A TWELVE-YEAR RETROSPECTIVE STUDY OF ODONTOGENIC MAXILLOFACIAL SPACE INFECTIONS IN DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY, P.M.N.M DENTAL COLLEGE AND HOSPITAL, BAGALKOT.
6. BRIEF RESUME OF THE INTENTED WORK:
6.1 NEED FOR THE STUDY:
Maxillofacial infections are a public health concern, primarily related with odontogenic origin, if not treated at an early stage may rapidly evolve and spread to adjacent anatomic structures, leading serious complications like airway obstruction, mediastinitis, septicemia, cavernous sinus thrombosis, jugular vein thrombosis, carotid aneurysm, shock and, occasionally to death. In this study all odontogenic maxillofacial infections were evaluated over a period of 12-years to analyze potential risk factors, clinical presentation, management and outcome.
6.2 REVIEW OF LITERATURE: J. Wang, et al conducted a study to analyze the etiology, clinical presentation, management and outcome of odontogenic maxillofacial infections seen in an urban population over a period of 5-years. A total of 250 patients were admitted with maxillofacial infections, and in 157 cases the infection was odontogenic in origin. Age, gender, site of infection, investigations were performed and treatment carried out to study the outcomes. Length of hospital stay, complications and readmissions were also noted. Males outnumbered females (102:55). Children had a preponderance of maxillary buccal infections whilst adults had more mandibular infections. Hospital stays ranged from 1 to 23 days and only 1 patient required re-admission. A wide range of antibiotics were prescribed and 122 patients required dental extractions. Author evaluated potential risk factors and suggested that early dental extractions, incision and drainage, coupled with intravenous antibiotic therapy is the most effective treatment and prevents potential life threatening complications. Author stated that antibiotic therapy can be empirical since in no case where cultures were performed and did this alter the antibiotic management.
Fabio Ricardo Loureiro Sato, et alretrospectively analyzed data from patients with infections attended by the Department of Oral and Maxillofacial Surgery at the State University of Campinas over the period of 8-years. Sampling comprised of 210 patients and their demographic data were reviewed which included age, gender, signs and symptoms, facial spaces affected and therapy adopted. The authors found that mean age of the patients was 30 years, origin of infection was mainly odontogenic with principal signs and symptoms included trismus, fever and dysphagia. The facial spaces commonly affected were buccal mandibular space (50%), submandibular space (31.9%), buccal maxillary space (19.05%). Surgical drainage was carried out in 46.67% of cases and only 10.95% of these interventions required general anaesthesia. Only 3 patients had developed complications. Authors stated that infection patients were basically young adults, and no predisposition concerning gender or race was detected.
S. Nikakhlagh, et al reveiwed patients with head and neck space infections in ear, nose and throat ward over a period of 12 years, 1998-2009. The aim of this study was investigating the anatomical position, cause and relation of head and neck space infections with age and gender. Author further evaluated co-existing symptoms, associated addictions and bacterial culture results. Authors found that the most common cause of deep neck infections was odontogenic in origin (49%) followed by tonsillar infection (16.6%). Bacterial culture was done only in 50 patients, of which, 28 cases of bacterial growth occurred. Authors stated, the most common organism was streptococcus viridians in 18 patients. So author concluded that promoting public knowledge about oral health, increase in dental treatment centers, timely cure and management of infections play an important role in reducing the deep neck infections.
Thomas B. Dodson, et al evaluated 113 children with head and neck infections admitted to a tertiary care hospital. The study variables were age, sex, symptoms, preadmission use of antibiotics, admission temperature, anatomic location, source of infection, length of hospital stay. Authors reported that head and neck infections in children are common and multiple anatomic structures are present within the small area result in significant clinical and bacteriologic variability. So a limited diagnostic focus may retard discovery of the true source of infection. Author conducted this study to better understand clinical and bacterial epidemiology, biologic behavior, treatment and prognosis.
Thomas R. Flynn, et alconducted a study to prospectively evaluate a series of patients with severe odontogenic infections. In this study 37 consecutive hospitalized patients were treated with intravenous penicillin (unless allergic) and prompt incision and drainage. Data collection included demographic, preadmission, preoperative, anatomic space treatment, microbiology and complications. This study indicated that penicillin resistance, resulting in penicillin therapeutic failure was unacceptably high and alternative antibiotics like clindamycin should be considered. Symptoms like trismus and dysphagia are significant indicators of severe odontogenic infection.
Thomas R. Flynn, etal conducted a prospective study to identify significant predictors namely abscess formation, penicillin therapeutic failure, length of hospital stay, and need for reoperation in patients with severe odontogenic infections. Study variables included demographic, preadmission, preoperative, anatomic spaces, treatment micrbiologic and complications. The study indicated that culture of peptostreptococci was a negative predictor of abscess formation. Length of hospital stay was predicted by the anatomic extent and severity of the infection and the occurrence of complications such as penicillin therapeutic failure and the need for reoperation.
OBJECTIVE OF THE STUDY:
The objective of this study was to analyze data retrospectively of the patients admitted with odontogenic maxillofacial space infections in the Department of Oral and Maxillofacial Surgery, Bagalkot from year 2001 to 2012.
7.MATERIALS AND METHODS:
Patients admitted from 2001-2012 to the Department of Oral and Maxillofacial Surgery, P.M.N.M Dental College and Hospital, Bagalkot with odontogenic maxillofacial space infections.
Refusal of consent
Incomplete data were not analyzed
7.1 SOURCE OF DATA :
All odontogenic maxillofacial space infection patients admitted to the Department of Oral and Maxillofacial Surgery, P.M.N.M Dental College and Hospital, Bagalkot over a period of 12 years, from 2001 to 2012.
7.2METHODS OF COLLECTION OF DATA: Records / case files of patients admitted with odontogenic maxillofacial space infections were taken from the Department of Oral and Maxillofacial Surgey, P.M.N.M Dental College and Hospital, Bagalkot from 2001 to 2012.
SAMPLE SIZE: 140 Patients were evaluated.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS. TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
1. Routine blood investigations like Hemoglobin, Bleeding time, Clotting time, Total Leukocyte Count, Differential Leukocyte Count, Erythrocyte Sedimentation Rate, Random blood sugar, HIV and HbsAg tests were done.
2. Orthopantomograph and Intra-Oral Periapical radiograph of the offending tooth was done.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3? Yes
8.LIST OF REFERENCES:
1. J. Wang, A. Ahani, M. A. Pogrel: A Five-Year Retrospective Study Of Odontogenic Maxillofacial Infections In A Large Urban Public Hospital. Int. J. Oral maxillofac. Surg. 2005; 34: 646-649
2. Fabio Ricardo Loureiro Sato, Felipo Augusto Casseb Hajala, Francisco Wagner Vasconcelos Freire Filho, Roger William Fernandes Moreira, Marcio De Moraes : Eight Year Retrospective Study Of Odontogenic Origin Infections In A Post Graduation Program On Oral And Maxillofacial Surgery. J Oral Maxillofac Surg 67 : 1092-1097, 2009
3. S. Nikakhlagh, F. Rahim, G. Saki, A. Khosravi, H. rekabi and N. Saki: Deep Neck Infections: A Case Study of 12- year. Asian Journal of Biological Sciences 3 (3): 128-133,2010
4. Thomas B. Dodson, David H. Perrott, Leonard B. Kaban : Pediatric Maxillofacial Infections- A Retrospective Study of 113 Patients. J of Oral and Maxillofac Surg. 47: 327-330, 1989
5. Thomas R. Flynn, Michael H. Levi, Richard A. Kraut : Severe Odontogenic Infections, Part 1- A Prospective Report. J Oral Maxillofac Surg 64: 1093-1103, 2006
6. Thomas R. Flynn, Michael H. Levi, Richard A. Kraut : Severe Odontogenic Infections, Part 2- Prospective Outcomes Study. J Oral Maxillofac Surg 64: 1104-1113, 2006