Spreading Oro-fascial Infections: Is the Trend in Burden Changing?

  • Adewale Francis Adejobi Consultant and lecturer, Oral and maxillofacial surgery, OAUTHC, Ile Ife
  • Olasunkanmi Funmilola Kuye Consultant and Lecturer, Oral and maxillofacial surgery, Lagos State University College Medicine, Ikeja, Lagos
  • Olawunmi Adedoyin Fatusi Consultant and professor, Oral and maxillofacial surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife
  • Mcking Izieza Amedari Department of Preventive and community dentistry, Obafemi Awolowo University Teaching Hospital Complex, Ile-ife.
  • Azuka Raphael Njokanma Oral and maxillofacial surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife
  • Adetayo O. Aborisade Oral Diagnostic science, Aminu Kano Teaching Hospital, Bayero University, Kano
  • Sola Egunjobi Oral and maxillofacial surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife
Keywords: Spreading, orofacial infection, disease, the burden

Abstract

Spreading orofacial infections are often encountered and managed by oral and maxillofacial surgeons. Several factors have been attributed to this spread. It has been reported to be the leading cause of death in maxillofacial patients seen in most hospitals, especially in a resource constraint country like Nigeria. The current study aims to assess factors that contribute to the disease burden of patients with orofacial infection. The case files of 101 patients who were diagnosed clinically of spreading orofacial infections with radiographic confirmation of involved tooth/teeth managed at the LASUTH and OAUTHC Ile Ife over twelve months. The following information was obtained in a prospective study using a proforma; patients’ demographics, underlying morbidity, teeth involved, site location, fascial spaces involved, treatment, and outcome. Patients with incomplete data were excluded. All patients had adequate rehydration followed by incision and drainage or decompression as the case required before administration of empirical antibiotics via the intravenous route. Data were analyzed using IBM SPSS version 21.0. One hundred and one cases were retrieved for the study. There was an almost equal gender distribution of males 51 (50.05%) and females 50 (49.50%). The female to male ratio of 1.02:1.00. The age range was 12-82 years, the mean age for females and males was (17.6 ± 0.448). The majority of the cases were in the 21-40 age group. A significant percentage (95.0%) of the patients were managed as in-patients. The majority of the death 8 out of 12 were recorded among the age group 51-82 years. Mandibular teeth were more affected compared to the maxillary teeth. Though not statistically significant (p=0.054). The lower right first and second molar (17.82%) each were mostly implicated in the mandible while the maxillary upper right second molar tooth (one-third of the total number of maxillary teeth affected) was the most implicated tooth in the maxilla. Twenty-five of the patients had underlying medical conditions with diabetes mellitus being the commonest (66.7%) among the patients under review. Majority of the patients presented with multiple facial spaces involvement with Ludwig’s angina being the commonest presentation. The submandibular space was the most involved space both in single and multiple spaces involvement. The mortality recorded were in patients with Ludwig’s angina, temporal and parapharyngeal space involvement. Seven (58.33%) out of the recorded death had involvement of more than four fascial spaces. The commonest treatment offered was incision and drainage with the extraction of the offending tooth/teeth. There was a positive correlation between the length of hospital stay and the duration of drain in-situ. Fascial space infections in a resource- and personnel-scarce setting still confers a great burden on management. The need for quick surgical intervention, aggressive and adequate antibiotics administrations, high protein nutritional support, and co-managing of patients with other medical teams in controlling associated morbidities are very essential to a good outcome.

Author Biography

Sola Egunjobi, Oral and maxillofacial surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife
   

References

B. Christensen, M. Han, and J. K. Dillon, “The cause of cost in the management of odontogenic infections 1: A demographic survey and multivariate analysis,” Journal of Oral and Maxillofacial Surgery, vol. 71, no. 12, pp. 2058–2067, 2013, doi: 10.1016/j.joms.2013.05.026.

B. O. Akinbami, O. Akadiri, and D. C. Gbujie, “Spread of odontogenic infections in Port Harcourt, Nigeria,” Journal of Oral and Maxillofacial Surgery, vol. 68, no. 10, pp. 2472–2477, 2010, doi: 10.1016/j.joms.2010.01.019.

V. N. Okoje et al., “ORO-FACIAL FASCIAL SPACE INFECTION IN A PAEDIATRIC GAMBIAN POPULATION: A REVIEW OF 93 CASES.,” Journal of the West African College of Surgeons, vol. 8, no. 4, pp. 1–23, [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/33553049

K. Uchenna, I. Olushola, O. Daniel, and A. Adeyemi, “Causes of maxillofacial patient mortality in a Nigerian tertiary hospital,” South Sudan Medical Journal, vol. 9, no. 1, pp. 4–7, 2016.

B. Christensen, M. Han, and J. K. Dillon, “The cause of cost in the management of odontogenic infections 2: Multivariate outcome analyses,” Journal of Oral and Maxillofacial Surgery, vol. 71, no. 12, pp. 2068–2076, 2013, doi: 10.1016/j.joms.2013.05.027.

H. Weise, A. Naros, C. Weise, S. Reinert, and S. Hoefert, “Severe odontogenic infections with septic progress – a constant and increasing challenge : a retrospective analysis,” pp. 1–6, 2019.

L. Qu, X. Liang, B. Jiang, W. Qian, W. Zhang, and X. Cai, “Risk Factors Affecting the Prognosis of Descending Necrotizing Mediastinitis From Odontogenic Infection,” Journal of Oral and Maxillofacial Surgery, vol. 76, no. 6, pp. 1207–1215, 2018, doi: 10.1016/j.joms.2017.12.007.

B. Fomete, R. Agbara, D. O. Osunde, and C. N. Ononiwu, “Cervicofacial infection in a Nigerian tertiary health institution: a retrospective analysis of 77 cases,” Journal of the Korean Association of Oral and Maxillofacial Surgeons, vol. 41, no. 6, p. 293, 2015, doi: 10.5125/jkaoms.2015.41.6.293.

J. Hasegawa et al., “An analysis of clinical risk factors of deep neck infection,” Auris Nasus Larynx, vol. 38, no. 1, pp. 101–107, 2011, doi: 10.1016/j.anl.2010.06.001.

E. S. N. Supreet Ratnakar Prabhu1, “acute fascial space infections of neck:1034 cases in 17yrs follow up,” Annals of Maxillofacial Surgery, vol. 8, no. 1, pp. 121–123, 2018, doi: 10.4103/ams.ams.

J. Han et al., “The financial burden of acute odontogenic infections: the South Australian experience,” Australian Dental Journal, vol. 65, no. 1, pp. 39–45, 2020, doi: 10.1111/adj.12726.

D. A. Adewole, A. M. Adebayo, E. I. Udeh, V. N. Shaahu, and M. D. Dairo, “Payment for health care and perception of the national health insurance scheme in a rural area in Southwest Nigeria,” American Journal of Tropical Medicine and Hygiene, vol. 93, no. 3, pp. 648–654, 2015, doi: 10.4269/ajtmh.14-0245.

R. Mirochnik et al., “Severity Score as a Prognostic Factor for Management of Infections of Odontogenic Origin, a Study of 100 Cases,” Open Journal of Stomatology, vol. 7, no. 1, pp. 25–34, Dec. 2016, doi: 10.4236/OJST.2017.71002.

N. Ahmad, A. O. Abubaker, D. M. Laskin, and D. Steffen, “The financial burden of hospitalization associated with odontogenic infections,” Journal of Oral and Maxillofacial Surgery, vol. 71, no. 4, pp. 656–658, 2013, doi: 10.1016/j.joms.2012.11.024.

H. W. Kim and C. H. Kim, “Factors associated with treatment outcomes of patients hospitalized with severe maxillofacial infections at a tertiary center,” Journal of the Korean Association of Oral and Maxillofacial Surgeons, vol. 47, no. 3, pp. 197–208, 2021, doi: 10.5125/JKAOMS.2021.47.3.197.

T. R. Flynn, “Principles of Management and Prevention of Odontogenic Infections,” Contemporary Oral and Maxillofacial Surgery, pp. 296–318, 2014, doi: 10.1016/B978-0-323-09177-0.00016-5.

B. Fu, K. Mcgowan, J. H. Sun, and M. Batstone, “Increasing frequency and severity of odontogenic infection,” pp. 1–7, 2020, doi: 10.1016/j.bjoms.2020.01.011.

E. S. Keswani and G. Venkateshwar, “Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai,” Journal of Maxillofacial and Oral Surgery, vol. 18, no. 3, pp. 345–353, 2019, doi: 10.1007/s12663-018-1152-x.

S. T. Ibiyemi, V. N. Okoje-Adesomoju, H. O. Dada-Adegbola, and J. T. Arotiba, “Pattern of Orofacial Bacterial Infections in a Tertiary Hospital in Southwest, Nigeria.,” Journal of the West African College of Surgeons, vol. 4, no. 4, pp. 112–41, 2014.

R. Bahl, S. Sandhu, K. Singh, N. Sahai, and M. Gupta, “Odontogenic infections: Microbiology and management,” Contemporary Clinical Dentistry, vol. 5, no. 3, pp. 307–311, 2014, doi: 10.4103/0976-237X.137921.

Y. Ariji et al., “Odontogenic infection pathway to the submandibular space: Imaging assessment,” International Journal of Oral and Maxillofacial Surgery, vol. 31, no. 2, pp. 165–169, 2002, doi: 10.1054/ijom.2001.0190.

S. VN, Okoje, 1 KU, Omeje, corresponding author2 E, Okafor, 3 YI, Adeyemo, 4 J, Abubaccar, 5 CAP, Roberts, 5 and AL, “orofacial space infection in a peadriatric common population, review of 93 cases.pdf.”

S. T. Ibiyemi, V. N. Okoje-Adesomoju, H. O. Dada-Adegbola, and J. T. Arotiba, “PATTERN OF OROFACIAL BACTERIAL INFECTIONS IN A TERTIARY HOSPITAL IN SOUTHWEST, NIGERIA,” Journal of the West African College of Surgeons, vol. 4, no. 4, p. 112, 2014, Accessed: Jan. 22, 2022. [Online]. Available: /pmc/articles/PMC4866728/

B. Akinbami, “Factors associated with orofacial infections,” Port Harcourt Medical Journal, vol. 3, no. 2, Aug. 2009, doi: 10.4314/phmedj.v3i2.45244.

A. B. Suehara et al., “Predictive factors of lethality and complications of deep fascial space infections of the neck,” Revista do Colegio Brasileiro de Cirurgioes, vol. 47, pp. 1–8, 2020, doi: 10.1590/0100-6991E-20202524.

K. Ndukwe, I. Okeke, J. Akinwande, A. Aboderin, and A. Lamikanra, “Bacteriology And Antimicrobial Suceptibility Profile Of Agents Of Orofacial Infections In Nigerians,” African Journal of Clinical and Experimental Microbiology, vol. 5, no. 3. 2004. doi: 10.4314/ajcem.v5i3.7390.

E. S. Keswani and G. Venkateshwar, “Odontogenic Maxillofacial Space Infections: A 5-Year Retrospective Review in Navi Mumbai,” Journal of Maxillofacial and Oral Surgery, vol. 18, no. 3, pp. 345–353, 2019, doi: 10.1007/s12663-018-1152-x.

B. Rashi, S. Sumeet, S. Kanwardeep, S. Nilanchal, and G. Mohita, “Odontogenic infections: Microbiology and management,” Contemporary Clinical Dentistry, vol. 5, no. 3. pp. 307–311, 2014.

V. Ugboko, K. Ndukwe, and F. Oginni, “Ludwig’s angina: an analysis of sixteen cases in a suburban Nigerian tertiary facility.,” African Journal of Oral Health, vol. 2, no. 1–2, pp. 16–23, Jul. 2010, doi: 10.4314/ajoh.v2i1-2.56993.

R. Bhardwaj, S. Makkar, A. Gupta, and K. Khandelwal, “Deep Neck Space Infections : Current Trends and Intricacies of Management ?,” Indian Journal of Otolaryngology and Head & Neck Surgery, 2020, doi: 10.1007/s12070-020-02174-4.

R. M. S. H. Anti and T. R. Flynn, “Principles of Antimicrobial and Surgical Infection Management,” 1981, doi: 10.1016/B978-0-323-28945-0.00007-7.

F. Qiam, M. Khan, B. Mehboob, and Q. Din, “Assessing the Mortality Rate of Patients in a,” vol. 3, no. 1, pp. 2–6, 2012.

F. R. L. Sato, F. A. C. Hajala, F. W. V. F. Filho, R. W. F. Moreira, and M. de Moraes, “Eight-Year Retrospective Study of Odontogenic Origin Infections in a Postgraduation Program on Oral and Maxillofacial Surgery,” Journal of Oral and Maxillofacial Surgery, vol. 67, no. 5, pp. 1092–1097, 2009, doi: 10.1016/j.joms.2008.09.008.

J. Park et al., “A retrospective analysis of risk factors of oromaxillofacial infection in patients presenting to a hospital emergency ward,” Maxillofacial Plastic and Reconstructive Surgery, vol. 41, no. 1, 2019, doi: 10.1186/s40902-019-0238-9.

T. T. Huang, F. Y. Tseng, T. C. Liu, C. J. Hsu, and Y. S. Chen, “Deep neck infection in diabetic patients: Comparison of clinical picture and outcomes with nondiabetic patients,” Otolaryngology - Head and Neck Surgery, vol. 132, no. 6, pp. 943–947, 2005, doi: 10.1016/j.otohns.2005.01.035.

D. Igoumenakis, G. Gkinis, G. Kostakis, M. Mezitis, and G. Rallis, “Severe Odontogenic Infections : Causes of Spread and Their Management,” vol. 14, no. Xx, pp. 1–5, 2013, doi: 10.1089/sur.2012.178.

D. Bertossi et al., “Odontogenic orofacial infections,” Journal of Craniofacial Surgery, vol. 28, no. 1, pp. 197–202, 2017, doi: 10.1097/SCS.0000000000003250.

T. Y. Wong, “A nationwide survey of deaths from oral and maxillofacial infections: The Taiwanese experience,” Journal of Oral and Maxillofacial Surgery, vol. 57, no. 11, pp. 1297–1299, 1999, doi: 10.1016/S0278-2391(99)90863-7.

V. Ugboko, K. Ndukwe, and F. Oginni, “Ludwig’s angina: an analysis of sixteen cases in a suburban Nigerian tertiary facility.,” African Journal of Oral Health, vol. 2, no. 1–2, pp. 16–23, 2010, doi: 10.4314/ajoh.v2i1-2.56993.

R. Braimah, A. Taiwo, and A. Ibikunle, “Ludwig′s angina: Analysis of 28 cases seen and managed in Sokoto, Northwest Nigeria,” Saudi Surgical Journal, vol. 4, no. 2, p. 77, 2016, doi: 10.4103/2320-3846.183700.

Published
2022-04-02
Section
Articles