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Shenoi R, Situt N, Waghchoure A. Multispace Maxillofacial Space Infections Involving Orbit: Report of a Rare Case. Indian J Otolaryngol Head Neck Surg 2024; 76:2095-2099. [PMID: 38566670 PMCID: PMC10982271 DOI: 10.1007/s12070-023-04421-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 04/04/2024] Open
Abstract
Peri-apical infection is a prevalent form of odontogenic infection, typically following the path of least resistance through cancellous bone towards the cortical plate. This infection begins as cellulitis and may progress to an abscess, sometimes involving various anatomically potential spaces. While frontal space infection is a rare complication of odontogenic infection spread, it can occur in conjunction with buccal space, sub-mental space, and orbital space involvement. In this report, we present the case of a 62-year-old man with a history of tooth pain and diabetes mellitus for the past decade. The patient exhibited symptoms of swelling, multiple draining sinuses, pain, proptosis, and fever. Prompt action was taken to drain the multiple abscesses, and the causative teeth were subsequently extracted. This case illustrates one of the severe complications associated with odontogenic infection, which has the potential to be life-threatening.
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Affiliation(s)
- Ramakrishna Shenoi
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra India
| | - Nimish Situt
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra India
| | - Alvina Waghchoure
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra India
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Omami G, Wiggins RH. Inflammatory Lesions of the Jaws. Dent Clin North Am 2024; 68:259-276. [PMID: 38417990 DOI: 10.1016/j.cden.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article defines the fascial and spatial anatomy of the suprahyoid neck region, delineates the role of CT and MR imaging, discusses the inflammatory conditions of the jaws and adjacent spaces and their clinical symptomatology, and illustrates the appearance of these conditions.
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Affiliation(s)
- Galal Omami
- Division of Oral Diagnosis, Oral Medicine, and Oral Radiology, Department of Oral Health Practice, University of Kentucky College of Dentistry, 770 Rose Street, MN320, Lexington, KY 40536, USA.
| | - Richard H Wiggins
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, 30 North 1900 East, Room 1A071, Salt Lake City, UT 84132, USA
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Kim TS, Lee YH. Orofacial fascial space abscess disguised as temporomandibular disorder: a report of 3 cases and literature review. BMC Oral Health 2024; 24:12. [PMID: 38172867 PMCID: PMC10765852 DOI: 10.1186/s12903-023-03800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
Fascial space abscess is a condition in which infections spread into fascial spaces. It is a severe and life-threatening disease unless treated at an early stage. Due to the similarity of clinical symptoms, fascial space abscesses in the orofacial area are often disguised as other diseases, such as temporomandibular disorder (TMD). In this case series, we report three cases of fascial space abscesses disguised as TMD. In all cases, patients complained of severely limited mouth opening and pain in the temporomandibular joint (TMJ) and masseter muscles, which led clinicians to diagnose them with TMD. After two patients showed facial swelling and the third complained of dyspnea, clinicians realized the possibility of an orofacial fascial space abscess. On further evaluation, all patients showed increased C-reactive protein in blood tests, and the location of the fascial space abscess was confirmed by enhanced computed tomography images. Moreover, all patients had suspicious sources of odontogenic infections in panoramic images, periapical abscess on maxillary molars and periodontal disease on maxillary and mandibular molars, which were not appropriately evaluated at the first visit. This case series emphasizes the need for clinicians to realize the possibility of orofacial fascial space abscesses based on: clinical symptoms of severely limited mouth opening (< 15 mm) with pain in the facial area, including TMJ or masseter muscle, and possible sources of infection such as odontogenic infection, other infectious lesions, trauma, or invasive treatments. These clinical insights will enable the early detection of fascial space abscesses.
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Affiliation(s)
- Tae-Seok Kim
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea.
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Sheikh Z, Yu B, Heywood E, Quraishi N, Quraishi S. The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis. Clin Otolaryngol 2023. [PMID: 37147934 DOI: 10.1111/coa.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/03/2023] [Accepted: 03/19/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To summarise current practices in the diagnosis and management of deep neck space infections (DNSIs). To inform future studies in developing a framework in the management of DNSIs. DESIGN This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with two independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach. SETTING Secondary or tertiary care centres that undertook management of DNSIs. PARTICIPANTS All adult patients with a DNSI. MAIN OUTCOME MEASURES The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs. RESULTS Sixty studies were reviewed. Thirty-one studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single randomised controlled trial, all other studies were observational (n = 25) or case series (n = 36). Computer tomography (CT) was used to diagnose DNSI in 78% of patients. The mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration, respectively. Qualitative analysis identified seven major themes on DNSI. CONCLUSIONS There are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.
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Affiliation(s)
- Zain Sheikh
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
- Department of Academic Clinical Training, University of Sheffield, Sheffield, UK
| | - Beverley Yu
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Emily Heywood
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Natasha Quraishi
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Shahed Quraishi
- Department of ENT Head and Neck Surgery, Doncaster Royal Infirmary, Doncaster, UK
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Patel J, Maymeskul V, Kim J. Infections of the Oral Cavity and Suprahyoid Neck. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00001-8. [PMID: 37032180 DOI: 10.1016/j.coms.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Acute infections of the oral cavity and suprahyoid neck range from simple superficial conditions that can be treated as an outpatient to complex multispatial processes that require surgical intervention and inpatient admission. This article provides an imaging overview of the range of infections in this region that may be encountered by oral and maxillofacial surgeons, emergency physicians, and primary care providers.
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Affiliation(s)
- Jeet Patel
- Department of Radiology, University of Florida College of Medicine - Jacksonville, 655 West 8th Street C90, Clinical Center 2nd Floor, Jacksonville, FL 32209, USA.
| | - Volodymyr Maymeskul
- Department of Radiology, University of Florida College of Medicine - Jacksonville, 655 West 8th Street C90, Clinical Center 2nd Floor, Jacksonville, FL 32209, USA
| | - John Kim
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive B2A205, Ann Arbor, MI 48109, USA
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Nagaura M, Saitoh K, Tsujimoto G, Yasuda A, Shionoya Y, Sunada K, Kawai T. Usefulness of preoperative computed tomography findings for airway management in patients with acute odontogenic infection: a retrospective study. Odontology 2023; 111:499-510. [PMID: 36279070 DOI: 10.1007/s10266-022-00756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
Odontogenic infection is more likely to affect the airway and interfere with intubation than non-odontogenic causes. Although anesthesiologists predict the difficulty of intubation and determine the method, they may encounter unexpected cases of difficult intubation. An inappropriate intubation can cause airway obstruction due to bleeding and edema by damaging the pharynx and larynx. This study was performed to determine the most important imaging findings indicating preoperative selection of an appropriate intubation method. This retrospective study included 113 patients who underwent anti-inflammatory treatment for odontogenic infection. The patients were divided into two groups according to the intubation method: a Macintosh laryngoscope (45 patients) and others (video laryngoscope and fiberscope) (68 patients). The extent of inflammation in each causative tooth, the severity of inflammation (S1-4), and their influence on the airway were evaluated by computed tomography. The causative teeth were mandibular molars in more than 90%. As the severity of inflammation increased, anesthesiologists tended to choose intubation methods other than Macintosh laryngoscopy. In the most severe cases (S4), anesthesiologists significantly preferred other intubation methods (33 cases) over Macintosh laryngoscopy (9 cases). All patients with S4 showed inflammation in the parapharyngeal space, and the airway was affected in 41 patients. The mandibular molars were the causative teeth most likely to affect the airway and surrounding region. In addition to clinical findings, the presence or absence of inflammation that has spread to the parapharyngeal space on preoperative computed tomography was considered an important indicator of the difficulty of intubation.
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Affiliation(s)
- Madoka Nagaura
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan.
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan.
| | - Keisuke Saitoh
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Gentaro Tsujimoto
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Asako Yasuda
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Yoshiki Shionoya
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Katsuhisa Sunada
- Department of Dental Anesthesiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan
| | - Taisuke Kawai
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
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Shah N, Patel S, Rupawala T, Makwana S, Mansuri S, Bhimani K. Evaluation of Efficacy of Ultrasonography as an Additional Diagnostic Tool for Deciding Management Protocol of Odontogenic Superficial Fascial Space Infections: A Prospective Clinical Study. J Maxillofac Oral Surg 2022; 21:1148-1154. [PMID: 36896083 PMCID: PMC9989102 DOI: 10.1007/s12663-021-01560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022] Open
Abstract
Objective To explore the efficacy of ultrasonography as an additional diagnostic tool in superficial odontogenic fascial space infections of maxillofacial region and modifying the treatment plan when needed. Materials and Methods Forty patients with superficial fascial space infections underwent a detailed clinical, plain radiological and ultrasonographic examination. Based on the ultrasonographic findings, final diagnosis was made and compared with clinical findings. Patients diagnosed with cellulitis were given medical line of treatment, and those with abscess were subjected to incision and drainage along with standard general supportive care and removal of etiologic agent. Results In this study, out of 40 patients (male = 22, female = 18), clinical diagnosis of cellulitis was made in 26 cases (65%) and abscess in 14 (35.0%). On USG examination, cellulitis was present in 21 cases (52.5%), while abscess in 19 (47.5%). Final diagnosis of cellulitis was made in 13 (59.1%) males and 12(66.7%) females, while abscess was confirmed in 9 (40.9%) male and 6 (33.3%) female patients. The results showed that sensitivity of the clinical examination alone was 64% with 33% specificity, and for USG, sensitivity was 84% with specificity of 100%. Conclusion The adjuvant role of ultrasonography in the diagnosis and timely management of superficial fascial space infections is promising owing to its accessibility, relative safety, repeatability and cost-effectiveness.
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Affiliation(s)
- Naiya Shah
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Shital Patel
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Taher Rupawala
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Sanjay Makwana
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Saloni Mansuri
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
| | - Kruna Bhimani
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Bhalakia Mill compound, Opp. Anupam cinema, Khokhra, Ahmedabad, 380008 India
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EKİCİ Ö. Epidemiological Analysis and Management of Patients with Facial Space Infections of Odontogenic Origin: A Retrospective Evaluation of Two Years. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.994256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Abstract
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.
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Affiliation(s)
- Ömer EKİCİ
- AFYONKARAHİSAR SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ, KLİNİK BİLİMLER BÖLÜMÜ, AĞIZ, DİŞ VE ÇENE CERRAHİSİ ANABİLİM DALI
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Tsujimura T, Nakajima Y, Chotirungsan T, Kawada S, Tsutsui Y, Yoshihara M, Suzuki T, Nagoya K, Magara J, Inoue M. Inhibition of Water-Evoked Swallowing During Noxious Mechanical Stimulation of Tongue in Anesthetized Rats. Dysphagia 2022; 38:965-972. [PMID: 36127446 DOI: 10.1007/s00455-022-10522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022]
Abstract
Dysphagia is sometimes accompanied by pain. Because orofacial structures subserve mastication and swallowing, orofacial pain might impair both functions. Tongue biting can occur not only accidentally while eating but also in some pathological conditions. However, it remains unclear whether noxious mechanical stimulation of the tongue affects swallowing. To explore this question, we evaluated the effects of lingual pinch stimulation on the initiation of swallowing evoked by distilled water (DW) infusion with a flow rate of 5.0 µL/s for 20 s into the pharyngolaryngeal region in anesthetized rats. The swallowing reflex was identified by electromyographic (EMG) bursts in the suprahyoid muscles which include the anterior belly of the digastric muscle, mylohyoid and geniohyoid muscles, and laryngeal elevation by visual inspection. The number of DW-evoked swallows during pinch stimulation was significantly smaller than that in a control condition or during pressure stimulation. The onset latency of the first swallow during pinch stimulation was significantly longer than that in the control condition. DW-evoked swallowing was almost abolished following bilateral transection of the superior laryngeal nerve (SLN) compared with the control condition, suggesting that the SLN plays a crucial role in the initiation of DW-evoked swallowing. Finally, electrophysiological data indicated that some SLN-responsive neurons in the nucleus tractus solitarii (nTS) exhibited delayed latency from a single SLN stimulation during lingual pinch stimulation. These results suggest that noxious mechanical stimulation of the tongue inhibits the initiation of swallowing and modulates neuronal activity in the nTS.
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Affiliation(s)
- Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan.
| | - Yuta Nakajima
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan
| | - Titi Chotirungsan
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan
| | - Satomi Kawada
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan
| | - Yuhei Tsutsui
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan
| | - Midori Yoshihara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan
| | - Taku Suzuki
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan
| | - Kouta Nagoya
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, 951-8514, Japan
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Odontogenic Infection Pathway to the Parapharyngeal Space: CT Imaging Assessment. J Maxillofac Oral Surg 2022; 21:235-239. [PMID: 35400906 PMCID: PMC8934784 DOI: 10.1007/s12663-020-01401-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022] Open
Abstract
Introduction Parapharyngeal space infection may lead to severe and potentially life-threatening complications. The aim of this study was to assess the odontogenic infection pathway to the parapharyngeal space using CT imaging. Materials and Methods Nineteen patients in mandibular odontogenic infections with abscess who underwent contrast-enhanced CT were evaluated in this study. We reviewed the location of abscess and spread of odontogenic infections to the different components of the buccal space, submandibular space, sublingual space, masticator space and parapharyngeal space using CT imaging. The location of abscess and spread of odontogenic infections were analyzed with the Pearson Chi-square test. Results Regarding the odontogenic infection pathway to parapharyngeal space, the masticator space (100%) was the most frequent, followed by the buccal space (85.7%), submandibular space (85.7%) and sublingual space (57.1%), while those without parapharyngeal space, the submandibular space (83.3%) was the most frequent, followed by the buccal space (75.0%), masticator space (58.3%) and sublingual space (33.3%). The masticator space was significant space in patients with/without parapharyngeal space infection (P = 0.047). Conclusion CT imaging could be an effective method in assessment of odontogenic infection pathway to the parapharyngeal space. The odontogenic infection in masticator space tends to display spread of parapharyngeal space.
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11
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Ata N, Görgülü MH. "Large skin fistula". JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:309-310. [PMID: 33930601 DOI: 10.1016/j.jormas.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nurdoğan Ata
- Department of Otorhinolaryngology, KTO Karatay University Medical Faculty, Medicana Konya Hospital, Konya, Turkey.
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12
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Musha A, Ohno T. Subcutaneous Emphysema Caused by Third Molar Extraction. OTO Open 2021; 5:2473974X211004527. [PMID: 33855255 PMCID: PMC8010816 DOI: 10.1177/2473974x211004527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Atsushi Musha
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan.,Department of Oral and Maxillofacial Surgery/Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
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Ghali S, Katti G, Shahbaz S, Chitroda PK, V A, Divakar DD, Khan AA, Naik S, Al-Kheraif AA, Jhugroo C. Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging. World J Clin Cases 2021; 9:573-580. [PMID: 33553395 PMCID: PMC7829733 DOI: 10.12998/wjcc.v9.i3.573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/29/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The introduction of modern diagnostic tools has transformed the field of maxillofacial radiology. Odontogenic infection and fascial space involvement have been evaluated with many diagnostic tools, including ultrasonography (USG) and magnetic resonance imaging (MRI).
AIM To explore USG as an alternative model to MRI in the detection of fascial space spread of odontogenic infections.
METHODS Among 20 patients, 50 fascial spaces were clinically diagnosed with odontogenic infection and included in this prospective study. Fascial space infection involvement was examined by USG and MRI. Results were compared for both and confirmed by microbiological testing.
RESULTS Ultrasonography identified 42 (84%) of 50 involved fascial spaces. Whereas MRI identified all 50 (100%). USG could stage the infections from edematous change to cellulitis to complete abscess formation.
CONCLUSION MRI was superior in recognizing deep fascial space infections compared to USG. However, USG is a significant addition and has a definite role in prognosticating the stage of infection and exact anatomic location in superficial space infections.
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Affiliation(s)
- Sreenivasarao Ghali
- Department of Oral Medicine and Radiology, Nanded Rural Dental College and Research Center, Nanded 431606, Maharashtra, India
| | - Girish Katti
- Department of Oral Medicine and Radiology, Al-Badar Dental College and Hospital, Kalaburagi 585102, Karnataka, India
| | - Syed Shahbaz
- Department of Oral Medicine and Radiology, Al-Badar Dental College and Hospital, Kalaburagi 585102, Karnataka, India
| | - Parita K Chitroda
- Department of Oral Medicine and Radiology, Al-Badar Dental College and Hospital, Kalaburagi 585102, Karnataka, India
| | - Anukriti V
- Department of Oral Medicine and Radiology, Nanded Rural Dental College and Research Center, Nanded 431606, Maharashtra, India
| | - Darshan Devang Divakar
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Aftab Ahmed Khan
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Sachin Naik
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Abdulaziz A Al-Kheraif
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Chitra Jhugroo
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
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Pham Dang N, Delbet-Dupas C, Mulliez A, Devoize L, Dallel R, Barthélémy I. Five Predictors Affecting the Prognosis of Patients with Severe Odontogenic Infections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238917. [PMID: 33266250 PMCID: PMC7730806 DOI: 10.3390/ijerph17238917] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023]
Abstract
Background: Dental cellulitis management is no longer a simple procedure, as more and more patients are needing long-time hospitalization, several surgeries and intensive care follow-up. This prospective study seeks to highlight criteria that can split patients with severe odontogenic infection into two groups: those with simple evolution and those for whom complex management is necessary. Methods: In this observational study, all patients considered with a severe odontogenic infection (which necessitated hospital admission, intravenous antibiotics and general anaesthesia) were enrolled between January 2004 and December 2014 from Clermont-Ferrand University Hospital (France). They were split into two groups: those who needed one surgical intervention with tooth extraction and collection drainage combined with probabilistic antibiotic to treat infection and those who need several surgeries, intensive care unit follow-up or tracheotomy to achieve healing. Results: 653 patients were included, of which 611 (94%) had one surgery, 42 (6%) had more than one surgery before healing. Penicillin allergy (p < 0.001), psychiatric disorders (p = 0.005), oropharyngeal oedema (p = 0.008), floor oedema (p = 0.004), fever (p = 0.04) and trismus (p = 0.018) on admission were the most relevant predictors of complex evolution. A conditional inference tree (CTREE) illustrated the association of prognostic factors and the need of multiple surgery. Conclusions: Besides clinical symptoms of severity, complications of severe odontogenic infection are predicted by measurables and objectives criteria as penicillin allergy, mandibular molar, C-reactive protein level, psychiatric disorders and alcohol abuse. Their specific association potentialize the risks. IRB number: CE-CIC-GREN-12-08.
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Affiliation(s)
- Nathalie Pham Dang
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
- Correspondence: ; Tel.: +33-473-750-102; Fax: +33-473-750-103
| | - Candice Delbet-Dupas
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation Recherche Clinique & Innovation, 63003 Clermont-Ferrand, France;
| | - Laurent Devoize
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| | - Radhouane Dallel
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
| | - Isabelle Barthélémy
- CHU Clermont-Ferrand, Inserm, Neuro-Dol, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (C.D.-D.); (L.D.); (R.D.); (I.B.)
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Affiliation(s)
- Kumar Nilesh
- Oral & Maxillofacial Surgery, Krishna Institute of Medical Sciences Deemed University, Karad, India
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Tsujimura T, Inoue M. Evaluation of the association between orofacial pain and dysphagia. J Oral Sci 2020; 62:156-159. [DOI: 10.2334/josnusd.19-0408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences
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Pippi R, Pietrantoni A, Patini R, Santoro M. Is telephone follow-up really effective in early diagnosis of inflammatory complications after tooth extraction? Med Oral Patol Oral Cir Bucal 2018; 23:e707-e715. [PMID: 30341259 PMCID: PMC6261002 DOI: 10.4317/medoral.22465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To establish whether telephone follow-up is really able to intercept post-extraction complications and to evaluate the degree of patient satisfaction with this kind of post-surgical monitoring. MATERIAL AND METHODS six hundred and thirty-eight patients were enrolled and randomly assigned to a test or control group. Test group patients were monitored by telephone follow-up 24 and 72 hours after surgery to investigate the presence of local symptoms that are frequently associated with surgical wound infection and inflammation. Both test and control group patients were examined 7 days at suture removal. Patients with systemic diseases, those in which intra-operative accidents occurred during surgery and those for whom extraction suture was not required, were excluded. RESULTS At least one complication among alveolar osteitis, alveolar inflammation, alveolar infection and dehiscence involved 15.70% of the patients in the test group and 30.70% of the patients in the control group and telephone follow-up proved to be useful in early identification of anomalies in the post-extraction wound healing process. Comparable results were recorded in all extraction subgroups divided according to the type (surgical and non-surgical) and the number (single and multiple) of extractions performed in the same session. Telephone follow-up showed an 8.60 ± 1.17 (0 to 10 score scale) average acceptance. All cases of alveolar osteitis and infection occurred in patients who underwent antibiotic prophylaxis. CONCLUSIONS Telephone follow-up seems to allow early detection of any possible wound healing complications, it is widely accepted by patients and it could therefore be considered a valid method for wound healing monitoring after tooth extractions, due to its effectiveness, feasibility and low costs.
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Affiliation(s)
- R Pippi
- Department of Odontostomatological and Maxillo Facial Sciences, "Sapienza" University of Rome, Via Caserta 6, 00161 Rome,
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Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai. J Maxillofac Oral Surg 2018; 18:345-353. [PMID: 31371872 DOI: 10.1007/s12663-018-1152-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose 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 5 years. Methods 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. Results 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 72 h. 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. Conclusion We concurred that any form of odontogenic maxillofacial space infection should be rendered prompt and aggressive treatment and hospitalisation should be recommended wherever required.
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Babu VR, Ikkurthi S, Perisetty DK, Babu KAS, Rasool M, Shaik S. A Prospective Comparison of Computed Tomography and Magnetic Resonance Imaging as a Diagnostic tool for Maxillofacial Space Infections. J Int Soc Prev Community Dent 2018; 8:343-348. [PMID: 30123768 PMCID: PMC6071350 DOI: 10.4103/jispcd.jispcd_315_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/15/2017] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- V Ramesh Babu
- Department of Oral and Maxillofacial Surgery, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Srikanth Ikkurthi
- Department of Oral and Maxillofacial Surgery, CKS Theja Institute of Dental Sciences Research, Tirupati, Andhra Pradesh, India
| | - Dinesh Kumar Perisetty
- Department of Endodontics and Operative Dentistry, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - K A Saran Babu
- Department of Prosthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Mahammad Rasool
- Department of Prosthodontics, CKS Theja Institute of Dental Sciences Research, Tirupati, Andhra Pradesh, India
| | - Shanawaz Shaik
- Department of Oral and Maxillofacial Surgery, Narayana Dental College, Nellore, Andhra Pradesh, India
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Fu B, McGowan K, Sun H, Batstone M. Increasing Use of Intensive Care Unit for Odontogenic Infection Over One Decade: Incidence and Predictors. J Oral Maxillofac Surg 2018; 76:2340-2347. [PMID: 29958865 DOI: 10.1016/j.joms.2018.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/01/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine whether intensive care unit (ICU) admissions for odontogenic infections have increased during the past decade and whether certain clinical features are associated with a greater rate of ICU admission. MATERIALS AND METHODS The data from patients undergoing surgery for odontogenic infections at the Royal Brisbane and Women's Hospital in the 24 month from January 2003 to December 2004 were compared with those from patients treated from January 2013 to December 2014. A χ2 analysis was used to compare the demographic, admission, and clinical patient data in each cohort. A multiple logistic regression model was used to determine which clinical features were associated with greater rates of ICU admission. RESULTS The rate of ICU admission increased significantly from 7 to 24% during the decade (χ2 = 12.74; P = .000), although the clinical presentation of patients admitted to the ICU was similar in both cohorts. The mean number of days spent in the ICU increased significantly from 1.7 ± 0.5 to 3.24 ± 2.5 days (t = -3.63; P = .001), and the overall length of stay increased from 1.7 ± 0.5 to 3.5 ± 4.1 days (t = 2.99; P = .004). The use of preoperative computed tomography (CT) increased significantly from 42.9 to 93.3% (χ2 = 13.25; P = .000). The most significant predictors of ICU admission were lower third molar involvement (P = .026), dysphagia (P = .020), and C-reactive protein (CRP) levels exceeding 150 mg/L (P = .039). CONCLUSIONS The use of the ICU in the management of odontogenic infection has increased significantly at the Royal Brisbane and Women's Hospital over 1 decade. The demographic data and clinical presentation of the patients admitted to the ICU did not change significantly. However, the length of ICU stay and the total length of stay have both increased. A significant increase in CT usage for odontogenic infections also occurred. Third molar infections, dysphagia, and elevated CRP might be relevant clinical predictors of a more complicated course of care requiring ICU admission. More judicious use of CT scanning, combined with prompt surgical consultation and intervention, might reduce the rate of ICU admissions for odontogenic infections.
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Affiliation(s)
- Benjamin Fu
- Registrar, Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia and Masters Candidate, School of Medicine, University of Queensland, QLD, Australia.
| | - Kelly McGowan
- Associate Lecturer, School of Dentistry, University of Queensland, QLD, Australia and PhD Candidate, School of Dentistry and Oral Health, Griffith University, QLD, Australia
| | - Hansen Sun
- Adjunct Associate Professor, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Martin Batstone
- Director, Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Fomete B, Agbara R, Osunde DO, Ononiwu CN. Cervicofacial infection in a Nigerian tertiary health institution: a retrospective analysis of 77 cases. J Korean Assoc Oral Maxillofac Surg 2016; 41:293-8. [PMID: 26734555 PMCID: PMC4699929 DOI: 10.5125/jkaoms.2015.41.6.293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/04/2015] [Accepted: 08/04/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Infection involving the orbit, zygomatic space, lateral pharyngeal space, or hemifacial and oral floor phlegmon is referred to as cervicofacialvinfection (CFI). When diagnosis and/or adequate treatment are delayed, these infections can be life-threatening. Most cases are the result of odontogenic infections. We highlight our experiences in the management of this life-threatening condition. MATERIALS AND METHODS This was a retrospective study of patients who presented with CFI from December 2005 to June 2012 at the Oral and Maxillofacial Surgery Clinic or the Accident and Emergency Unit of Ahmadu Bello University Teaching Hospital (Zaria, Nigeria). The medical records of all patients who presented with either localized or diffuse infection of the maxillofacial soft tissue spaces were retrospectively collected. Data collected was analyzed using SPSS version 13.0 and are expressed as descriptive and inferential statistics. RESULTS Of the 77 patients, 49 patients (63.6%) were males, a male to female ratio of 1:7.5. The ages ranged from two years to 75 years with a mean of 35.0±19.3 years, although most patients were older than 40 years. The duration of symptoms prior to presentation ranged from 6 to 60 days, with a mean of 11.0±9.4 days. More than 90% of the patients presented to the clinic within the first 10 days. The most commonly involved anatomical space was the submandibular space (n=29, 37.7%), followed by hemifacial space (n=22, 28.6%) and buccal space (n=7, 9.1%). Ludwig angina accounted for about 7.8% of the cases. CONCLUSION CFI most commonly involves the submandibular space, typically affects individuals with a low level of education, and is influenced by traditional medical practices. Despite improved health care delivery, CFI remains a significant problem in developing countries.
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Affiliation(s)
- Benjamin Fomete
- Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria
| | - Rowland Agbara
- Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria
| | - Daniel Otasowie Osunde
- Department of Dental and Maxillofacial Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Charles N Ononiwu
- Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria
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Rare periodontal ligament drainage for periapical inflammation of an adjacent tooth: a case report and review of the literature. Case Rep Dent 2015; 2014:879562. [PMID: 25587462 PMCID: PMC4283423 DOI: 10.1155/2014/879562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022] Open
Abstract
Aim. To report a case with an unusual drainage route of periapical inflammation exiting through the gingival sulcus of an adjacent vital tooth and review probable factors determining the diversity of the discharge routes of periapical inflammation. Summary. An 18-year-old male patient presented with periodontal abscess of tooth 46, which was found to be caused by a periapical cyst with an acute abscess of tooth 45. During endodontic surgery, a rarely reported drainage route for periapical inflammation via the gingival sulcus of an adjacent vital tooth was observed for the first time. Complete periodontal healing of the deep pocket of tooth 46 and hiding of the periapical cyst of tooth 45 followed after root canal treatment and periapical surgery with Bio-Oss Collagen implantation on tooth 45. The drainage routes of periapical inflammation are multivariate and the diversity of drainage pathways of periapical inflammation is mainly related to factors such as gravity, barriers against inflammation, and the causative tooth itself.
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Nisha V A, J P, N S, A G G, Devi B K Y, Reddy S S, N R. The role of colour Doppler ultrasonography in the diagnosis of fascial space infections - a cross sectional study. J Clin Diagn Res 2013; 7:962-7. [PMID: 23814756 DOI: 10.7860/jcdr/2013/5617.2990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 01/18/2013] [Indexed: 11/24/2022]
Abstract
AIMS AND OBJECTIVES (1) To evaluate the role of ultrasonography with colour Doppler in the diagnosis of fascial space infections, (2) To determine the nature, size and extent of the odontogenic infections which involve the primary and secondary fascial spaces of the maxilla and the mandible (3) To evaluate the sensitivity of ultrasonography in determining whether the inflammatory process is in a stage of cellulitis or abscess and to thus determine the appropriate time for a surgical intervention during the course of the infection and to correlate the clinical and radiographic findings with the ultrasonographic findings and (4) to determine the treatment plan. METHODOLOGY Thirty four patients with odontogenic infections which involved the superficial and the deep fascial spaces of the head and neck were subjected to ultrasonographic examinations over the suspected area in the transverse and axial directions to determine the stage of the infection, its anatomic location and the treatment plan. RESULTS Ultrasonography showed 95.7% sensitivity and 100% specificity as compared to the clinical and radiographic diagnoses and it proved to be an effective investigation modality in the diagnosis of fascial space infections.
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Affiliation(s)
- Aarthi Nisha V
- Senior Lecturer, Department of Oral Medicine and Radiology, Sree Balaji Dental College and Hospital , Chennai, India
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Boffano P, Roccia F, Pittoni D, Di Dio D, Forni P, Gallesio C. Management of 112 hospitalized patients with spreading odontogenic infections: correlation with DMFT and oral health impact profile 14 indexes. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:207-213. [PMID: 22677738 DOI: 10.1016/j.tripleo.2011.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 02/04/2011] [Accepted: 02/08/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to report our experience in treating patients affected by spreading odontogenic infections and to discuss their management and outcome. STUDY DESIGN Demographic and clinical information was collected from hospitalized patient records. Decayed, missing, and filled teeth (DMFT) index was calculated for 45 randomly selected patients. Statistical analysis was used to search for associations among multiple variables. RESULTS Statistical analysis of the variance by univariate test found significant associations between a longer hospital stay and patients >30 years old (P < .05) and patients with the presenting symptoms of dysphagia and/or dyspnea (P < .05). Statistical analysis using Fisher exact test found significant associations between patients with a DMFT index >10 and female patients (P < .05), patients >30 years old (P < .005), and a hospital stay >4 days (P < .0005). CONCLUSIONS Rapid resolution of the infection was appreciated when removal of the cause, drainage of the infection, and intravenous antibiotics were performed.
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Affiliation(s)
- Paolo Boffano
- Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
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Bassiony M, Yang J, Abdel-Monem TM, Elmogy S, Elnagdy M. Exploration of ultrasonography in assessment of fascial space spread of odontogenic infections. ACTA ACUST UNITED AC 2009; 107:861-9. [PMID: 19464659 DOI: 10.1016/j.tripleo.2009.02.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 01/29/2009] [Accepted: 02/04/2009] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to explore the capability of ultrasonography (USG) as an alternative imaging modality to magnetic resonance imaging (MRI) in detection of fascial space spread of odontogenic infections. STUDY DESIGN Forty-two fascial spaces in 16 subjects, clinically diagnosed as odontogenic infections, were included in this prospective study. The fascial space involvements were examined with USG. The results were confirmed by MRI and microbiologic tests. RESULTS Ultrasonography demonstrated 32 (76%) of 42 involved fascial spaces. There was 100% agreement between USG and MRI on 32 superficial space involvements, including 13 buccal, 10 submandibular, 5 canine, 2 submasseteric, 1 submental, and 1 infraorbital. Ultrasonography did not detect 4 masticator spacs, 4 parapharyngeal spacs, and 2 sublingual space involvements. Ultrasonography was able to stage infections starting from edematous change to cellulitis to complete abscess formation. CONCLUSIONS Ultrasonography could be considered to be an effective method in detecting and staging spread of odontogenic infections to the superficial fascial spaces. However, it might be difficult to detect deep fascial space involvements.
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Affiliation(s)
- Maaly Bassiony
- Department of Oral and Maxillofacial Pathology, Division of Oral and Maxillofacial Radiology, School of Dentistry, Temple University, Philadelphia, Pennsylvania 19140, USA.
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Computed tomographic anatomy of the mandibular first and second molars and their surrounding structures in the spread of odontogenic infection. Oral Radiol 2009. [DOI: 10.1007/s11282-009-0016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vaiman M, Nahlieli O. Oral vs. pharyngeal dysphagia: surface electromyography randomized study. BMC EAR, NOSE, AND THROAT DISORDERS 2009; 9:3. [PMID: 19460159 PMCID: PMC2693508 DOI: 10.1186/1472-6815-9-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 05/21/2009] [Indexed: 12/05/2022]
Abstract
BACKGROUND A clear differential diagnosis between oral and pharyngeal dysphagia remains an unsolved problem. Disorders of the oral cavity are frequently overlooked when dysphagia/odybophagia complaints are assessed. Surface electromyographic (sEMG) studies were performed on randomly assigned patients with oral and pharyngeal pathology to evaluate their dysphagia complaints for the sake of differential diagnosis. METHODS Parameters evaluated during swallowing for patients after dental surgery (1: n = 62), oral infections (2: n = 49), acute tonsillitis (3: n = 66) and healthy controls (4: n = 50) included timing and amplitude of sEMG activity of masseter, infrahyoid and submental muscles. RESULTS The duration of swallows and drinking periods was significantly increased in dental patients and was normal in patients with tonsillitis. The electric activity of masseter was significantly lower in Groups 1 and 2 in comparison with the patients with tonsillitis and controls. The submental and infrahyoid activity was normal in dental patients but infrahyoid activity in patients with tonsillitis was high. CONCLUSION Dysphagia following dental surgery or oral infections does not affect pharynx and submental muscles and has clear sEMG signs: increased duration of a single swallow, longer drinking time, low activity of the masseter, and normal range of submental activity. Patients with tonsillitis present hyperactivity of infrahyoid muscles. These data could be used for evaluation of symptoms when differential dental/ENT diagnosis is needed.
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Affiliation(s)
- Michael Vaiman
- Department of Otolaryngology, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Nahlieli
- Department of Oral and Maxillofacial Surgery, Barzilai Medical Center, Ashkelon, Israel, and Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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Vaiman M, Nahlieli O, Eliav E. Oynophagia in patients after dental extraction: surface electromyography study. Head Face Med 2006; 2:34. [PMID: 17044922 PMCID: PMC1621058 DOI: 10.1186/1746-160x-2-34] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 10/17/2006] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Surface electromyographic (sEMG) studies were performed on 40 adult patients following extraction of lower third and second molars to research the approach and limitations of sEMG evaluation of their odynophagia complaints. METHODS Parameters evaluated during swallowing and drinking include the timing, number of swallows per 100 cc of water, and range (amplitude) of EMG activity of m. masseter, infrahyoid and submental-submandibular group. The above mentioned variables (mean + standard deviation) were measured for the group of dental patients (n = 40) and control group of healthy adults (n = 40). RESULTS The duration of swallows and drinking in all tests showed increase in dental patients' group, in which this tendency is statistically significant. There was no statistically significant difference between male and female adults' duration and amplitude of muscle activity during continuous drinking in both groups (p = 0.05). The mean of electric activity (in muV) of m. masseter was significantly lower in the dental patients' group in comparison with control group. The electric activity of submental-submandimular and infrahyoid muscle groups was the same in both groups. CONCLUSION Surface EMG of swallowing is a simple and reliable noninvasive method for evaluation of odynophagia/dysphagia complaints following dental extraction with low level of discomfort of the examination. The surface EMG studies prove that dysphagia following dental extraction and molar surgery has oral origin, does not affect pharingeal segment and submental-submandibular muscle group. This type of dysphagia has clear EMG signs: increased duration of single swallow, longer drinking time, low range of electric activity of m. masseter, normal range of activity of submental-submandibular muscle group, and the "dry swalow" aftereffect. The data can be used for evaluation of complaints and symptoms, as well as for comparison purposes in pre- and postoperative stages and in EMG monitoring during treatment of post-surgical oral cavity discomfort and dysphagia.
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Affiliation(s)
- Michael Vaiman
- Chief Surgeon, Department of Otolaryngology, Assaf Harofeh Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Nahlieli
- Professor and Chairman, Dept. of Oral and Maxillofacial Surgery, Barzilai Medical Center, Ashkelon, Israel, and Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Eli Eliav
- Associated Professor, UMDNJ – New Jersey Dental School, Newark, NJ, USA
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Exercise therapy for trismus in head and neck cancer. Oral Oncol 2006; 43:389-94. [PMID: 16979926 DOI: 10.1016/j.oraloncology.2006.04.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 04/10/2006] [Accepted: 04/11/2006] [Indexed: 02/06/2023]
Abstract
The aim of this study was to analyze retrospectively effects of exercise therapy on trismus related to head and neck cancer or as a consequence of its treatment, and to compare these effects with trismus not related to head and neck cancer. Medical records of patients referred to the department of physical therapy with the diagnosis trismus were retrieved and analyzed. Data of 27 patients with trismus related to head and neck cancer and data of eight patients with trismus not related to cancer were found. The number and type of exercises were registered from the records, as was the extent of mouth opening before and after exercise therapy. The median (IQR) number of exercise treatments was 4 (3-9.3). Exercises included active range of motion exercises, hold relax techniques, manual stretching and joint distraction. The increase in mouth opening was significantly (p<or= 0.05) less in the group of patients with trismus related to head and neck cancer (mean increase: 5.5, sd: 6.0) as compared to the increase in mouth opening in the group with trismus not related to cancer (mean increase: 17.1, sd: 9.0). The mean number of treatments given to the group with trismus related to head and neck cancer (7.7) and the group with trismus not related to head and neck cancer (6.1) did not differ significantly. It is concluded that trismus related to head and neck cancer is difficult to treat with exercise therapy.
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Ariji Y, Obayashi N, Goto M, Izumi M, Naitoh M, Kurita K, Shimozato K, Ariji E. Roots of the maxillary first and second molars in horizontal relation to alveolar cortical plates and maxillary sinus: computed tomography assessment for infection spread. Clin Oral Investig 2005; 10:35-41. [PMID: 16362431 DOI: 10.1007/s00784-005-0020-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Accepted: 10/17/2005] [Indexed: 11/26/2022]
Abstract
The purposes of this study were to investigate the horizontal relationship of the roots of maxillary molars with the cortical plates and the maxillary sinus and to investigate the influence of these relationships on the spread of odontogenic infection. Computed tomography images of 120 control subjects and 49 patients with infection originating in the maxillary first or second molar were investigated. In the control group, more than 60% of the first molar roots contacted both palatal and buccal cortical plates (type A), while such contact was not seen in more than 60% of second molars. The floor of maxillary sinus was most frequently observed at the level between the bifurcation and apices of roots in both first and second molars. In patients with infection, cortical changes were more frequently seen on the buccal side than on the palatal side, and 80% of patients with buccal cortical change showed the position in which the buccal roots were close to the buccal cortical plate. Mucosal thickening of the maxillary sinus was found in 87.8%. The buccopalatal spread of odontogenic infection originating in the maxillary first and second molars was influenced by the horizontal root position in relation to the cortices.
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Affiliation(s)
- Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Nagoya 464-8651, Japan.
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Hopp E, Mortensen B, Kolbenstvedt A. Mylohyoid herniation of the sublingual gland diagnosed by magnetic resonance imaging. Dentomaxillofac Radiol 2005; 33:351-3. [PMID: 15585816 DOI: 10.1259/dmfr/31454077] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Mylohyoid herniation of the sublingual gland has been a frequent finding at dissection of adult human cadavers and at retrospective studies of computed tomography (CT) and magnetic resonance imaging (MRI) of the floor of the mouth. Even so, very few clinical reports exist. The present report describes an adolescent boy with a suspected submental tumour, which at MRI was shown to be caused by a mylohyoid hernia of part of an enlarged, but otherwise normal sublingual gland.
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Affiliation(s)
- E Hopp
- Department of Radiology, Rikshospitalet University Hospital, Oslo, Norway.
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Abstract
Oral infections can be odontogenic or nonodontogenic in origin. Odontogenic infections are most prevalent and include dental caries, periodontal disease, and suppurative deep space infections. Nonodontogenic infections include sialadenitis and parotitis, vesiculobullous gingivostomatitis, aphthous ulcers, oropharyngeal candidiasis, and severe oral mucositis in the immunocompromised host. Clinical presentations can be variable. An understanding of the underlying anatomic structures, the oral microflora, and associated medical conditions of the host is critical to guide appropriate diagnosis and management. In this paper, preventative strategies to reduce dental plaque formation and promote oral health are emphasized.
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Affiliation(s)
- Mark W Hull
- Division of Infectious Diseases, Vancouver Hospital, 2733 Heather Street, Vancouver, BC V5Z 3J5, Canada.
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Ohshima A, Ariji Y, Goto M, Izumi M, Naitoh M, Kurita K, Shimozato K, Ariji E. Anatomical considerations for the spread of odontogenic infection originating from the pericoronitis of impacted mandibular third molar: Computed tomographic analyses. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.tripleo.2004.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Obayashi N, Ariji Y, Goto M, Izumi M, Naitoh M, Kurita K, Shimozato K, Ariji E. Spread of odontogenic infection originating in the maxillary teeth: computerized tomographic assessment. ACTA ACUST UNITED AC 2004; 98:223-31. [PMID: 15316549 DOI: 10.1016/j.tripleo.2004.05.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the pathways of infection originating in the maxillary teeth through the interpretation of computerized tomographic (CT) appearances. STUDY DESIGN CT images of 78 patients were analyzed with reference to lateral asymmetry of shape and density of fascial spaces and tissues. RESULTS Changes in the alveolar cortical plates were observed more frequently in the labial/buccal side than in the palatal side. The facial expression muscles were involved in 23 (19.4%) patients. Infection caused by anterior teeth often spread into the levator labii superioris and levator anguli oris muscles. Deep spread into the fascial space was found in 9 (11.5%) patients. Masticator space changes were predominantly seen in the patients with infection caused by molars. Maxillary sinus changes were found in 57 (71.3%) patients with infection originating in the canines, premolars and molars. CONCLUSION Infection spread characteristics are related to the causal teeth, and the pathways were clearly demonstrated on CT images.
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Affiliation(s)
- Naofumi Obayashi
- Second Department of Oral and Maxillofacial Surgery, Aichi-Gakuin University School of Dentistry, Nagoya, Japan
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