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Management of severe orofacial infections: Report of two cases and literature review

International Journal of Infectious and Tropical Diseases
Volume 4 Issue 1 January–June 2017
© Adetayo et al.; licensee Michael Joanna Publications
Case Series Open Access
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Management of severe orofacial infections: Report of two
cases and literature review
Adetayo AM
, Oyedele TA
, Sodipo BO
, Olawale E
, Ajimoko AO
, Somoye MS
Department of Surgery, Benjamin Carson Snr School of Medicine, Babcock University, Ilisan-Remo,
Ogun State, Nigeria.
Dental Department, Babcock University Teaching Hospital, Ilisan-Remo, Ogun
State, Nigeria.
Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-araba,
Surulere, Lagos State, Nigeria.
Corresponding author:
Received: 10.11.16; Accepted: 12.06.17; Published: 19.06.17
Oral and maxillo-facial infections are common
health issues and major causes of dental
consultation globally.
They are of importance
due to the associated high rate of morbidity and
probable mortality.
Despite enhanced
socioeconomic status of people and advents in
antibiotic therapy, there still exists numerous
cases of severe maxillofacial infections. “The
: Severe orofacial infections are end results of initially long and slow
disease process, usually of odontogenic origin. The outcome of the management
of these conditions is to a large extent affected by the duration of the disease and
extent of s
pread prior to presentation in the hospital. Mediastinitis, pleuritis,
cerebral abscess and meningitis are documented complications secondary to
spreading odontogenic infections. Odontogenic infections should therefore, be
handled as an urgency to prevent acute emergency situations. Methods
: We
present two cases of severe orofacial infections that were seen and managed at
our center. Findings
: Apart from the advanced age of the case 2, there was no
systemic co-morbidity that usually predispose to severe oro
facial infection, and
not yield any growth in case 2. Successful management of the two cases was,
however, achieved with aggressive serial surgical debridement. Conclusion:
successful management of these patients through serial surgical debridement
further lends credence to the importance of less dependence on waiting to know
the microbiology and its potentially harmful sensitive medications in the
management of severe orofacial infections.
Key words:
Odontogenic infections, fascial spaces, orofacial infections, surgical
debridement, dental decay, trismus
Adetayo et al.: Management of severe orofacial infections
Int J Infect Trop Dis 2017;4(1):18-27
high numbers of connecting spaces in the head
and neck region allow fast spread of
inflammation in case of late or improper
treatment of these infections”.
Microbial-induced inflammatory disease in the
orofacial or head and neck region could be
odontogenic arising from dental tissues, or non-
odontogenic arising from non-dental tissues.
Huang et al.
found that 50 per cent of 185
cases of deep neck infections were odontogenic
in origin. Similarly, Bridgeman et al.
53 per cent in their 107 cases,
while Bross-
Soriano et al.
and Juang et al.
reported as
high 89 and 86 per cent respectively in their
Severe odontogenic infections are usually
polymicrobial and are a combination of aerobic,
facultative anaerobes and strict anaerobes.
“Generally, the more skilled and intensive the
microbiologic study, the greater the range and
type of bacteria demonstrated”.
It has been
documented that the commonest bacteria found
in odontogenic infections are streptococci, which
are aerobes, peptostreptococci, pigmented and
non-pigmented prevotella, and fusobacterium,
which are anaerobes.
“Severe odontogenic infections are end results
of initially long and slow disease process”.
microorganisms involved in dental decay take
months if not years to reach the dental pulp to
cause pulp necrosis and then periapical abscess
and similarly, symptoms from partially erupted
teeth are initially subtle before a serious
symptom ensues.
Bridgeman et al.
that all infected patients experienced pain prior
to presentation.
This is
usually intermittent and
the patients fail to seek medical attention.
The predisposing factors to severe orofacial
infections are generally agreed to be local and
Low socio-economic status, low level of
education, neglect, self-medications and
ignorance are also contributory factors to the
development, progress and outcome of orofacial
Diabetes mellitus, obesity,
recently, low social economic factor,
especially have been shown to predispose for
maxillofacial space infections.
These factors
influence the spread of the infection and are
dependent on the balance between patient- and
microorganism-related conditions.
related conditions include systemic factors that
influence host resistance, which may be
impaired in some conditions (table 1), as well as
local factors that also determine the spread of
the infection.
Consequently, the severity of
orofacial infection is determined by the number
and virulence of micro-organisms and resistance
of the host.
The maxillofacial spaces related to the mandible
include submandibular, sublingual, submental
spaces, sub- and supra-masseteric,
pterygomandibular and lateral pharyngeal while
those related to the maxilla are canine fossa,
buccal space, maxillary antrum, infratemporal
space, and subtemporal space.
The most
common fascial spaces affected are the
submandibular (20.3% - 68%) and the buccal
space (8.5%– 96%),
followed by lateral
pharyngeal space, submental space, sublingual
space and the canine space.
Children have
been shown to more likely develop maxillary
infections than mandibular infections.
addition, multiple space involvement is currently
more common than single space involvement
compared to the past.
This, however, might
be due to emerging new strains of
Odontogenic infections generally pass through
three stages before they resolve.
During the
first 1 to 3 days the swelling is soft, mildly
tender, and doughy in consistency. Between
days 2 and 5 the swelling becomes hard, red,
and exquisitely tender. Its borders are diffuse
and spreading.
Between the fifth and seventh
day the center of the cellulitis begins to soften
and the underlying abscess undermines the skin
or mucosa, making it compressible and
All these might be seen in the
presenting clinical features. The typical signs
and symptoms of severe/spreading odontogenic
maxillofacial infections, however, include
trismus, fever, dysphagia, pain, swelling,
leucocytosis, dehydration, airway compromise,
and respiratory distress.
The outcome of the management of these
conditions is to a large extent determined by the
duration of the disease and extent of spread
Adetayo et al.: Management of severe orofacial infections
Int J Infect Trop Dis 2017;4(1):18-27
prior to presentation in the hospital, virulence of
causative organisms, as well as the presence
and control of local and systemic diseases.
is worthy to note that severe odontogenic
infection is now found with higher incidence in
seemingly immunocompetent patients.
time should be wasted in waiting to know the
microbiological profile of the aspirate or drainage
as aggressive surgical intervention is still the
mainstay of management. Odontogenic
infections should therefore, be handled with
every sense of urgency, otherwise within a short
period of time, they might result in acute
emergency situations.
We present two cases of severe maxillofacial
space infections that occurred in seemingly
immunocompetent subjects managed by our
Case 1
An 18year old female student of BU that
presented with a 2-day history of left sided facial
swelling. She gave a history of sore throat that
made her present at the accident and
emergency one week prior to the swelling where
she was managed for tonsillitis. Medical history
was not remarkable.
At presentation, patient was clinically stable.
There was a diffused swelling at the lower part
of left side of the face extending into the left
submandibular region (figures 1a and 1b).
Swelling was brawny hard, slightly warm and
slightly painful. There was marked trismus of
about 10mm. Intraoral examination was limited,
but the lower left wisdom tooth was seen to be
impacted. A provisional diagnosis of left
submasseteric and submandibular fascial space
abscess was consequently made. Random
blood glucose check, electrolyte, urea and
creatinine, and full blood count were within
normal range as shown in table 2.
Intravenous ceftriaxone 2g stat and 500mg
metronidazole was immediately given, and
incisions and drainage instituted. Pus was
aspirated and sent for microscopy culture and
sensitivity. Intraoral drainage was done for
submasseteric space by making a mucosal
incision of about 1cm along the ascending
mandibular ramus and thereafter passing a
curved artery forceps lateral to the ramus to
enter deep to the master muscle. The
submandibular space was drained extra-orally
through a 2cm skin incision placed 2cm below
the lower border of the mandible. A curved
artery forceps was also introduced and passed
to enter both the submandibular and sublingual
spaces on that side. Drains were placed and left
in-situ. Patient was allowed to go home to be
seen on out-patient basis because there was no
immediate threat to the airway, and was placed
on tablet augmentin 625mg 12-hourly and tablet
metronidazole 400mg 8-hourly for seven days.
Re-exploration coupled with jaw exercise was
done daily for 4 days and the patient mouth
opening improved (figures 2a and 2b) and later
on alternate basis till the swelling resolved
(figures 3a, 3b and 3c). Patient was then
subsequently discharged.
Case 2
An 83year old male that presented to accident
and emergency section of the institution with
facial and neck swelling of a day duration. He
gave a history of hitting his lower jaw on the
concrete floor of the house following a slip.
Medical history was not significant.
At presentation, there was gross diffused lateral
facial swelling that was more severe on the left
side, and the upper part of the neck. Swelling
was brawny hard mostly on the face, but
fluctuant on the neck (figures 4a, 4b and 4c).
Mouth opening was about 20mm. The tongue
was raised almost to the palate and the
sublingual folds were ballooned out (figure 5).
There were numerous retained roots and the
lower left 2nd premolar, and 1st and 2nd molars
were grossly mobile. A provisional diagnosis of
Ludwig’s angina and left buccal space infection
was subsequently made.
Intravenous ceftriaxone 2g stat followed by 1g
12-hourly and intravenous metronidazole 500mg
8-hourly was immediately commenced. Pus was
aspirated and sent for microscopy culture and
sensitivity. Incision and drainage of bilateral
submandibular and submental spaces was
instituted, as described for case 1, and multiple
incisions were also made on the neck to drain
the lateral pharyngeal spaces. Drains were
placed and left in-situ. Electrolyte urea and
Adetayo et al.: Management of severe orofacial infections
Int J Infect Trop Dis 2017;4(1):18-27
creatinine were within normal range but the
white cells count was very high, 28,000/l (as
shown in table 3). Patient was subsequently
admitted and daily exploration with twice daily
dressing regimen was instituted. Culture and
sensitivity did not yield any microorganism after
two attempts. Medication was however changed
to intramuscular benzyl penicillin 1.2MU 12-
hourly for 1 week when copious drainage
persisted after 4 days of intravenous ceftriaxone.
This however improved significantly after (figure
6a, 6b and 6c), and patient was discharged after
10 days.
Table 1: Local and systemic predisposing factors to severe orofacial infections
Local factors Systemic factors
1. Caries, impaction, pericoronitis
2. Poor oral hygiene, periodontitis
3. Trauma
4. Foreign body, calculi
5. Local fungal and viral infections
6. Post extraction/surgery
7. Irradiation
8. Failed root canal therapy
9. Needle injections
10. Secondary infection of tumours,
cyst, fractures
11. Allergic reactions
Human immunodeficiency virus
Measles, chronic malaria, tuberculosis
Diabetes mellitus, hypo- and hyperthyroidism
Liver disease, renal failure, heart failure
Blood dyscrasias
Steroid therapy
Excessive antibiotics
Sickle cell disease
Table 2: Case 1 laboratory investigations and results
Laboratory test Result
Random blood glucose
Microscopy, culture and sensitivity
White cell count
Normal oral flora
Table 3: Case 2 laboratory investigations and results
Laboratory test Result
Random blood glucose
White cell count
Microbiology and sensitivity
No growth after 48hrs
Adetayo et al.: Management of severe orofacial infections
Int J Infect Trop Dis 2017;4(1):18-27
Table 4: Eight steps of management of orofacial infection
Determine the severity of infection.
Evaluate host defenses.
Decide on the setting of care.
Treat surgically.
Support medically.
Choose and prescribe antibiotic therapy.
Administer the antibiotic properly.
Evaluate the patient frequently.
Figure 1a Figure 1b
Figure 1: Patient immediately after the 1st surgical intervention (Case 1)
Figure 2a Figure 2b
Figure 2: Patient mouth opening after 4 days of surgical intervention and jaw exercise
(Case 1)
Adetayo et al.: Management of severe orofacial infections
Int J Infect Trop Dis 2017;4(1):18-27
Figure 3: Final appearance (Case 1)
Figure 4: Patient at presentation (Case 2)
Adetayo et al.: Management of severe orofacial infections
Int J Infect Trop Dis 2017;4(1):18-27
Figure 5: Final appearance of patient (Case 2)
Odontogenic infections are conditions often
managed by oral and maxillofacial surgeons. A
large number of people are affected by these
infections which is associated with serious
complications if not promptly and adequately
Thus, the significance of infections of
dental origin is their high incidence and
morbidity, and more importantly the potential of
spreading to the orofacial spaces.
Orofacial infection has been said to affect males
or females in equal proportion.
The two cases
seen and managed in our unit would seem to fit
into this assertion. Marina-George and Frank
and Dailey et al.
also reported that there was
no significant gender difference for clinic visit
rate due to orofacial infections in their study.
However, Akinbami et al.
recently reported a
female preponderance in their study while
Abdulazziz et al.
reported a male
preponderance. Geographical differences in the
study cohorts may explain these disparities.
Various studies on orofacial infections
have put the mean age of patients with severe
orofacial infections at 37.5 years, but the
consensus is that orofacial infections occur in a
broad age range.
Our patients’ ages were
18years and 83years respectively.
Our patients presented within 3 days of onset of
the orofacial swelling. Abdulazziz,
Flynn et
and Ulibau
also reported that most cases
of orofacial infections seen in their studies
presented within 1-10 days of noticing the
A plausible reason for this is that
most patients are alarmed to see a rapidly
developing facial swelling, even though they
have had recurring symptoms much before the
onset of space infection. This is also echoed by
George et al.
and consequently, swelling is a
ubiquitous complaint in maxillofacial
The two patients in this report
presented with submandibular space infection.
Swelling of the submandibular spaces is said to
be the most common presentation followed by
the buccal space swelling.
Abdulazziz et al.
found the buccal space to be
the most affected in their study.
This two
reported cases seem to support the finding of
the former study.
Trismus (limitation in mouth opening) is another
common finding in maxillofacial space
This indicates that the infection has
involved the masticatory spaces. Both cases in
this report presented with trismus. Trismus in
patients with an odontogenic infection is said to
be a danger sign according to the study of 212
cases by Zhang et al.
where significant
Adetayo et al.: Management of severe orofacial infections
Int J Infect Trop Dis 2017;4(1):18-27
number of the cases developed airway
obstruction associated with trismus.
deeper examination of the patient is necessary
for clinical manifestations of upper airway
compromise such as tongue elevation, stridor,
difficulty in swallowing saliva, and
Only one of the two cases in
this report developed signs of airway
obstruction. This, however, improved quickly
following incision and drainage of the facial
Infection of the lower posterior teeth is
considered the most common source of
Both cases in this report were
found to have infection of the lower posterior
teeth. Posterior teeth are known to have wider
surface area, and are used for mastication,
hence vulnerable to occlusal stress, more micro-
/macro-trauma, more caries, more impaction
and stagnation of food debris and also have
reduced accessibility to thorough hygiene.
“Treatment failure and recurrent treatment are
also more common with posterior teeth”.
These factors predispose them to infections.
Imaging studies are useful to determine the
extent of orofacial infections particularly when
there is an abscess formation, however
diagnosis is made on the basis of clinical
Consequently, treatment must be
prompt, vigorous and initiated early with the
administration of antibiotics and prophylactic
debridement of the spaces involved, without
waiting for fluctuation to appear; the airways
must also be assessed for potential obstruction.
The eight steps in the management of
odontogenic infections as outlined by Flynn et
are as shown in table 4.
Surgery in form of incision and drainage of the
spaces affected and removal of the source of
infection is the mainstay of treatment of orofacial
infections. Following assessment of the two
cases in this report, drainage of the spaces was
instituted and antibiotics were given empirically.
There was significant improvement and
consequent resolution of the facial swelling. This
treatment protocol is widely accepted.
However, Dailey and Martin
and Marina-
George and Frank
in their reviews noted that
medical treatment alone, without removing the
focus of infection produced a resolution of the
odontogenic infections.
This, however, could
be due to the fact that the majority of the cases
seen in their reviews were ordinary pulpitis.
Also, patients were not followed up to know if
possible recurrences or complications occurred.
It still remains a controversy whether drainage
should be performed when the patient has only
cellulitis. “The issue of cellulitis being managed
differently is a carryover from a pre-antibiotic
era, during which time there was a risk that
surgical intervention could make the condition
Currently, there is an evolving
consensus that the difference between cellulitis
and abscess is no longer clinically relevant and
that both need to be drained”.
As echoed by
George et al,
high treatment success rate is
only guaranteed by active surgical
The relevance of odontogenic infection lies in
that it can cause infections that compromise
more distant structures (via direct spread and
distant spread), as stated previously. Much
more, studies
have documented
mediastinitis, pleuritic, cerebral abscess and
meningitis secondary to spreading odontogenic
In conclusion, ignoring a toothache can pose a
threat to more than a person’s dental health.
The tooth chamber acts as an incubator for the
bacteria proliferation once tooth decay destroys
the pulp or inner chamber of the tooth. The
resultant inflammation and infection can spread
to contiguous parts of the body and through the
blood stream to distant parts of the body,
leading to significant morbidity and sometimes,
mortality. While it might be difficult to prevent the
occurrence of toothache, it is important to
enlighten people on early presentation at the
dental facility if affected, in order to avoid
progression to severe orofacial infection with its
attendance morbidity and mortality. As shown by
the management of these cases, the clinician
needs to know that medications are only
complimentary in odontogenic infection, and
much less in severe orofacial infections.
Aggressive surgical management remains the
mainstay of severe orofacial infections.
Adetayo et al.: Management of severe orofacial infections
Int J Infect Trop Dis 2017;4(1):18-27
The authors would like to thank all the nursing
staff of the Dental and Maxillofacial unit of the
institution for their priceless contribution to the
successful management of these patients.
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How to cite this article:
Adetayo AM,
Oyedele TA, Sodipo BO, Olawale E,
Ajimoko AO, Somoye MS.
of severe orofacial infections: Report of
two cases and literature review.
Int J
Infect Trop Dis 2017;4(1):18-27.
Conflict of Interest: None declared
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Background: Severity of orofacial infections is dependent on a balance between host immunity and causative microbe related factors. Severe orofacial infections (SOI), if not controlled, could lead to serious complications. Aim: The aim of this study was to determine the conditions associated with severe orofacial infections seen at the Komfo Anokye Teaching Hospital (KATH). Materials and Methods: This was a 2-year retrospective study of all cases of orofacial infections admitted to the oral and maxillofacial surgery ward of KATH from January 2017 to December 2018. A specially designed form was used to collect relevant information from patients' records. Data was entered into Excel and later transported to SPSS for analysis. Ethical approval was obtained. Results: A total of one hundred and twenty (120) patients were seen during the period comprising 75 males and 45 females, giving a male to female ratio of 1.6:1. Eighty-one (67.5%) of the patients had low haemoglobin levels at the time of admission and 11.7% were known hypertensives on medication while 10.3% were newly diagnosed cases of hypertension. 17.0% were knowndiabetes mellitus (DM) patients and were on oral hypoglycemic agents but only 56.8% of them took their medication regularly. An additional 23.7% were newly diagnosed with DM. Sixty-four (64) has liver impairment, 79 had renal impairment. Conclusion: Anemia was the major condition associated with the SOI. This meant that in the management of SOI, correction of anaemia should be prioritized. DM, uncontrolled hypertension, renal and liver diseases were also seen to be associated with SOI.
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To retrospectively evaluate the treated cases with odontogenic abscess and identify the outcome of odontogenic infections, their characteristics and treatment modalities. This retrospective study was performed by collecting data from 310 patient records at the oral and maxillofacial surgery department of Taleghani hospital, Tehran, Iran from January 2001 to January 2011. The variables were age, gender, affected teeth, affected facial spaces, type of bacterial source, type of antibiotic therapy, previous medication, hospital stay, body temperature on admission and past medical history. The patients' ages were between 2 and 84 years and 62.6% of the patients with odontogenic infection were younger than 35 years old. Most of the patients had a body temperature of 37-37.5°C. The most involved teeth were mandibular third molar. Deciduous teeth contained 6.4% of the involved teeth, among which mandibular molars were the most involved. 24.3% of the patients were hospitalized for 4 days. Streptococci were the most detected bacterial strain. The most involved anatomic space was the buccal space and 22.5% of the cases had multi space involvement and 17 cases had Ludwig's angina. The most common used antibiotic regimens were penicillin G and metronidazole or cefazolin and metronidazole. The mortality rate was 1%, all of whom had Ludwig's angina. The main affected facial spaces were buccal and submandibular spaces. The most common used antibiotic was penicillin, proving its effectiveness in the treatment of jaw infections. Odontogenic abscesses are mostly related to the eruption of mandibular molars.
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Odontogenic infections contribute to a significant proportion of maxillofacial space infections (MSI) across the world. MSI can cause several life-threatening complications despite skillful management. The objective of this study was to review the clinical characteristics, management, and outcome of odontogenic MSI treated at a tertiary care center, and to identify the factors predisposing to life-threatening complications. A retrospective chart review of all patients treated for MSI from January 2006 to December 2010 at the Christian Medical College Hospital in Ludhiana, North India, was conducted. Out of 137 patients identified, 66.4% were men. Mean patient age was 40 years, and 24.1% of the patients were diabetic. The most common origin was pulpal (70.8%), the most common space involved was the submandibular space, and the most common teeth responsible were the lower third molars. Twenty patients (14.6%) developed complications. Diabetes, multiple space involvement, and a total leukocyte count of ≥15×10(9)/l were associated with complications. Patients with MSI who present with multiple space involvement, a high leukocyte count, and those with diabetes are at higher risk of developing life-threatening complications and need to be closely monitored.
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Orofacial infections are common reasons for dental consultations worldwide. However, there is scarcity of data on clinico-epidemiological profiles reported from primary care dental practices. To address this issue, a study was done to characterize the clinical pattern, age groups affected and sex predilection of orofacial infections in the primary care dental practice. Clinical data was evaluated from random electronic files of patients for whom antimicrobials were prescribed at two Dental Practices in UK between January 2009 and December 2010. 200 case records were studied. 104 (52%) cases were females. Mean age was 37.2 (+/-15.1) years. 107 (53.5%) cases belonged to age group 21-40 years. Posterior teeth were involved in 112 (56%) cases. Types of disease were as follows: dentoalveolar abscess 63(31.5%), pulpitis 27(13.5%), apical periodontitis 21(10.5%), pericoronitis 21(10.5%), dry socket 13(6.5%), periodontitis 9(4.5%) infected root stump 5(2.5%), facial swelling 5(2.5%) and infections unspecified 36(18%) cases. Orofacial infections affect both sexes equally. 21-40 years is the commonest age-group affected. Dentoalveolar abscess is the commonest infection followed by unspecified infections and pulpitis.
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Spreading odontogenic infections (SOI) are the commonest type of serious infections encountered in the orofacial region. A prospective multi-centre study was conducted in the West of Scotland to investigate the contributing role of social, systemic and microbial factors in the pathogenesis of SOI. Twenty-five patients with severe odontogenic infections were recruited over a period of six months. At admission, clinical assessment included temperature rise, haematological and biochemical investigations. Demographic data, social and past medical histories were obtained. Microbiology samples were collected to identify causative microorganisms and the clinical management of each infection was recorded. Most infections were associated with teeth or roots. Eighty percent of the patients were tobacco smokers and 72% came from deprived areas. Five patients were intravenous drug users, four admitted chronic alcohol abuse, six had underlying systemic disorders and two were at high risk of malnutrition. A raised C-reactive protein at admission was a useful indicator of the severity of infection. Inappropriate prior antibiotic treatment in the absence of surgical drainage was common. Microbiology results showed a predominance of strict anaerobes, notably anaerobic streptococci, Prevotella and Fusobacterium species. SOIs remain surprisingly common and our present pilot study showed a particular association with social deprivation and tobacco smoking. Further elucidation of the role of malnutrition in SOI would be of interest. Molecular characterisation of the microflora associated with SOI may help to highlight whether bacterial factors play a role in converting a localised dentoalveolar abscess into a serious, spreading odontogenic infection.
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.
Odontogenic infections constitute a substantial portion of diseases encountered by oral and maxillofacial surgeons. Infections start from dental tissues and sometimes rapidly spread to contiguous spaces. The consequence is a fulminant disease with significant morbidity and mortality. The study was aimed at studying the pattern of spread, approach to management, and outcome of these infections at a Nigerian teaching hospital. A retrospective study of all patients with orofacial infections who presented to our center over an 18-month period was carried out. The medical records were reviewed to retrieve the following: age, gender, source of infection, anatomic fascial spaces involved, associated medical conditions, various treatment modalities, types of antibiotics administered, causative micro-organisms, length of stay in the hospital, and any complications encountered. Infections were classified into 2 categories: those that are confined to the dentoalveolar tissues belong to category I, and those that have spread into the local/regional soft tissue spaces and beyond belong to category II. Odontogenic infections constituted 11.3% of the total oral and maxillofacial surgery cases. A total of 261 patients were treated for odontogenic infections. There were 146 female patients (59.8%) and 98 male patients (40.2%) in the first category, whereas the second category comprised 10 male patients (58.8%) and 7 female patients (41.2%). The fascial spaces involved, in descending order, were submasseteric in 10 (22.7%), submandibular in 9 (20.5%), and sublingual in 6 (13.6%). The causative micro-organisms commonly found were Klebsiella and Streptococcus spp. Incision and drainage were performed in the 17 cases with spreading infection. Amoxicillin, amoxicillin/clavulanate, and metronidazole were the most routinely administered antibiotics. Our experience shows that delay in presentation, self-medication, aging, male gender, and unusual causative agents are some of the factors associated with spread. Therefore efforts must be made to further improve public dental awareness.