Severe odontogenic infections

Background : Severe odontogenic infections are serious potentially lethal conditions. Following the death of a patient in the authors' institution this study was initiated to determine the risk factors, management and outcome of a consecutive series of patients.
Methods : All patients admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with odontogenic infections in calendar year 2003 were investigated. Detailed information relative to their pre-presentation history, surgical and anaesthetic management and outcome was obtained and analysed.
Results : Forty-eight patients, 32M, 16F, average age 34.5, range 19 to 88 years were treated. All presented with pain and swelling, with 21 (44 per cent) having trismus. Forty-four (92 per cent) were as a result of dental neglect and four (8 per cent) were regular dental patients having endodontic treatment which failed. Of those known to have been treated prior to presentation, most had been on antibiotics. Most patients had aggressive surgical treatment with extraction, surgical drainage, high dose intravenous antibiotics and rehydration. The hospital stay was 3.3 (range 1–16) days. Patients requiring prolonged intubation and high dependency or intensive care (40 per cent) had longer hospitalization. No patient died and all fully recovered.
Conclusion : Severe odontogenic infections are a serious risk to the patient's health and life. Management is primarily surgical with skilled anaesthetic airway management. Antibiotics are required in high intravenous doses as an adjunct and not as a primary treatment.     

Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department

PurposeThe aims of the present study are to present the epidemiology and management of patients hospitalized with odontogenic infections in a major Greek hospital from 2015 to 2016 and to find out whether the basic principles of management of odontogenic infections were followed before referral to the emergency department of the Oral and Maxillofacial Surgery Clinic (OMFSED).MethodsA retrospective study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED.ResultsDuring the two-year period from 2015 to 2016, 102 patients, 54 men (52.9%) and 48 women (47.1%) were hospitalized with severe odontogenic infections. The most common space involved in severe odontogenic infections was the submandibular (52.9%), and in 31.4% of the patients multiple spaces were involved. The lower third molars were the most common cause (36.5%). In 83 patients (81.4%) the tooth causing the infection had not received any treatment whatsoever and in all cases (100%) no decision for early incision and drainage prior to the referral to the OMFSED was made.ConclusionThe data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.     

A five-year retrospective study of odontogenic maxillofacial infections in a large urban public hospital

The aim of this study was to analyze the etiology, presentation, management and outcome of odontogenic maxillofacial infections seen in an urban population that has only one major public hospital, which is also the only level I trauma center. All patients admitted to the Oral and Maxillofacial Surgery Service of San Francisco General Hospital with odontogenic infections over a 5-year period were included. Age, gender, site of infection, investigations performed, treatment carried out and outcomes were studied. Length of hospital stay and any readmissions were also noted. A total of 250 patients were admitted with maxillofacial infections, and in 157 cases the infection was odontogenic in origin. Males outnumbered females (102:55). Children had a preponderance of maxillary buccal infections whilst adults had more mandibular infections. Hospital stays ranged from 1 to 23 days, and only one patient required re-admission. A wide range of antibiotics were prescribed and 122 patients required dental extractions. Odontogenic maxillofacial infections are a public and personal health issue with potential life-threatening complications. This study identifies potential risk factors and suggests that early dental extraction, incision and drainage, coupled with intravenous antibiotic therapy, is the most effective treatment. Antibiotic therapy can be empirical since in no case where cultures were performed did this alter the antibiotic management.     

Acute fetal distress following tooth extraction and abscess drainage in a pregnant patient with maxillofacial infection

Oral infections have been implicated in adverse pregnancy outcomes such as pre‐eclampsia, premature delivery and growth retardation. A 28‐year‐old and 9 months pregnant otherwise healthy woman with a complaint of facial swelling and dental pain was referred to the Department of Oral and Maxillofacial Surgery. Oral examination revealed perimandibular and masticator space infection related to the left mandibular third molar tooth. Eight hours after surgical intervention, fetal distress developed. The patient was immediately taken into surgery and a male baby delivered by Caesarean section. The baby was then admitted to the intensive care unit. On the twelfth day of his admission, the baby was discharged in good health. Severe maxillofacial infection in pregnancy is a medically complicated situation which should be treated by an oral and maxillofacial surgeon in consultation with an obstetric and gynaecology service.     

Day-stay oral surgery

A bstract — A review of the literature revealed selection criteria for patients undergoing day-stay oral surgery. Information obtained from patients and operating theatre records in the day-stay theatre of the Oral Surgery Unit, Royal Adelaide Hospital, was reviewed. Pairs of variables selected from a detailed proforma were tested for significance. It is concluded that a large range and number of oral surgery rocedures can be performed safely on a day-stay basis.     

An evidence-based surgical algorithm for management of odontogenic keratocyst

Oral and Maxillofacial Surgery - The effective management of odontogenic keratocyst (OKC) remains a subject of interest and confusion in the oral and maxillofacial surgery literature. Currently,...     

Clinical features and presentation of cervicofacial infection: a Maxillofacial Trainee Research Collaborative (MTReC) study

Cervicofacial infection (CFI) is a common presentation to the Oral and Maxillofacial (OMFS) department and accounts for significant emergency activity. The current study aims to understand the aetiology, management, and clinical features of patients hospitalised with CFI. Our study included all patients admitted for management of CFI from May to October 2017 at 25 OMFS units across 17 UK regions. Data were collected prospectively and included age, comorbidities, prior treatment received, markers of sepsis, and presenting clinical features. One thousand and two (1002) admissions were recorded; 546 (54.5%) were male. Median (range) age was 34 (1–94) years. The most common presenting complaints were trismus (46%) and dysphagia (27%). Airway compromise was present in 1.7% of cases. Odontogenic infection accounted for 822/1002 (82%) admissions. Of those with an infection of odontogenic origin, 453/822 (55.1%) had received previous treatment. Two-thirds of those who had received treatment were managed by antibiotics alone (300/453, 66.2%). Patients met criteria for sepsis in 437/1002 (43.6%) of CFI, and in 374/822 (45.5%) of odontogenic infections. This is the largest study worldwide of patients requiring inpatient management for CFI. Infection due to odontogenic origin is the most frequent reason for admission and nearly half do not seek treatment before presentation. Patients with CFI often present late in their disease and frequently meet criteria for sepsis, requiring timely and aggressive treatment to ensure optimum outcomes. Trismus is an emerging dominant feature with all the implications related to the anaesthetic management of these patients. Knowledge of these factors has implications for the referrer, triage, the emergency department, the anaesthetic team, and members of the OMFS team.     

Rare clear cell odontogenic carcinoma associated with impacted tooth in a young patient: case report and literature review

Oral and Maxillofacial Surgery - Clear cell odontogenic carcinoma (CCOC) is a rare malignant odontogenic tumor. It is characterized by showing, on histopathological examination, clusters of...     

Abscesses caused by deciduous teeth

Abscesses in children, caused by deciduous teeth, ar not so frequently as seen in the permanent dentition. In most cases caries or an odontogenic infection of the associated deciduous tooth have already been treated by the dentist or oral surgeon at an earlier stage, i.e. before the infection exacerbates to an abscess. At the department of Oral and Maxillofacial Surgery of the Academic Hospital Nijmegen, between April 1997 and April 1998 20 children have been treated on a total of 1,693 patients with an odontogenic infection. Of this group, nine young children had an abscess caused by a deciduous tooth. In most cases the mandibular deciduous molars were involved. In one case an osteomyelitis of the mandible was diagnosed. All abscesses and infections could be treated adequately. The use of antibiotics is of paramount importance in the treatment of these abscesses in children.     

The epidemiology and management of odontomas: a European multicenter study

Oral and Maxillofacial Surgery - Odontoma is the most commonly diagnosed odontogenic tumor of the oral cavity. The objective of the present study was to assess the demographic variables, patterns,...     

Peripheral dentinogenic ghost cell tumor—report of two cases and review of the literature

Oral and Maxillofacial Surgery - Peripheral dentinogenic ghost cell tumor (DGCT) is a rare and non-aggressive benign odontogenic tumor. They usually affect the elderly and are predominantly located...     

FRCSEd (Oral and Maxillofacial Surgery): a milestone in the history of Oral and Maxillofacial Surgery in the United Kingdom

The British Association of Oral and Maxillofacial Surgeons (BAOMS) and the Royal College of Surgeons of Edinburgh (RCSEd) have had leading roles in organisation, assessment and improvement of surgical training in the United Kingdom. This was particularly well illustrated by the establishment of the fellowship examination in Oral and Maxillofacial Surgery (FRCSEd, OMFS).     

The use of steroids in cervicofacial infections in UK OMFS departments: a Maxillofacial Surgery Trainees Research Collaborative (MTReC) study

Oral and Maxillofacial Surgery - Defining current inpatient management of cervicofacial infections is key to identifying strategies to optimise care. Steroid use is beneficial in peritonsillar and...     

What are the Lessons We Can Glean from a Review of Recent Closed Malpractice Cases Involving Oral and Maxillofacial Infections?

OMS National Insurance Company insures over 4700 oral and maxillofacial surgeons, 83% of the fellows and members of the American Association of Oral and Maxillofacial Surgeons. The company has over 10,000 closed malpractice claims involving oral and maxillofacial surgeons. Data and trends involving infections that developed following elective surgical procedures and trends involving patients with preexisting odontogenic infections with adverse outcomes are well known to the company. Seven percent of the 10,000+ closed claims involve infections. Recognition and diagnosis of the infection leads to appropriate and timely treatment of infections. Delayed recognition, consultation, and referral leads to delay in the institution of appropriate treatment and can lead to adverse outcomes.     

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

Purpose

To assess efficacy of C-reactive protein levels as monitoring tools for patients with fascial space infections of odontogenic origin.

Material and Method

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 60 years 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.

Result

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.

Conclusion

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.

     

The prevalence of inflammatory and developmental odontogenic cysts in a Jordanian population: a clinicopathologic study.

OBJECTIVE: To determine the prevalence of odontogenic jaw cysts in a Jordanian population and to compare these data with previously published reports from other geographic areas. METHOD AND MATERIALS: The files on odontogenic jaw cysts treated between 1989 and 2001 in the Oral and Maxillofacial Pathology Diagnosis Service at the Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, were reviewed. Clinical and radiographic data were recorded and microscopic slides evaluated according to the most recent World Health Organization classification. Cases were analyzed with regard to age, sex, and anatomic site. RESULTS: A diagnosis of odontogenic jaw cyst was established in 654 patients, with a male-to-female ratio of 1.7:1. Radicular cyst was the most common type of odontogenic cyst found (41.7%), followed by dentigerous cysts (24.8%). The peak age affected was between the third and fifth decades. Both jaws were almost equally affected. The most common anatomic site of incidence was the maxillary incisor/canine region, followed by the mandibular molar region. CONCLUSION: This study indicates that there are some geographic differences with regard to the relative frequency, sex, and anatomic distributions of odontogenic cysts.     

The diagnosis and surgical management of major salivary gland pathology

BACKGROUND: Major salivary gland pathology is an uncommon but important finding which may initially present to general dental and medical practitioners. The consequences of misdiagnosis are important, as acute obstruction and neoplasia are the main pathological lesions diagnosed. The purpose of this study was to analyze a consecutive series of major gland pathologies treated surgically to determine diagnostic and treatment problems. METHODS: A retrospective analysis of all cases of the major salivary glands treated on an inpatient surgical basis over a five-year period by the Oral and Maxillofacial Surgery Unit of the Royal Adelaide Hospital was performed. Particular emphasis was placed on the referring diagnosis as compared to the final diagnosis. RESULTS: Fifty-four patients had surgical management of 62 major salivary glands over the five-year period. By gland, 18 (33.3 per cent) were parotid, 35 (51.1 per cent) submandibular and nine (16.6 per cent) were sublingual. Fifty-one (82 per cent) of all lesions were inflammatory and 11 (18 per cent) neoplastic. The most common presentations were swelling (72 per cent) and pain (33 per cent). Most patients were referred by general dentists (37 per cent), followed by general medical practitioners (32 per cent) and specialists (28 per cent). The referring diagnosis was correct for only 45 per cent of the dentists but 76 per cent for the general medical practitioners and 87 per cent for the specialists. Only two of the 11 gland neoplasms were correctly identified as neoplasms, both by specialists. The morbidity of the surgical treatment was low. CONCLUSION: The general dental practitioner is often the first health professional with the opportunity to assess salivary gland pathology, and therefore needs to be aware of the presenting signs and symptoms of major salivary gland lesions.     

Adenomatoid odontogenic tumor arising in a dental cyst: report of unusual case

The case of an adenomatoid odontogenic tumor developing over a dentigerous cyst is reported. A 12-year-old boy was referred by his pediatric dentist to the service of Oral and Maxillofacial Surgery of the Asturias Central Hospital (Spain) for evaluation of a radiolucent image compatible with a dentigerous cyst. Microscopic examination revealed the presence of an adenomatoid odontogenic tumor located over the linear epithelium of a dentigerous cyst. Based on the literature, the clinico-pathological, diagnostic, radiological and therapeutic characteristics of the case are commented in detail.     

Kritische odontogene Infektion mit Mediastinalbeteiligung

Background

Occasionally, trivial odontogenic infections may develop into complex diseases. This may even result in an unrestrained phlegmonous spread causing life-threatening complications. These problems have decreased since the introduction of antibiotics and also due to improved oral hygiene and improved diagnostic measures resulting in optimized medical treatment. However, life-threatening forms are still seen, in particular if infections spread along the cervical fascial sheaths down towards to the mediastinum. Over the past decade the number of critical infections has increased in other medical specialties. This is usually explained by the development of multiresistant pathogens in the context of nosocomial infections.

Patients and methods

We reviewed the patients’ records of the past 15 years at the Department of Oral and Maxillofacial Surgery of the University Hospital Kiel to assess a possible increase of odontogenic infections with life-threatening complications. From 1990 to 2004, four patientswith odontogenic infections exhibiting critical phlegmonous spread were treated in the intensive care unit. Two patients developed bacterial mediastinitis which could be controlled by intravenous antibiotics only. One patient progressed to general septic mediastinitis and eventually died of cardiorespiratory arrest. The last patient also had septic mediastinitis and developed right pleural empyema. Several operations were necessary before the disease could be controlled. This patient’s case report is presented in detail.

Conclusion

The prognosis of patients with mediastinitis crucially depends on (a) early diagnosis including computed tomography of the neck and thorax, (b) early radical surgical intervention, and (c) optimized pathogen-oriented antibiotic treatment.