A review of complications of odontogenic infections

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Abstract

Life-threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous sinus thrombosis, sepsis, thoracic empyema, Lemierre's syndrome, cerebral abscess, orbital abscess, and osteomyelitis. The incidence of these “space infections” has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. This study reviews complications of odontogenic infections. The search done was based on PubMed and Google Scholar, and an extensive published work search was undertaken. Advanced MEDLINE search was performed using the terms “odontogenic infections,” “complications,” and “risk factors.”

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Most cited references 78

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Lemierre's syndrome due to Fusobacterium necrophorum.

Krutika Kuppalli, Sapan N Talati, Melissa Osborn … (2012)

We present a case of a patient with Lemierre's syndrome caused by Fusobacterium necrophorum who developed a right frontal lobe brain abscess. We summarise the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, complications, therapy, and outcomes of Lemierre's syndrome. F necrophorum is most commonly associated with Lemierre's syndrome: a septic thrombophlebitis of the internal jugular vein. Patients usually present with an exudative tonsillitis, sore throat, dysphagia, and unilateral neck pain. Diagnosis of septic thrombophlebitis is best confirmed by obtaining a CT scan of the neck with contrast. Complications of the disease include bacteraemia with septic abscesses to the lungs, joints, liver, peritoneum, kidneys, and brain. Treatment should include a prolonged course of intravenous beta-lactam antibiotic plus metronidazole. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Descending necrotizing mediastinitis.

M J Landay, J GRISHAM, Andrew Platt … (1983)

From January 1975 through July 1981, ten patients with mediastinitis complicating an oropharyngeal infection, that is, a form of mediastinitis best termed as DNM, were encountered at our institution. Based upon rather relatively stringent diagnostic criteria, 21 other instances were found in the literature from 1960 to 1980, a time period well into the antibiotic era. The predominant underlying oropharyngeal infection was of odontogenic origin, specifically, infection involving the mandibular molars. Bacteriologically, DNM is most frequently a polymicrobial process, with anaerobes playing a major role. Although there has been a decline in the over-all incidence of DNM since the introduction of antibiotics, its morbid and lethal nature persists, as evidenced by the present prohibitive mortality of approximately 42 per cent. Delayed diagnosis and inadequate drainage procedures are the primary underlying factors contributing to this high mortality. At present, CT scan is the single most important tool for the early diagnosis of DNM. This noninvasive procedure also helps determine the adequacy of the surgical drainage procedure performed. However, with all the presently available diagnostic tools, it is still the high index of suspicion by physicians toward patients with unrelenting oropharyngeal or deep neck infection that is of utmost importance for making an early diagnosis of DNM. In view of our experience and that of others, we believe that only through aggressive combined medical and surgical management can the highly morbid, if not lethal, course of DNM be reversed. It should be emphasized that, to accomplish successful operative intervention, a thorough knowledge of the complex anatomy of the region is crucial.

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Deep neck abscess: a retrospective review of 210 cases.

A Parhiscar, Marwa G. El-Gazzar (2001)

This study was performed to review our experience with deep neck abscesses (DNAs) and compare it to the experiences in the available literature, and to study changing trends within our patient population. We retrospectively studied 210 patients who had DNAs between 1981 and 1998. Peritonsillar abscesses and limited intraoral abscesses were excluded. Demographics, presentation, etiology, site of abscess, associated systemic diseases, bacteriology, radiology, treatment, airway management, and outcome were reviewed. We compared the entire group to those in the available literature and studied changing trends within this patient population. Dental infection (43%) was the most common cause, followed by intravenous drug abuse (12%) and pharyngotonsillitis (6%). The incidences of intravenous drug abuse and mandibular fractures as causes of DNA were 19% and 8%, respectively, during the period 1981 to 1990, but were only 1% each during the period 1991 to 1998. Streptococcus viridans was the most common pathogen (39% of positive cultures), followed by Staphylococcus epidermidis (22%) and Staphylococcus aureus (22%). Lateral pharyngeal space abscess was the most common DNA (43%), followed by submandibular space abscess, Ludwig's angina, and retropharyngeal space abscess (28%, 17%, and 12%, respectively). Seventy-five percent of patients with true Ludwig's angina underwent tracheotomy. Nondental infections are no longer a significant etiologic factor in DNA. Streptococcus viridans has replaced S aureus and beta-hemolytic streptococci as the most common pathogen. Lateral pharyngeal space abscess was the most common DNA; however, its incidence has progressively decreased over the past decade. Intravenous drug abuse and mandibular fractures are no longer major etiologic factors. Tracheotomy is indicated in patients with Ludwig's angina.

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Author and article information

Journal

Journal ID (nlm-ta): Natl J Maxillofac Surg

Journal ID (iso-abbrev): Natl J Maxillofac Surg

Journal ID (publisher-id): NJMS

Title: National Journal of Maxillofacial Surgery

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0975-5950

ISSN (Electronic): 2229-3418

Publication date (Print): Jul-Dec 2015

Volume: 6

Issue: 2

Pages: 136-143

Affiliations

[1]Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India

Author notes

Address for correspondence: Dr. Rishi Kumar Bali, Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India. E-mail: rshbali@ 123456hotmail.co.uk

Article

Publisher ID: NJMS-6-136

DOI: 10.4103/0975-5950.183867

PMC ID: 4922222

PubMed ID: 27390486

SO-VID: e74eb081-6ada-4e5b-921d-c5ec5b7b4bf8

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A review of complications of odontogenic infections

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International Journal of Applied Technology in Medical Sciences

Most cited references 78

Lemierre's syndrome due to Fusobacterium necrophorum.

Descending necrotizing mediastinitis.

Deep neck abscess: a retrospective review of 210 cases.

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