Validación del instrumento para determinación de prevalencia de celulitis facial y su relación con la caries dental en pacientes de 5 a 9 años de edad / Validation of the instrument for the determination of prevalence of facial cellulite and its relationship with cariesdental in patients from 5 to 9 years of age

La celulitis facial odontogénica es comúnmente observada en las salas de emergencia hospitalarias en los pacientes pediátricos debido a la caries dental. Objetivo: Validar el instrumento de prevalencia de celulitis facial y su relación con la caries dental en pacientes de 5 a 9 años de edad en el Hospital General IESS Milagro. Materiales y métodos: Enfoque mixto cuantitativa y cualitativa, tipo de investigación de campo, corte transversal, descriptivo, no experimental, se realizó un plan piloto de 15 pacientes pediátricos, un instrumento cuantitativo (Ficha de recolección de datos) contó con 9 expertos para un juicio de expertos y en el instrumento cualitativo (Entrevista) contó con 6 expertos para la validación del instrumento en total son de 15 profesionales en salud, calificando Validez, Pertinencia y Coherencia. Resultados: El instrumento cuantitativo tiene una puntuación de 80,85 de confiablidad y el instrumento cualitativo tiene una puntuación de 87,11 de confiablidad. En el instrumento cuantitativo se determinó la prevalencia de celulitis facial de niños de 5 a 9 años de edad, género masculino (80%), rango de 7 a 8 años (53,3%), cita por primera vez (60%), antecedente referencial caries dental (93,3%), diagnóstico CIES10 fue el L032 celulitis de la cara (93,3%), región afectada en la zona submandibular (73,3%), prevalencia de caries dental, molares deciduos (93,3%), no registran antecedentes de buena salud (73,3%), tratamientos odontológicos de prevención al año ninguna (80%), causa frecuente en la aparición de celulitis facial, la necrosis pulpar K041. Conclusión: La validación del instrumento tuvo un grado de confiabilidad muy buena y su cifra de alfa de Cronbach alto, la misma que da seguridad y confianza, gracias a la calificación de los jueces que revisaron cada detalle(AU)

Odontogenic facial cellulite is commonly observed in hospital emergency rooms in pediatric patients due to the dental caries. Objective: to validate the facial cellulite prevalence instrument and its relationship with dental caries in patients from 5 to 9 years of age in the IESS Miracle General Hospital. Materials and methods: mixed approach quantitative and qualitative, type of field research, cross section, descriptive, non-experimental, a pilot plan of 15 patients was carried out ediatric patients, a quantitative instrument (data collection form) counted with 9 experts for an expert judgment and in the qualitative instrument (Interview) had 6 experts for the validation of the instrument in total they are of 15 health professionals, qualifying Validity, Relevance and Coherence. Results: the quantitative instrument has a score of 80.85 of reliability and the qualitative instrument has a score of 87.11 out of reliability. In the quantitative instrument, the prevalence of facial cellulite in children 5 to 9 years of age, male gender (80%), range 7 to 8 years old (53.3%), appointment for the first time (60%), referential history dental caries (93.3%), CIES10 diagnosis was L032 facial cellulite (93.3%), affected region in the submandibular area (73.3%), prevalence of dental caries, deciduous molars (93.3%), do not record a history of good health (73.3%), preventive dental treatments per year none (80%), frequent cause in the appearance of facial cellulitis, pulpal necrosis K041. Conclusion: the validation of the instrument had a very high degree of reliability. good and its high Cronbach's alpha figure, the same one that gives security and confidence, thanks to the rating of the judges who reviewed every detail(AU)

Mediastinitis necrotizante descendente de origen odontogénico / Descending necrotizing mediastinitis of odontogenic origin

Introducción: las infecciones odontogénicas afectan al 80 %-90 % de la población y pueden dar lugar a complicaciones potencialmente mortales como la mediastinitis necrotizante descendente, una infección polimicrobiana aguda en el mediastino con una tasa de mortalidad entre el 11 % y 40 %. Su detección precoz y el tratamiento adecuado con manejo antibiótico y drenaje quirúrgico a cargo de un equipo multidisciplinario representan factores influyentes en el pronóstico de la enfermedad. Objetivo: en este artículo presentamos un caso de mediastinitis necrotizante descendente en un paciente masculino de 34 años, que se originó por una infección odontogénica que requirió un procedimiento dental. El paciente fue hospitalizado por el empeoramiento del estado clínico a pesar de la profilaxis antibiótica. La tomografía axial computarizada (TAC) confirmó la extensión de la infección al mediastino, y el paciente fue tratado con éxito con antibioterapia intravenosa y múltiples drenajes quirúrgicos intraorales, cervicotomía y toracoscopia. Materiales y métodos: se realizó una búsqueda en bases de datos globales y se seleccionaron los artículos por los siguientes términos MeSH y DeCS: "mediastinitis necrotizante descendente", "angina de Ludwig", "absceso", "toracoscopia" y sus respectivos en inglés, priorizando los referentes a la mediastinitis necrotizante descendente de origen odontogénico. Conclusiones: en la mediastinitis necrotizante descendente, la combinación de diagnóstico precoz, tratamiento antibiótico de amplio espectro, mantenimiento de la vía aérea y drenaje quirúrgico amplio y a cargo de un equipo multidisciplinario mejora de manera importante el pronóstico de la enfermedad.

Introduction: Odontogenic infections affect 80%-90% of the population and can lead to life-threatening complications such as descending necrotizing mediastinitis. Is an acute polymicrobial infection in the mediastinum with a mortality rate of 11%-40%. Its early detection and adequate treatment with antibiotic management and surgical drainage by a multidisciplinary team represent influential factors in the prognosis of the disease. Objective: In this article, we present a case of descending necrotizing mediastinitis in a 34-year-old male patient that originated from an odontogenic infection that required a dental procedure. The patient was hospitalized for worsening clinical status despite antibiotic prophylaxis. Computed axial tomography confirmed the extension of the infection to the mediastinum and the patient was successfully treated with intravenous antibiotherapy and multiple intraoral, cervicotomy, and thoracoscopic surgical drains. Materials and methods: A search was made in global databases, articles were selected by the following MeSH and DeCS terms: "descending necrotizing mediastinitis", "Ludwig's angina", "abscess", "thoracoscopy", and their respective English terms, prioritizing those referring to descending necrotizing mediastinitis of odontogenic origin. Conclusions: In descending necrotizing mediastinitis, the combination of early diagnosis, broad-spectrum antibiotic treatment, airway maintenance, and extensive surgical drainage by a multidisciplinary team significantly improves the prognosis of the disease.

Changes in Vital Signs and Laboratory Tests in Patients with Odontogenic Infections Requiring Hospitalization / Cambios en los Signos Vitales y Pruebas de Laboratorio en Pacientes con Infecciones Odontogénicas que Requirieron Hospitalización

ABSTRACT: The purpose of this study was to evaluate the changes in vital signs and laboratory tests of patients with odontogenic infections who required hospitalization as well as checking their effectiveness in determining the severity of the case and possible correlations with the length of stay. Patients with odontogenic infections who required hospitalization were assessed prospectively between October 2016 and April 2018. The patients were divided into two groups considered as simple (Group 1) or complex (Group 2) cases according to the length of stay. The personal data, comorbidities, signs and symptoms, vital signs and laboratory tests were analyzed. In this study, 84 cases of maxillofacial infections were detected and 50 cases of odontogenic infections were included. There were significant increases in heart rate (p = 0.012), leukocytosis (p = 0.037), neutrophilia (p = 0.021), neutrophil/lymphocyte (N/L) ratio (p = 0.044) and C-reactive protein (CRP) levels (p = 0.004) in Group 2. Additionally, there were positive correlations between the length of stay and the following variables: heart rate (p = 0.028), leukocytosis (p = 0.045), neutrophilia (p = 0.033), N/L ratio (p = 0.041) and CRP level (p = 0.003). The N/L ratio was found to have a greater value in regression analysis. It was concluded that there were significant increases in heart rate, leukocytosis, neutrophilia, N/L ratio and CRP levels for the complex cases. There were also positive correlations between the length of stay and the following variables: heart rate, leukocytosis, neutrophilia, N/L ratio and CRP level.

RESUMEN: El propósito de este estudio fue evaluar los cambios en los signos vitales y las pruebas de laboratorio de pacientes con infecciones odontogénicas que requirieron hospitalización, así como verificar su efectividad para determinar la gravedad del caso y las posibles correlaciones con la duración de la internación. Pacientes con infecciones odontogénicas que requirieron hospitalización fueron evaluados prospectivamente entre octubre de 2016 y abril de 2018. Los pacientes se dividieron en dos grupos considerados como casos simples (Grupo 1) o complejos (Grupo 2) según la duración de la internación. Se analizaron los datos personales, comorbilidades, signos y síntomas, signos vitales y pruebas de laboratorio. En este estudio, se detectaron 84 casos de infecciones maxilofaciales y se incluyeron 50 casos de infecciones odontogénicas. Hubo aumentos significativos en la frecuencia cardíaca (p = 0,012), leucocitosis (p = 0,037), neutrofilia (p = 0,021), relación neutrófilos / linfocitos (N/L) (p = 0,044) y niveles de proteína C reactiva (PCR) (p = 0,004) en el Grupo 2. Además, hubo correlaciones positivas entre la duración de la internación y las siguientes variables: frecuencia cardíaca (p = 0,028), leucocitosis (p = 0,045), neutrofilia (p = 0,033), relación N/L (p = 0,041) y nivel de PCR (p = 0,003). Se encontró que la relación N/L tenía un mayor valor en el análisis de regresión. En conclusión, hubo aumentos significativos en la frecuencia cardíaca, leucocitosis, neutrofilia, relación N/L y niveles de PCR para los casos complejos. También hubo correlaciones positivas entre la duración de la internación y las siguientes variables: frecuencia cardíaca, leucocitosis, neutrofilia, relación N/L y nivel de PCR.

Mediastinitis necrotizante descendente de origen dental: revisión de la literatura y presentación de un caso / Descending necrotizing mediastinitis of dental origin: a case study and review of the literature

La mediastinitis se define como una inflamación aguda severa de los tejidos conectivos ubicados en la cavidad torácica media, en la que 20% de los casos puede implicar una infección difusa y polimicrobiana del mediastino denominada mediastinitis necrotizante descendente (MND), secundaria a la propagación de una infección grave desde los tejidos bucofaríngeos o cervicales tales como infecciones odontogénicas (de 36 a 47%), faríngeas (de 33 a 45%), cervicales (15%) y otras infecciones de cabeza y cuello (5%). Clínicamente, los pacientes presentan aumento de volumen, temblores, trismus, odinofagia con disnea, disfagia, hipotensión, dolor de cuerpo y del ángulo de la mandíbula. Puede observarse signo de Hamman (crepitación mediastinal con el latido cardiaco) y enfisema subcutáneo. El manejo quirúrgico de las infecciones odontogénicas, sin importar su severidad, consta de dos principios: eliminar el foco etiológico y el vaciamiento quirúrgico de los espacios anatómicos comprometidos con la instalación de un drenaje adecuado. Se presenta el caso de un masculino de 60 años con diagnóstico de mediastinitis necrotizante descendente de origen dental (AU)

Mediastinitis is defined as a severe acute inflammation of the connective tissues affected in the middle thoracic cavity, in which 20% of cases may involve a diffuse and polymicrobial infection of the mediastinum, descending necrotizing mediastinitis (MND), secondary to the spread of a serious infection from the oropharyngeal or cervical tissues, stories such as odontogenic infections (36 to 47%), pharyngeal (33 to 45%), cervical (15%) and other head and neck infections (5%). Clinically, patients present with increased volume, tremors, trismus, odynophagia with dyspnea, dysphagia, hypotension, pain in the body and in the angle of the jaw. Hamman sign (mediastinal crepitus with heartbeat) and subcutaneous emphysema may be observed. The surgical management of odontogenic infections, regardless of their severity, consists of two principles: eliminate the etiological focus and the surgical emptying of the anatomical spaces compromised with the installation of adequate drainage. We present the case of a 60-year-old man diagnosed with descending necrotizing (AU)

Inflamación mixta severa con pérdida del techo del canal mandibular: una variación de las infecciones odontogénicas asociada a pericoronaritis / Severe mixed inflammation with loss of the mandibular canal roof: a variation in odontogenic infections associated with pericoronaritis

Las infecciones cuando pasan a ser crónicas y recurrentes como puede ser el caso de una pericoronaritis medicada, mas no tratada una y otra vez, traen como consecuencia resistencia y proliferación bacteriana. Se da el caso de formaciones de tejidos patológicos e imágenes radiográficas que orientan a posibles diagnósticos, que hasta no ser tratadas por medio de diferentes técnicas como la marsupialización o enucleación, con el complemento de la biopsia insicional o exicional que determina el tipo de patología presente. Esto lleva al objetivo general: determinar el tipo de lesión patológica presente en el ángulo y cuerpo mandibular asociado a la ud: 48 Objetivos específicos: Identificar la lesión patológica presente en Angulo y parte del cuerpo mandibular asociada a la ud: 48. Muestra: paciente de 30 años de edad, masculino, caso clínico de una inflamación mixta severa, la clínica y sus hallazgos radiográficos, se sospechaba de un posible queratoquiste, quiste dentígeros o quiste odontogénico ortoqueratinizado, extracción dental ud: 48, retiro y legrado del tejido circundante, toma de biopsia exicional, exámenes de laboratorio, ortopantomografia, tomografía, fotografías clínicas. Metodología: paradigma positivista, enfoque cuantitativo, diseño no experimental. Modalidad de campo, tipo estudio de caso. La entrevista, el instrumento guión de las preguntas para la historia clínica fueron la técnica y el instrumento. Resultados: inflamación mixta severa, lo cual procede de una infección asociada a pericoronaritis recurrente, esto mediante resultado histopatológico. Conclusiones: el estudio histopatológico es quien determina el diagnóstico final a pesar que la clínica induzca a posibles diagnósticos diferenciales(AU)

When infections become chronic and recurrent, such as a medicated pericoronitis, but not treated repeatedly, they result in resistance and bacterial proliferation. There is the case of pathological tissue formations and radiographic images that guide possible diagnoses, which until they are not treated by means of different techniques such as marsupialization or enucleation, with the complement of the incitional or exicional biopsy that determines the type of pathology present. This leads to the general objective: to determine the type of pathological lesion present in the mandibular angle and body associated with ud: 48. Specific objectives: Identify the pathological lesion present in Angle and part of the mandibular body associated with ud: 48. Sample: 30-year-old male patient, clinical case of severe mixed inflammation, clinical symptoms and radiographic findings, suspected of a possible keratocyst, dentigerous cyst or orthokeratinized odontogenic cyst, tooth extraction ud: 48, removal and curettage of the surrounding tissue, exicional biopsy, laboratory tests, orthopantomography, tomography, clinical photographs. Methodology: positivist paradigm, quantitative approach, non-experimental design. Field modality, case study type. The interview, the instrument script the questions for the clinical history were the technique and the instrument. Results: severe mixed inflammation, which comes from an infection associated with recurrent pericoronitis, this through histopathological result. Conclusions: the histopathological study is the one who determines the final diagnosis, despite the fact that the symptoms lead to possible differential diagnoses(AU)

Application of 3D-CT reconstruction technology to predicting difficult airway in patients with odontogenic infections / 上海交通大学学报（医学版）

Objective: To evaluate the application of 3D-CT airway reconstruction images to predicting difficult airway in patients with odontogenic infections. Methods: A retrospective analysis was performed on patients with odontogenic infections who were treated by incision and drainage under general anesthesia at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from August 2017 to July 2019, and patients who were evaluated as difficult airway receiving awake tracheal intubation were selected as the case group (n=27). From the "Hospital Inpatient System", patients who were evaluated as non-difficult airway receiving fast induction were selected as the control group (n=27). Maxillofacial CT scans of all the patients were collected. The Dolphin Imaging software version 11.9 Premium was used to perform 3D-CT reconstruction of the airway. The upper airway was divided into oropharynx and hypopharynx, and the oropharynx was divided into velopharynx and glossopharyngeal. The indicators such as airway volume, median sagittal area, minimal cross-sectional area, and thickness of pharyngeal soft tissue were collected. The indicators of the difference between the two groups were compared and selected. Logistic re-gression analysis was conducted to investigate the association of these factors with difficult airway. Results: The volume of velopharynx and hypopharynx, the median sagittal area of velopharynx, oropharynx and hypopharynx, the mean cross-sectional area of velopharynx and hypopharynx, the minimal cross-sectional area and its lateral dimension of oropharyngeal of patients in the case group were significantly smaller than those of the controls (P<0.05). Thickness of pharyngeal soft tissue in the most inferior-anterior point of the second and the third cervical vertebrae of patients in the case group was significantly higher than that of the controls (P<0.05). The Logistic regression analysis showed that the median sagittal area of velopharynx, oropharynx and hypopharynx, the volume and mean cross-sectional area of hy-popharynx, and thickness of pharyngeal soft tissue in the most inferior-anterior point of the second and the third cervical vertebrae of patients were related to difficult airway in patients with odontogenic infections (P<0.05). Conclusion: Airway 3D-CT reconstruction can clearly show the airway anatomy of patients with odontogenic infections. The median sagittal area of pharynx, the volume and mean cross-sectional area of hypopharynx, and thickness of pharyngeal soft tissue in the most inferior-anterior point of the second and the third cervical vertebrae may will be used as predictors of difficult airway in patients with odontogenic infections.

Bilateral canine space infection secondary to odontogenic origin: a rare case report

Odontogenic infections (OI) are a major reason for consultation in dental practice. They affect people of all ages, and most of them respond well to current medical and surgical treatments. The aim of this paper is to emphasize different and rare etiological factors that can play a role in odontogenic abscesses, which can lead to complications. A 54-year-old man complaints of pain and swelling on the upper front-side of his face. Physical examination of the face showed enlargement and swelling in the upper front region. Panoramic radiograph images showed a ra-diolucent appearance of the canine region. Based on the results of the clinical and radiographic examinations, the patient was diagnosed with a bilateral canine space infection. The treatment performed was FNAC (Fine neddle aspiration cytology) from canine region followed by intraoral drainage incision at the most prominent part of swelling (Modified Hiltons method), 5 ml of pus was removed, postoperative dressing was applied and regular follow-up was done with continued antibiotic therapy. Bilateral canine space abscess is a rare odontogenic infection that can cause life-threatening complications. The success of treatment requires early recognition, determination of etiological factors, and appropriate medical and surgical management. To per-form treatment of odontogenic infections, the Oral & Maxillofacial Surgeon should understand the terminology regarding infectious diseases and pathophysiology. The success of treatment requires early recognition, determination of etiological factors, and appropriate medical and surgical management.

A Questionnaire Based Survey on the Antibiotic Prescription Pattern of Dentists in Eastern Part of India

Introduction: Recent surveys reported that dentists inseveral countries have restricted knowledge about prescribingantibiotics. The aim of this study was to investigate theknowledge and attitude of a group of dentists in Jharkhandtowards antibiotic prescription.Material and Methods: The present study was conductedamongst a group of dentists in Jharkhand, a state in easternpart of India. A questionnaire was mailed to 150 dentists outof which 131 responded back. The questionnaire includedquestions about the knowledge and attitudes of dentists towardprescribing antibiotics to dental patients.Results: Amoxicillin and amoxicillin clauvanic acid were themost popular antibiotics. More than 66% of the sample prescribed antibiotics daily.Conclusion: There is a need to improve awareness of dentistsregarding antibiotic prescribing to patients particularly in theaspects of type of antibiotic and its clinical indications.

Estudo epidemiológico de pacientes portadores de infecção do complexo bucomaxilofacial tratados no Hospital Universitário de Maringá: estudo retrospectivo ao longo de 8 anos / Epidemiological study of patients with oral maxillofacial infection treated at Universitary Hospital of Maringá: retrospective study about 8 years

Infecções agudas bucomaxilofaciais podem ser condições clínicas graves e de ocorrência comum, caracterizadas pela disseminação do processo infeccioso a tecidos adjacentes e espaços faciais da região de cabeça e pescoço, podendo resultar em várias complicações, até mesmo em óbito, embora seja raro. Objetivo: realizar uma análise epidemiológica de infecções maxilofaciais, relacionando os dados ao tratamento instituído e à sua efetividade, bem como analisar dados referentes a idade, sexo, principais dentes envolvidos e tempo total de internação. Sujeito e método: foram analisados retrospectivamente 240 prontuários de pacientes admitidos no Hospital Universitário de Maringá com infecção odontogênica, atendidos pela equipe de Cirurgia e Traumatologia Bucomaxilofacial no período de janeiro de 2009 a janeiro de 2017. Resultados: a média de idade dos pacientes foi de 38 anos, com 57 mulheres e 54 homens. A média de temperatura de admissão foi 38,5°C. A região mais acometida foi o ramo posterior da mandíbula, tendo uma média de duração de infecção e hospitalização de 6,1 dias. A principal conduta foi drenagem e antibioticoterapia, sendo que cerca de 13 pacientes não precisaram desse tipo de intervenção, e um paciente evoluiu a óbito. Conclusão: com base nestes resultados e na literatura, infecções odontogênicas merecem atenção, pois podem ser fatais e requerem internação rápida e tratamento adequado. Esse, portanto, é um assunto de grande importância para o cirurgião- -dentista, que exerce papel fundamental na prevenção e no tratamento. A resolução precoce ainda é a forma mais adequada para evitar complicações mais graves. (AU)

Acute Oral maxillofacial infections can be serious and relatively common clinical conditions, characterized by the spread of the infectious process to adjacent tissues and facial spaces of the head and neck region, which can result in several complications and lead to even death, although it is rare. Objective: the objective of this study was to perform an epidemiological analysis of maxillofacial infections and relate their data to the treatment instituted and the effectiveness of the same, as well as to analyze data regarding the age, sex, main teeth involved and total time of hospitalization. Subjects and method: in order to carry out study, 240 medical recordswere analyzed retrospectivelyat the University Hospital of Maringá of the patients with odontogenic infection attended by the Oral Maxillofacial Surgeon in the period of January 2009 to January 2017. Results: as a result, mean age was 38 years, with 57 women and 54 men and mean intake temperature was 38.5 °. The most affected region was the posterior branch of the mandible, with a mean duration of infection and hospitalization of 6.1 days. The main conduct was drainage and antibiotic therapy, and about 13 patients did not need this intervention and only 1 died. Conclusion: Based on these results and in literature, attention should be paid to odontogenic infections, which can be fatal and require proper treatment. This is a subject of great importance for the dentist, who plays a key role in prevention and proper treatment, its early resolution is still the most appropriate way to avoid serious complications. (AU)

Parálisis del XI par craneal secundaria a enfisema subcutáneo por uso de pieza de mano de alta velocidad en cirugía de terceros molares / Paralysis of the XI cranial nerve following subcutaneous emphysema by use of high speed handpiece in third molar surgery

Introducción: La cirugía de los terceros molares es el procedimiento quirúrgico más frecuentemente realizado por los cirujanos orales y maxilofaciales, que a pesar de contar con una vasta experiencia y entrenamiento en el área quirúrgica pueden presentarse complicaciones transoperatorias y postoperatorias. Cuando éste es realizado por un cirujano dentista de práctica general las complicaciones pueden aumentar. Presentación de caso clínico: Se trata de un paciente de 25 años de edad sometido a extracción quirúrgica de terceros molares por un dentista de práctica general, el cual realiza procedimiento quirúrgico con uso de pieza de mano de alta velocidad. Tres días posteriores al evento quirúrgico el paciente acude al Departamento de Cirugía Oral y Maxilofacial del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado por presentar edema, infl amación y crepitación en región bucal, maseterina y submandibular derecha, así como limitación a la apertura bucal de 25 mm. En tomografía computarizada contrastada se obs erva desviación de la vía aérea hacia el lado izquierdo. Se decide manejó del proceso infeccioso y de enfi sema subcutáneo con farmacoterapia y drenaje del mismo. Una vez remitido el enfi sema subcutáneo, en la cuarta semana de evolución el paciente refi ere limitación a la abducción del hombro derecho, observándose atrofi a del músculo trapecio y esternocleidomastoideo ipsilateral, correspondiente a lesión del XI par craneal. Discusión: La lesión del nervio accesorio (XI par craneal) ocasiona parálisis del músculo trapecio, principal estabilizador de la escápula que contribuye en los movimientos de fl exión, rotación y abducción del hombro. El trayecto del XI par craneal es superfi cial en el triángulo posterior del cuello presentando susceptibilidad a ser lesionado de manera iatrogénica, en este caso la utilización de pieza de mano de alta velocidad durante la extracción quirúrgica de los terceros molares generó enfi sema subcutáneo que condicionó la posible compresión del nervio accesorio, lesionando al mismo (AU)

Introduction: The third molar surgery is the most frequent surgical procedure performed by oral and maxillofacial surgeons, who despite their vast experience and training in the surgical area can present transoperatory and postoperative complications. When the oral surgery is done by a general practice dentist the complications can be increased. Case presentation: A 25-year-old male patient undergoing third molar surgery by a general practice dentist who performs a surgical procedure using a high-speed handpiece. Three days after the surgical procedure patient comes to the Department of Oral and Maxillofacial Surgery Institute for Social Security and Services for State Workers by present edema, swelling and crepitus in buccal space, masseteric and right submandibular region and limitation of mouth opening of 25 mm. Contrast computed tomography shows airway deviation to the left side. We decided to manage the infectious process and subcutaneous emphysema with antibiotic therapy and drainage. After subcutaneous emphysema was in remission, in the fourth week of evolution, the patient reported limitation of abduction of the right shoulder, with atrophy of the trapezius muscle and ipsilateral sternocleidomastoid, corresponding to a lesion of the XI cranial nerve. Discussion: Accessory nerve injury (XI cranial nerve) causes palsy of the trapezius muscle, the major stabilizer of the scapula that contributes to the fl exion, rotation and abduction movements of the shoulder. The trajectory of the XI cranial nerve is superfi cial in the posterior triangle of the neck presenting susceptibility to iatrogenic injury, in this case, the use of high-speed handpiece during the surgical extraction of the third molars, caused subcutaneous emphysema that conditioned the possible compression of the spinal nerve (AU)

Celulitis facial odontógena en pacientes del Hospital Lenin de Holguín / Odontogenic Facial Cellulitis in Patients from Lenin Hospital of Holguín

Introducción: la celulitis odontógena es una inflamación difusa del tejido celular subcutáneo que se extiende por los espacios entre el tejido celular a más de una región anatómica a causa de la infección de uno o varios dientes o de enfermedades asociadas al tejido dentario o de sostén. Es una de las infecciones más frecuente y la urgencia más grave que puede presentarse en la práctica esto­matológica. Objetivo: caracterizar el comportamiento de la celulitis facial odontógena en los pacientes atendidos en el Hospital Vladímir Ilich Lenin, Holguín. Métodos: se realizó un estudio descriptivo de serie de casos durante los años 2014 y 2015. El universo estuvo constituido por 54 pacientes con celulitis facial odontógena, la muestra quedó conformada por 51 pacientes. Las variables estudiadas fueron: sexo, grupos de edad, etiología, grupo dentario, regiones anatómicas y clasificación clínica. Resultados: existió un predominio del sexo masculino y el grupo de edad de 35-59 años representado por el 62,75% y el 60,78% respectivamente. La principal etiología fue la caries dental con el 68,63%. El grupo dentario de los molares inferiores fue el más afectado con un 41,18%. La región submandibular fue la más afectada en el 25,49%. La celulitis moderada resultó ser la más frecuente representando el 74,51%. Conclusiones: la etiología de la infección fue variada al igual que las regiones anatómicas afectadas.

Introduction: odontogenic cellulitis is an undefined inflammation of the subcutaneous cell tissue that spreads over the spaces between the cell tissue in addition to an anatomic region because of the infection of one or several teeth or of correlated conditions of the dental and support tissues. It is one of the most frequent infections and the most serious urgency that can be presented in stomatological practice. Objective: to characterize the odontogenic facial cellulitis incidence in the patients attended at Vladímir Ilich Lenin Hospital, Holguín. Method: a descriptive study of series of cases was performed during the years 2014 and 2015. The universe was composed of 54 patients with odontogenic facial cellulitis. The sample comprised 51 patients. The studied variables were: sex, age bracket, etiology, dental group, anatomic regions and clinical classification. Results: the male sex was the most frequently affected and the age group between 35-59 representing 62.75% and 60.78% respectively. The main etiology was the dental cavity with 68.63%. The dental group of the inferior molars was the most affected one (41.18%). The region submandibular was the most affected one in 25.49% of patients. The moderate cellulitis turned out to be the most frequent, representing 74.51%. Conclusions: the etiology of infection was varied just like the anatomic affected regions.

Surgical Management of Extra-Oral Mandibular Cutaneously Pus Draining Sinus Tract in a 13-years Old Girl - A Case Report.

Odontogenic cutaneous sinus tract is a rare but well-documented condition. A common manifestation of pulp necrosis is draining sinus tract or fistula, which could be intra-oral or extra-oral. The microbiologically induced inflammation spreads along the path of least resistance by penetrating the alveolar bone. Ultimately, to form a path of drainage, the inflammatory process can reach the surrounding tissues. These conditions are often misdiagnosed as other non-pulp pathologies. So misdiagnosed as a local skin lesion and maltreated by systemic antibiotics, we came across a 13-year-old girl patient who presented with a cutaneous lesion of dental etiology in the sub-mental region with frequent purulent discharge which was not responding to systemic antibiotics. The management of this condition using endodontic therapy of the involved tooth followed by surgical excision of sinus tract so as to minimize the residual scar formation are presented here.

Microbiology and antibiotic sensitivity of odontogenic space infection.

Background: Dental infections, including gingivitis, odontogenic infections periodontitis, dental caries and, result in frequent dental visits. Infection can be mild buccal space infection or severe life threatening multi space infection. Objectives: To appraise causative microorganisms responsible for odontogenic space infections and to evaluate sensitivity and resistance to antibiotics used in the treatment. Materials and Methods: 90 patients with orofacial space infections were considered. Pus samples were collected with aseptic precautions and examined in the department of microbiology for culture and antibiotic sensitivity. Results: Aerobic organisms were highly sensitive to Ceftriaxone 95.2%, Levofloxacin 90.5% and Amoxicillin and Clavulanic acid for 81% and were resistance to Ampicillin and Cefaclor 47.6%. Anaerobic organisms were 100% resistance to Ampicillin and were 100% sensitive to Cephalothin, Cephalexin, Gatifloxacin, Linezolid and Tazact. 91.7% were sensitive to Amoxicillin and Clavulanic acid. Ampicillin resistance was seen in 47.6% of aerobes and 100% of the anaerobes. Conclusion: This study confirms that the microbiological flora of odontogenic infections consists of complex mixture of aerobic and anaerobic bacteria. The microorganisms isolated were Streptococcus viridians, Klebsiella, Pseudomonas Aeruginosa, and Coagulase negative Staphylococci. Most common anaerobic organisms were Peptococci and Peptostreptococci. Amoxicillin/clavulunic acid and Cefotaxime were most effective antibiotics.

Consideraciones sobre el uso de antibióticos en endodoncia / Considerations on the use of antibiotics in endodontics

Los antibióticos son substancias producidas por un microorganismo (generalmente bacteria u hongo) o una similar desarrollada total o parcialmente por síntesis química, que, en bajas concentraciones, inhiben el metabolismo o destruyen microorganismos. En la mayoría de los casos las defensas del organismo actúan controlando las agresiones bacterianas, siendo el papel de los antibióticos sólo de terapia coadyuvante. Como el uso indiscriminado de los antibióticos ha incrementado la resistencia bacteriana en todas partes del mundo, hay que limitar el uso de estos medicamentos solo para situaciones clínicas que lo ameriten. Este artículo presenta una revisión de los antibióticos más frecuentemente indicados en Odontología y sugiere los medicamentos de primera elección para su empleo en la práctica endodóntica, así como las situaciones clínicas donde se indica su uso.

Antibiotics are substances produced by microorganisms (usually bacteria or fungi) or a similar substance totally or partially synthesized in laboratory, and they must be able to inhibit the growth or kill microorganisms in low concentrations. In most cases, antibiotics are useful to help the host defenses to control bacterial infections. However, due to their abusive employment, antibiotics have generated an alarming increase in bacterial resistance throughout the world. Thus, the prescription of these drugs should be restricted to conditions where they are actually needed. This paper reviews the antibiotic drugs more commonly used in Dentistry and suggests the drugs of first choice as well as the indications for employment in endodontic practice.

Actividad antibacteriana y clínica de la moxifloxacina comparada con otros antibióticos para el manejo de infecciones bucales / Clinical antibacterial activity and moxifloxacin compared with other antibiotics for oral infections handling

La cavidad bucal constituye uno de los principales nichos ecológicos para bacterias aerobias y principalmente anaerobias. Estos microorganismos juegan un papel importante en la patogénesis de las infecciones bucales y en las infecciones focales de origen oral. Las infecciones bucales más frecuentes incluyen caries, periodontitis, absceso periapical, absceso periodontal, pericoronitis, pulpitis, osteítis e infección de los espacios aponeuróticos. Algunos estudios indican un aumento en la prevalencia de microorganismos presentes en la cavidad bucal que son resistentes a algunos de los antibióticos usualmente empleados para combatir este tipo de infecciones, por lo cual es necesario tener presente antibióticos alternativos para uso terapéutico o profiláctico. Moxifloxacina (MXF) es una 8-methoxiquinolona de amplio espectro, eficaz contra patógenos respiratorios intracelulares típicos y atípicos, bacterias gram negativas y muchas bacterias anaeróbicas obligadas. MXF es también muy activo contra cepas que son resistentes a la penicilina, macrólidos, tetraciclinas, thrimethoprim/sulfa y algunas fluroquinolonas. Cuando se compara con la amoxicilina/clavulánico (AMX-CLA), el esquema de dosificación de la MXF (400 mg/diarios), podría garantizar un mayor cumplimiento con las prescripciones. Además, su mecanismo de acción también puede proporcionar un alivio más rápido de los síntomas de la infección odontogénica, convirtiéndose en una posible alternativa antimicrobiana contra anaerobios obligados residentes en la cavidad bucal

The oral cavity constitutes one of the principal ecological niches for obligate anaerobic bacteria. These microorganisms play an important role in the pathogenesis of oral infections and focal infections of oral origin. Most of these infections are odontogenics, being the most frequent decays, periodontitis, periapical abscess, periodontal abscess, pericoronitis, pulpitis, osteitis and infection of the aponeurotic spaces. Some published studies highlight the growing prevalence of obligate anaerobes in oral origin that are resistant to some of these antibiotics, giving rise to the need to investigate alternative antibiotics for therapeutic or prophylactic use. Moxifloxacin (MXF) is an 8-methoxyquinolone with a broad spectrum of activity, including activity against typical, atypical and intracellular respiratory pathogens, gram negative pathogens and many obligate anaerobic bacteria. MXF is also highly active against strains that are resistant to penicillin, macrolides, tetracyclines, trimethoprim/sulfamethoxazole and some fluoroquinolones. The dosing schedule of the MXF (400 mg / day) could ensure greater compliance with the requirements and its mechanism of action may also provide a faster relief of symptoms of infection odontogenic, when compared with amoxicillin / clavulanate (AMX-CLA). In addition, may represent a possible alternative antimicrobial against oral anaerobes

Alopécia areata associada à infecção odontogênica e dentes inclusos: relato de caso / Alopecia areata associated with odontogenic infection and unerupted teeth: a case report

A etiologia da Alopécia Areata é multifatorial, porém apresenta-se com algumas controvérsias e sem o conhecimento claro dos fatores determinantes para o seu aparecimento. A correlação existente entre este tipo de enfermidade e as alterações presentes na cavidade bucal, com especial ênfase em focos de infecções e dentes inclusos, ainda se encontra sem comprovação científica, sendo raros os seus relatos na literatura. Os autores relatam um caso clínico, onde estas alterações foram relacionadas com a Alopécia Areata.

Alopecia Areata’s etiology is multifactorial; however there is some controversy and the determining factors for its manifestation are not known. The existing correlation between this type of infirmity and the alterations present in the buccal cavity, with special emphasis on infection foci and impacted teeth, have still not been scientifically proven, and reports on them in the literature are rare. The authors report a clinical case where these alterations were related to Alopecia Areata.

A clinical study on the care of odontogenic infections in the admission patients with age-relelated geriatric diseases

This is a reprospective study on the care of odontogenic infections in admission patients with geriatric diseases. The study was based on a series of 480 patients at Dong San Medical Center, Wonju Christian Hospital and Il San Health Insurance Hospital, From Jan. 1, 2000, to Dec. 31, 2002. The Obtained results were as follows: 1. The systemic malignant tumor was the most frequent cause of the geriatric diseases with odontogenic infectious diseases, and refractory lung disease, systemic heart disease, type II diabetes mellitus, cerebrovascular disease, bone and joint disease, senile psychologic disease were next in order of frequency. 2. Male prediction(57.5%) was existed in the odontogenic infectious patients with geriatric diseases. But, there were female prediction in senile psychologic disease, systemic heart disease and cerebrovascular disease. 3. The most common age group of the odontogenic infectious patient with geriatric disease was the sixty decade(47.9%), followed by the seventy and eighty decade in order. 4. In the contents of chief complaints on the odontogenic infectious patients with geriatric disease, peak incidence was occurred as toothache(52.7%), followed by extraction wish, tooth mobility, oral bleeding, oral ulcer, fracture of restoration, gingival swelling in order. 5. In the diagnosis group of odontogenic infectious diseases, periodontitis, pulpitis and periapical abscess were more common. 6. In the treatment group of odontogenic infectious diseases, the most frequent incidence(34.2%) was showed in primary endodontic treatment (pulp extirpation, occlusal reduction and canal opening drainage) and followed by scaling, incision and drainage, only drugs, pulp capping, restoration in order.

A clinical study on the care of odontogenic infections in the patients with major bleeding disorders

This is a retrospective study on the care of odontogenic infections in admission patients with major bleeding disorders. The study was based on a series of 514 patients treated at Dong San Medical Center, Wonju Christian Hospital and Il San Health Insurance Hospital, from Jan.1, 2000, to Dec.31,2002. The obtained results were as follows : 1. The cardiovascular disease was the most frequent cause of the systemic diseases with major bleeding disorders, and liver disease, cerebrovascular disease and renal failure were next in order of frequency. But, there was the most frequent dental consultation in the liver disease, owing to the many odontogenic infectious diseases. 2. Male prediction (66.3%) was almost existed in the odontogenic infectious patients with major bleeding disorders. But, there was slight female prediction (53.4%) in the cardiovascular disease. 3. The most common age group of the odontogenic infectious patients with major bleeding disorders was the fifty decade(27.2%), followed by the forty, sixtyand thirty decade in order. 4. In the contents of chief complaints on the odontogenic infectious patients with major bleeding disorder, peak incidence was occurred as toothache (42.2%), followed by intraoral bleeding, ulcer pain, dental extraction in order. 5. In the diagnosis group of odontogenic infectious diseases, periodontitis, pulpitis and periapical abscess were more common. 6. In the treatment group of odontogenic infectious diseases, the most frequent incidence(44.2%) was showed in primary endodontic drainage(pulp extirpation, occlusal reduction and canal opening drainage) and followed by the incision and drainage, the medications and oral hygiene instruction, scaling, indirect pulp capping in order.