Comparative Evaluation of Ultrasonography and MRI in Detection of Odontogenic Fascial Space Infections: A Prospective Study

Aims and objectives: Odontogenic infections, if not properly controlled, can spread to adjacent head and neck fascial spaces. However, because of the complicated anatomic structure of the head and neck, fascial space infections are often difficult to be determined by clinical examinations. The aim of the present study was to investigate ultrasonographic characteristics of fascial space infections and to correlate ultrasonography (USG) findings with those of magnetic resonance imaging (MRI). To assess the role of USG and MRI in diagnosing superficial and deep fascial space infections. Materials and methods: Total of 15 subjects clinically diagnosed with space infections secondary to the odontogenic cause were included in this potential study. The fascial space involvements were examined with USG and MRI. Results: A total of 31 fascial space infections were clinically identified in the subjects, comprising 24 superficial (77.41%) and 7 deep spaces (22.58%), whereas, ultrasonography successfully identified 30 involved fascial spaces, with 28 superficial (93.33%) and 2 deep spaces (6.66%). USG, staging for odontogenic fascial space infections revealed 2 edematous changes, 15 cellulitis, and 13 abscesses. Conclusion: Ultrasonography could be reflected to be an inexpensive, non-invasive technique in detecting the spread of odontogenic infections to the superficial fascial spaces.

Antibiotic sensitivity and resistance of bacteria from odontogenic maxillofacial abscesses

OBJECTIVES: This study investigated the types and antibiotic sensitivity of bacteria in odontogenic abscesses.MATERIALS AND METHODS: Pus specimens from 1,772 patients were collected from affected areas during incision and drainage, and bacterial cultures and antibiotic sensitivity tests were performed. The number of antibiotic-resistant bacteria was analyzed relative to the total number of bacteria that were tested for antibiotic susceptibility.RESULTS: Bacterial cultures from 1,772 patients showed a total of 2,489 bacterial species, 2,101 gram-positive and 388 gram-negative. For penicillin G susceptibility tests, 2 out of 31 Staphylococcus aureus strains tested showed sensitivity and 29 showed resistance. For ampicillin susceptibility tests, all 11 S. aureus strains tested showed resistance. In ampicillin susceptibility tests, 46 out of 50 Klebsiella pneumoniae subsp. pneumoniae strains tested showed resistance.CONCLUSION: When treating odontogenic maxillofacial abscesses, it is appropriate to use antibiotics other than penicillin G and ampicillin as the first-line treatment.

Application of iliac fascia gap blockage in elderly patients with femoral intertrochanteric fractures and its impact on stress indicators / 中国基层医药

Objective@#To investigate the anesthetic effect of the iliac fascia gap block in patients with senile femoral intertrochanteric fractures and its effect on stress indicators.@*Methods@#A total of 100 elderly patients with intertrochanteric fractures were selected and randomly divided into control group(n=50) and observation group(n=50) by digital table.The control group was treated with general anesthesia.The observation group was anesthetized with iliac fascia gap block on the basis of the control group.The levels of norepinephrine(NE), epinephrine(E) and cortisol(Cor) were measured by double antibody radioimmunoassay.The effects of anesthesia and stress indicators of the patients were compared.@*Results@#The dosages of propofol and remifentanil in the observation group were (721.21±21.24)mg and (421.25±8.94)μg, respectively, which were less than those in the control group [(946.46±24.35)mg and (545.42±9.13)μg, t=18.832, 19.231, P<0.05]. The time of extubation, the recovery time of anesthesia and agitation score in the observation group were (12.31±0.94)min, (16.43±1.21)min and (1.64±0.39)points, which were significantly lower than those in the control group[(18.43±1.21)min, (24.34±1.43)min, (2.54±0.64)points, t=21.124, 18.432, 19.831, all P<0.05]. Before anesthesia, there were no statistically significant differences in stress indicators and VAS score between the two groups (all P>0.05). The NE, E, Cor levels at 24h after operation had no statistically significant differences between the two groups (all P>0.05). The postoperative 24h VAS scores in the two groups were lower than those after extubation and before anesthesia(t=14.395, 13.882, 19.662, 12.501, all P<0.05). After anesthesia, the levels of NE, E Cor and VAS score in the observation group were (0.61±0.08)μg/L, (0.07±0.02)μg/L, (112.5±20.51)μg/L and (5.64±0.46)points, respectively, which were significantly lower than those in the control group [(0.84±0.12)μg/L, (0.98±0.06)μg/L, (178.42±29.49)μg/L, (6.75±0.49)points, t=10.773, 12.507, 11.295, 15.774, all P<0.05]. The incidence rate of adverse reaction of the observation group was 8.00%, which was lower than 6.00% of the control group, but the difference was not statistically significant(P>0.05).@*Conclusion@#The use of iliac fascia gap blockage in elderly patients with intertrochanteric fractures is effective and can reduce the dose of anesthetic drugs, reduce perioperative stress response, and does not increase the incidence of adverse reactions, it is worthy of application.

The use of ultrasonography in diagnosis and management of superficial fascial space infections.

Aims and Objectives: To evaluate the role of ultrasonography as a diagnostic aid to differentiate cellulitis from abscess; and efficacy of ultrasound-guided surgical drainage of superficial abscesses in the maxillofacial region. Materials and Methods: a total of 26 patients with acute facial swellings were included in the study. Clinical examination confirmed the presence of space infection. Ultrasonographic examination of the swelling was then performed. If ultrasound images showed no collection and only thickness of subcutaneous tissue and muscle involved were increased, then the diagnosis was made as cellulitis. When collection was identified, diagnosis was made as abscess. Dimensions of abscess cavity, amount of pus collected, and depth of the center of the abscess cavity from the skin surface were recorded. Pus evacuation was then prime consideration either by needle aspiration or by incision and drainage. The amount of collection recorded on ultrasonography was compared with that drained at the time of surgery. Results: of 26 patients, 14 patients were diagnosed with cellulitis and the remaining 12 patients with abscesses in the maxillofacial region. Five of 12 cases of abscess were managed with ultrasound-guided needle aspiration; rest seven cases underwent the incision and drainage procedure. Clinical specificity (69.23%) was found to be poorer than ultrasound specificity (100 %), both clinical and ultrasound showed the same percentage of sensitivity (92.30%) Conclusions: from our experience we can conclude that ultrasonography is an inexpensive and non-invasive diagnostic technique that should be used to supplement clinical examination in patients with superficial fascial space infection.

Clinical analysis of diagnosis and treatment of serious pyogenic infection in deep neck / 中国基层医药

Objective To explore the clinical features,diagnosis and treatment of serious pyogenic infection in deep neck.Methods The retrospective analysis was taken on clinical data of 49 cases.They were all with the deep neck space infections.Among them,19 cases were revealed with diabetes,and only 7cases had the treatment history of diabetes before.Results After systemic anti-inflammatory and local symptomatic treatment,the mean course of treatment in patients without diabetes was 10.1 days,and in patients with diabetes was 18.1 days.Conclusion For diabetic patients with more severe neck space infection,in the control of blood glucose under the premise of local treatments and systemic therapy were equally important.

Bacteriologic Features Investigaed by Aspiration technique in Oral and Maxillofacial Infections

Most purulent maxillofacial infections are of odontogenic origin. Treatment of infection includes the surgical intervention, such as incision and drainage, and adjunctive treatment. The use of high-dose antibiotics is also indicated. The choice of an antibiotics should be based on the knowledge of the usual causative microbes and the results of antibacterial sensitivity test. We have undertaken clinical studies on 119 patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from January 2000 to December 2007. Many anaerobic microbes are killed quickly when exposed to oxygen. Thus the needle aspiration techniques and the transfer under inert gas were used when culturing. The aim of this study was to obtain informations for the bacteriologic features and the effective antimicrobial therapy against maxillofaical odontogenic infections. The obtained results were as follows: 1. The most frequent causes of infections were odontogenic (88.3%), and in odontogenic cause, pulpal infections were the most common causes(53.8%). 2. The buccal and submandibular spaces (respectively 23.5%) were the most frequent involved fascial spaces, followed by masticator spaces (14.3%). 3. The most common underlying medical problems were diabetes (17.6%), however the relation with prognosis was not discovered. 4. The complications were the expiry, mediastinitis, necrotizing fasciitis, orbital abscess, and osteomyelitis. 5. The most common admission periods were 1-2 weeks, and the most patients were discharged within 3 weeks. However, patients who admitted over 5 weeks were about 10%. 6. A total of 99 bacterial strains (1.1 strains per abscess) was isolated from 93 patients (78.2%). The most common bacterium isolated was Streptococcus viridans (46.2%), followed by beta-hemolytic group streptococcus (10.1%). 7. Penicillins (penicillin G 58.3%, oxacillin 80.0%, ampicillin 80.0%) have slightly lower sensitivity. Thus we recommend the antibiotics, such as glycopeptides (teicoplanin 100%, vancomycin 100%) and quinolones (ciprofloxacin 90.0%) which have high susceptibility in cases in which penicillin therapy failed or severe infections.

A clinicostatistical study of fascial space infections of the oral and maxillofacial region

Oral and maxillofacial infection is the oldest and most common disease in human history. The infection ranges from the low-grade infection that only requires minimal treatment to the high-grade and life-threatening fascial space infection. In this study, the data on oral and maxillofacial infections were analyzed to aid in the diagnosis and treatment, and to predict the prognosis. This report was based on data from 831 patients with oral and maxillofacial infection (394 males and 437 females) who were hospitalized in the Department of Oral and Maxillofacial surgery of Chosun University Dental Hospital from January 1998 to May 2005. The ratio of males to females was 0.9:1. By age, patients between 60 and 70 years old were the greatest in number (17.1%), while only 5.9% of the patients were between 10 and 20 years old. The most common cause of infection was odontogenic origin (84.4%), followed by post-extraction infection (6.2%), unknown (5.9%), and trauma (3.5%). The most common fascial space involved was the buccal space (39.4%), followed by the canine (20.6%), submandibular (15.9%), pterygomandibular (9.5%), submental (7.6%) and sublingual (2.8%) space. The number of the involved fascial space was one (75.2%), two (19.8%), or more than three (5.0%). In terms of the treatment duration, the hospitalization period of 6 to 10 days was the greatest in number (49.9%). All patients had uneventful recovery without major complication. There are statistically significant correlations between age and treatment period, and the involved space and treatment period, but no correlations between the variables of sex and treatment.

Clinicostastical study of inpatients of abscess in fascial spaces for the last 5 years

One of the most difficult problems to damage in dentistry is an odontogenic infection. These infections may range from low-grade, well-localized infections that require only minimal treatment to a severe, life-threatenig fascial space infection. Although the overwhelming majority of odontogenic infections are easily managed by minor surgical procedures and supportive medical therapy that includes antibiotic administration, the practitioner must constantly bear in mind that these infections may become severe in a very short time. We made an investigation was targeting on 78 male and 47 female patients (125 patients in total) who had been hospitalized because of the fascial space abscess on the oral and maxillofacial area and gained a complete recovery in Daegu Catholic University Hospital, Oral and Maxillofacial Surgery from January 1999 to December 2003. By tracing their charts, we could grasp the characteristics such as age, gender, the time of breakout and specific areas of the attacks, making a conclusive study of the statistical analysis and finally, we could reach conclusions. Now, we report the conclusion from the investigation with the literature. The proportion of males and females was approximately 3 to 2, and in age group, patients under 10 years old marked the highest, 22.4%. The patients between the age of 10 and 40 were only 14.4%, yet those who were between 40 and 80 marked 53.6% in contrast. In the monthly distribution, the order was Dec.(13.6%)-Sep.(12%)-Jan.(10.4%) and in seasonal distribution, it was winter(30.4%)-fall(28%)- summer(24.4%)- spring(19.2%). Considering the medical history, D.M. was the highest which was 30.3%, hypertension marked 24.4%, and the patients with both D.M. and hypertension were 9.0%. The major cause of infection of oral and maxillofacial areas was odontogenic infection, which marked about 96%, and especially the cases related to dental caries occurred most frequently, which was 51.2%. In the number of relaxed fascial space, single fascial space was 81.6%, and in the degree of relaxation of fascial space, the buccal space abscess marked 40.8%, following submandibular space abscess, which was 30.4%.

A study of microorganisms in oral & maxillofacial infected patients

A Clinico-Statistical Analysis On The Fascial Space Infections Of Oral And Maxillofacial EGION

We have conducted a retrospective study of 224 patients with the diagnosis of oral and maxillofacial infection who had been treated between 1988 and 1999 at Gyeong-Sang National University Hospital. This study was aimed to furnish the data of oral and maxillofacial infection and to aid diagnosis and treatment. The most common fascial space involved, as determined by clinical, radiologic, and operative findings, were the submandibular space(39.4%). The most frequent cause of oral and maxillofacial infection was odontogenic 68.8%. In the odontogenic cause, dental caries was the most common cause. Two-hundred three patients required surgical drainage of the abscess. Seventeen patients needed tracheostomy for airway control. The overall mortality was 0.9% despite aggressive anti-microbial therapy and early surgical intervention. All other patients had an uneventful recovery without major complication except osteomyelitis case(6.0%). The combination of early radiologic diagnosis, effective antimicrobial therapy, and intensive surgical management contributed to the good prognosis.