinical Study.

The objective was to evaluate the efficacy of biochemical markers (WBC, CRP and fibrinogen) and the course of odontogenic space infections in 50 patients. Blood samples were taken preoperatively and postoperatively at day 0, day 4, day 8 and day 12 for measuring the levels of all three biomarkers. The trends of the biomarkers were observed and compared with assessment parameters such as dental etiology, number of teeth involved, number of spaces involved, mouth opening and pain. Active pus discharge, dysphagia, hoarseness and swelling were assessed and scored accordingly. The data were subjected to paired 't' test, McNemar's and Pearson's bivariate correlation as appropriate. Statistical analysis found strong correlation between laboratory values of markers and parameters used to measure severity of infection. All three biomarkers (WBC, CRP and fibrinogen) are significant markers for hospital stay (p < 0.01). Prospective analysis indicates that only one biomarker cannot be used to rule out specific diagnosis. The combination of three biochemical markers assessed in the present study (WBC, CRP and fibrinogen) should be used as prognostic factor in assessment, clinical severity and efficacy of treatment regime for patients as these can reliably predict the clinical course of odontogenic infection.

Hyperbaric Oxygen as Adjunctive Therapeutic in Management of Craniocervical Necrotizing Fasciitis: Case Series and Treatment Protocol

BackgroundOdontogenic infections are commonly encountered in OMS practices. Rarely, odontogenic infections can progress into craniocervical necrotizing fasciitis (CCNF). CCNF of the head and neck is a rare, potentially lethal disease process involving infection and subsequent destruction of fascial planes. Mortality ranges from 33% to 50% if the mediastinum is involved.1,2 CCNF diagnosis is based on clinical suspicion. Typical findings include dishwater-like purulence and easy spread of fascial planes using fingers.3 Treatment for CCNF usually consists of aggressive surgical debridement, source control, and intravenous antibiotics. Patients often experience prolonged hospital stays, around 24-33 days1,2 and require 2-5 debridements.1 Hyperbaric oxygen (HBO) has shown promising results as an adjunctive therapy in management. The authors' study reviewed their institution's protocols for CCNF of odontogenic origin and use of HBO in their treatment. MethodsPatients with deep neck fascial space infections of odontogenic origin at Hennepin County Medical Center (HCMC) were included. Inclusion criteria were odontogenic infections involving fascial spaces with a high degree of concern for CCNF based on clinical and radiographic presentation at the time of treatment and/or confirmed CCNF. Exclusion criteria were patients with deep fascial space infections of non-odontogenic source and those who did not receive HBO. Five patients were identified. Data, such as age, gender, length of hospital stay (LOS), intervention by outside providers, hierarchical condition category (HCC), and bacteria species, were recorded for each patient. Descriptive statistics were used to summarize quantitative variables. ResultsFrom 2016 to 2020, 5 patients were identified who had odontogenic infections, with high concern for necrotizing fasciitis based on clinical presentation for CCNF. There were 3 females and 2 males, with an average age of 44.6+/-8.65 years. The mean number of washouts/debridement procedures was 4.4+/-1.25. Patients required on average 3.4+/-0.87 HBO dives. The mean LOS was 18.8+/-6.37 days. Three patients underwent care by an outside provider prior to admission to the hospital, while 2 sought care at an urgent care or emergency department. The HCC for these patients ranged from 0 to 3. All patients grew milleri group streptococcus; 3 patients grew Candida species. No mortalities were recorded. DiscussionThis protocol involved initiating HBO dives within 24 hours of suspected or confirmed CCNF, followed by subsequent daily surgical debridements and HBO sessions. The HBO dives were at 2.8 ATA for 45 minutes followed by staged decompression for a total of 90 minutes. This protocol resulted in shorter LOS. In 1994, a comparative study with a comparable population was completed at this institution, in which HBO was not used for suspected CCNF. This study showed 2.8 average surgical debridements and LOS of 34 days, compared to 18.8+/-6.37 days in the authors' study.4 The increased number of surgical debridements in the authors' series theoretically decreased the bacterial burden, compared to the previous series. HBO theoretically reduced the bacterial burden, improved immune response, and spurred healing. HBO may reduce LOS for CCNF patients and should be considered as adjunctive therapy.

Microflora in odontogenic infections

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

An analysis of contributing factors of head and neck space infections of odontogenic origin: A long-term retrospective clinical study (including COVID-19 pandemic period).

The purpose of this study is to investigate predisposing factors for the head and neck infections (HNIs), regarding to the demographic data, anatomical spaces, microbiology and antibiotic sensitivity for affected patients. A 13-year of retrospective study evaluating 470 patients with HNIs, treated as inpatient management in the Department of Oral and Maxillofacial Surgery of KyungHee University school of Dentistry, Seoul, Korea, from January 2009 to February 2022. Statistical analysis of demographic, time-related, anatomic, microbiologic, and treatment variables were investigated for each patient. The frequency of HNIs was significantly higher in 50's in males, followed by 70's in females. High Severity score (SS) were significantly associated with increased LOH (Length of hospital stay) and LOM (Length of medication), while LOH showed more intensive relationship compared with LOM. The most frequently involved space in abscess was submandibular space, though incidence and severity of HNIs shows declining tendency throughout 13-year research. Streptococcus viridans was the most predominant species isolated from pus culture growth, and a combination of ampicillin and sulbactam was the 1st choice of antibiotics intravenously. According to the comparison analysis between recommended antibiotics from resistance testing result and clinically administered antibiotics, final coincidence rate was estimated about 55%. Due to HNIs being multifactorial, predicting progression and management of HNIs is still a challenge for oral and maxillofacial surgeons. The present study showed several predisposing factors of SHNIs and their correlations, which could contribute to earlier diagnosis and more effective treatment planning for clinicians, thereby leading to the improvement of prognosis for patients, ultimately.

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

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

Institutional microbial analysis of odontogenic infections and their empirical antibiotic sensitivity

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

A Discussion of Superficial Temporal Space Infection of Odontogenic Origin In An Uncontrolled Diabetic Patient: A Case Report

A Discussion of Superficial Temporal Space Infection of Odontogenic Origin In An Uncontrolled Diabetic Patient: A Case Report

Bacteriology of orofacial space infections-A retrospective study

Aim: The purpose of this study was to assess causative micro-organisms responsible for Orofacial space infections of odontogenic origin, and to evaluate their sensitivity to various antibiotics used in the treatment of these infections. Methods: The bacteriology and antimicrobial susceptibility of major pathogens in 30 patients with orofacial odontogenic infections were examined excluding the patients who were on prior antibiotic therapy, who were diagnosed to be immunocompromised and the patients were on immunosuppressants and the following patients underwent incision and drainage and received IV antibiotics. Results: A total of 46 bacterial strains were isolated from 30 patients out of which five patients' culture results were sterile. The most common aerobic bacteria isolated were Viridans Streptococci, Klebsiella Pneumonia and Streptococcus Pyogens, and anaerobic bacteria were Porphyromonas Gingivalis, Streptococci, Fusobacterium and Prevotella Melanogenicus. As per our study, Gentamycin (84%) and Cefotaxime (80%) were the most effective antibiotics. Conclusion: In conclusion, the surgical treatment incision and drainage must always be in the foreground for the therapy of orofacial space infections of odontogenic origin. Cultures and sensitivities commonly showed greater growth in aerobes (76%) than in anaerobes (23.9%).

Odontogenic Submandibular Space Infection Complicated By Temporal Space Abscess: Report Of A Rare Case

Cases of facial space infection of odontogenic origin are commonly reported in dentistry. Among them submandibular space infections are most common, but their extension to temporal region is seldom reported. Management of such infection is very challenging and requires expertise. This report describes the management of a rare case of a submandibular space infection extending to temporal space using incision and drainage in an eight years old male child.

Microbiology and antibiotic sensitivity of head and neck space infections of odontogenic origin. Differences in inpatient and outpatient management

IntroductionThe microbial flora of infections of the orofacial region of odontogenic origin is typically polymicrobial. Shortly after mass production of the first antibiotics, antibiotic resistant microorganisms were observed. MethodsA 28-months retrospective study evaluated hospital records of 107 patients that were treated for head and neck infections of odontogenic origin. All patients underwent surgical incision and drainage. ResultsThere were 65 male (61%) and 42 female (39%) patients ranging in age from 5 to 91 years, with a mean age of 48 years (SD = 21). 52 patients underwent outpatient management and 55 patients inpatient management. A total of 92 bacterial strains were isolated from 107 patients, accounting for 0.86 isolates per patient. Overall 46 bacterial strains were isolated from patients that underwent outpatient and 34 bacterial strains that underwent inpatient treatment. 32.6% of the strains, isolated from outpatient treated individuals showed resistances against one or more of the tested antibiotics. Isolated strains of inpatient treated individuals showed resistances in 52.9%. DiscussionAccording to this study's data, penicillin continues to be a highly effective antibiotic to be used against viridans streptococci, group C Streptococci and prevotella, whereas clindamycin was not shown to be effective as an empirical drug of choice for most odontogenic infections. ConclusionMicroorganisms that show low susceptibility to one or more of the standard antibiotic therapy regimes have a significantly higher chance of causing serious health problems, a tendency of spreading and are more likely to require an inpatient management with admission of IV antibiotics. Penicillin continues to be a highly effective antibiotic to be used against viridans streptococci, group C Streptococci and prevotella, whereas clindamycin could not be shown to be effective as an empirical drug of choice for a high number of odontogenic infections.

Comparative Evaluation of C-Reactive Protein and WBC Count in Fascial Space Infections of Odontogenic Origin.

To assess efficacy of C-reactive protein levels as monitoring tools for patients with fascial space infections of odontogenic origin. A randomized prospective study was conducted on 20 patients suffering from fascial space infection of odontogenic origin, in the department of Oral and Maxillofacial Surgery Bharati Vidyapeeth dental college and hospital, Pune, Patients between 18 and 60years of age of both the sexes were selected. All patients were treated and observed by the same surgeon. Patient's venous blood sample was collected pre-operatively and on 2nd and 5th post-operative days for evaluation of WBC count and C-reactive protein (CRP). All patients were encouraged for strict follow-up protocol. Where the results of WBC count and CRP when compared it was seen that the mean values of WBC were normal in 15 cases and abnormal in 5 cases on day 0, day 2 and day 5; whereas the mean values of CRP were abnormal on day 0 and day 2 and were within normal limit on day 5 in all cases. The findings of this prospective analysis indicate that White blood cells and C-reactive protein are effective markers for determining severity of infection, efficacy of treatment regime for patients with fascial space infections of odontogenic origin. Thus the markers also help in making treatment of patients with fascial space infections of odontogenic origin more cost effective and they also help protecting patients from side effects of excess drugs usage. Thus we conclude that CRP should be incorporated as monitoring tools for managing patients with fascial space infections of odontogenic origin.

Aerobic microbiology and culture sensitivity of head and neck space infection of odontogenic origin.

Context:Head and neck space infections source, age, gender, tooth involved, fascial spaces involved, microbiological study of aerobic flora, and antibiotic susceptibilities.Aims:The aim of the present study is to identify causative aerobic microorganisms responsible for deep fascial spaces of head and neck infections and evaluate the resistance of antibiotics used in the treatment of such.Settings and Design:Prospective study in 100 patients.Materials and Methods:This prospective study was conducted on 100 patients who reported in the outpatient department and fulfilled the inclusion criteria to study aerobic microbiology and antibiotic sensitivity in head and neck space infection of odontogenic origin. Pus sample was obtained either by aspiration or by swab stick from the involved spaces, and culture and sensitivity tests were performed.Statistical Analysis Used:Chi-square test and level of significance.Results:Result showed aerobic Gram-positive isolates were 73% and aerobic Gram-negative isolates were 18%. Nine percent cases showed no growth. Streptococcus viridans was the highest isolate in 47% cases among Gram-positive bacteria, and in Gram-negative, Klebsiella pneumoniae was the highest isolate of total cases 11%. Amoxicillin showed resistance (48.4%) as compared to other antibiotics such as ceftriaxone, carbenicillin, amikacin, and imipenem had significantly higher sensitivity.Conclusions:Amoxicillin with clavulanic acid showed (64.8%) efficacy for all organisms isolated, whereas ceftriaxone showed (82.4%) efficacy and could be used in odontogenic infections for both Gram-positive and Gram-negative microorganisms. Substitution of third generation cephalosporin for amoxicillin in the empirical management of deep fascial space infections can also be used. Carbenicillin, amikacin, and imipenem showed (93.4%) sensitivity against all microorganisms and should be reserved for more severe infection. Newer and broad-spectrum antibiotics are more effective in vitro than older narrow spectrum antibiotics.

Ultrasonographic evaluation of superficial space infections

Aims and Objectives: To evaluate the use of ultrasonography as a diagnostic tool in determining the state of infection, i.e., cellulitis or abscess, in the superficial space infection of odontogenic origin. Materials and Methods: A total of 35 patients visiting the department and having an inflammatory swelling of odontogenic origin were chosen. Thorough history and clinical examination of patients was done to reach a clinical diagnosis of cellulitis or abscess. Ultrasonography was performed with the help of transducing gel using a linear probe to determine the state of infection, i.e., cellulitis or abscess. Results: Out of 35 patients, 19 patients were clinically diagnosed as abscess whereas the remaining 16 patients were clinically diagnosed as cellulitis. For the 19 patients who were clinically diagnosed as abscess, ultrasonography revealed focal accumulation of fluid suggestive of abscess cavity in all the 19 cases, and ultrasound-guided aspiration was positive in all the cases. For the 16 patients who were clinically diagnosed as cellulitis, ultrasonography revealed focal areas of fluid accumulation suggestive of abscess formation in 5 cases, and ultrasound-guided aspiration was positive all these 5 cases. Sensitivity (100%) and negative predictive value (100%) of ultrasound is much better than that of clinical diagnosis, which is 79% and 69%, respectively, in the detection of state of infection. Conclusion: Ultrasonography was found to be a valuable adjunct to clinical diagnosis in determining the state of infection, i.e., cellulitis or abscess.

The esthetic surgical management of a submandibular fascial space infection of odontogenic origin

Background Odontogenic infections are common complications in dental practice and can sometimes spread through the cervical fascia and cause abscesses of the deep fascial spaces. Some of these abscesses can be life threatening. Early diagnosis of these deep fascial abscesses and aggressive antimicrobial and surgical treatment with extensive drainage are of utmost importance. The aim of this presentation is to show the clinical characteristics of a submandibular fascial space abscess and its esthetic, minimally-invasive surgical management.

The clinical relevance of microbiology specimens in head and neck space infections of odontogenic origin

It is common surgical practice to take a specimen for microbial culture and sensitivity when incising and draining infections of odontogenic origin in the head and neck. We aimed to find out if routine testing has any therapeutic value. We retrospectively studied 90 patients (57 male and 33 female) admitted to Northampton General Hospital for treatment of odontogenic infections, and reviewed admission details, antimicrobial treatment, microbiological findings and their sensitivity or resistance, and complications. Specimens were sent from 72 (80%) patients of which 61 (85%) were infected. The most commonly isolated organism was Streptococcus viridans. Interim reports were published after a mean of 3 days (range 1-4), and 94% of patients were discharged within a mean of 2 days (range 0-9) postoperatively. Almost 95% of patients were discharged before results were available, and there were no reported complications. We therefore suggest that microbial culture has little therapeutic value in the management of these patients. With culture and sensitivity tests costing £25 - £30, omission of this practice in the case of uncomplicated (single tissue space) odontogenic infections could save resources in the National Health Service without affecting the care of patients.

Ultrasonographic evaluation of fascial space infections of odontogenic origin

Introduction: Dental infection has plagued the human kind for as long as our species has existed. It is often difficult to diagnose the stage of infection. The relative blind surgical incision and drainage performed in such situations usually results in excessive harm through unnecessary extensive incisions, and failure to locate and evacuate the abscess cavity completely. The potential use of ultrasonography (USG) in fascial space infections of odontogenic origin has not been explored completely and deserves much more intensive, high quality research. Objectives: (1) To elucidate the role of USG as an adjunctive diagnostic aid for fascial space infections of odontogenic origin. (2) To aid in appropriate treatment planning and management of fascial space infections of odontogenic origin. Materials and Methods: The study group comprised of 30 patients of either genders, irrespective of age and presented with unilateral fascial space infection of odontogenic origin. After the clinical and radiographic examinations, patients underwent USG evaluation. USG-guided intraoperative aspiration was done to confirm the diagnosis. All the findings were tabulated and subjected to statistical analysis. Results: USG was as accurate as USG-guided intraoral aspiration (Gold standard) in diagnosing fascial space infections of odontogenic origin with sensitivity and specificity of 100%. In cases of abscess USG showed a well-defined homogenous anechoic pattern, cellulitis cases showed an ill-defined heterogeneous hyperechoic pattern while edema showed an ill-defined isoechoic pattern. Conclusion: The different stages of fascial space infections of odontogenic origin can be clearly depicted on the USG. USG can be used as a reliable adjunctive imaging technique in the diagnosis of fascial space infection of odontogenic origin and thus aids in appropriate treatment planning and management of such cases.

Microflora of Orofacial Space Infections of Odontogenic Origin in Children – A Bacteriological Study

Objectives: To investigate the causative micro-organisms and also to assess the anatomic distribution of orofacial space infections of odontogenic origin in pediatric patients. Materials and methods: A total of 25 patients, aged 3-14 years with orofacial odontogenic infections were selected and pus was collected using 22 gauge needles. The pus samples were immediately processed for Gram staining, aerobic and anaerobic cultures. Various parameters like gender, age, micro-organisms isolated and involved facial spaces were studied. Results: From 25 patients, total of 23 (92%) bacterial strains were isolated. In 2 (8%) patients no growth from cultures was observed. Among 23 isolates, 13 (56%) isolates were of mixed growth, 8 (34%) isolates of anaerobic growth and only 2 (8%) isolates of aerobic growth. Most commonly isolated aerobic species was Streptococcus viridans (47%). Peptostreptococcous (48%) was the most commonly isolated anaerobic species. The submandibular space (56%) was the most frequently involved space among single space infections. Involvement of multiple spaces was not observed. Conclusion: Pediatric orofacial space infections of odontogenic origin are a polymicrobial, mixed (aerobic – anaerobic) infection with predominance of anaerobic bacteria. Submandibular space is the most frequently involved space in children.