Diabetes mellitus and odontogenic infections: a life threatening combination in Ludwig's angina

Background: The present study was a prospective study which was aimed to assess the risk factors, microbiological profile, management strategies of Ludwig’s angina patients and its association with odontogenic infections and diabetes mellitus. Methods: The study population consisted of 40 patients of Ludwig’s angina those presented to and were managed in the department of ENT, Government Medical College, Amritsar, Punjab, India, from January 2022 to May 2023. All the patients exhibiting clinical symptoms and signs of Ludwig’s angina were examined and a detailed history of the duration of each symptom, present and past illness, dental infection, throat infection, diabetes mellitus was taken. Results: It was observed that in 85% cases of Ludwig’s angina history of dental infection was present. History of diabetes mellitus was present in 50% cases followed by tooth extraction (10%). Streptococcus viridans was found in 22.5% patients, Staphylococcus aureus (12.5%) and no growth was seen in 52.5% cases. Major co-morbidity was diabetes mellitus (50%), followed by HIV and HCV infections in 15% patients. Surgical drainage was performed in 90% cases including tracheostomy in 12.5% cases rest 10% patients were treated medically. Conclusions: Uncontrolled diabetes mellitus, delayed treatment of odontogenic infection complicates the management of Ludwig’s angina and leads to life threatening complications. Ludwig’s angina should be actively treated as a surgical and medical emergency in which incision and drainage is required as early as possible. Tracheostomy should be considered as an emergency measure to relieve the respiratory obstruction.

Ludwig's angina complicating pregnancy: an unusual presentation

Pregnancy is a state of several physiological changes, which predisposes many to oral health problems. However, the majority of pregnant women do not receive oral health counseling. Pregnant women who receive inadequate dental care are at risk for odontogenic infections, which can have serious consequences. Here we are presenting a case of 32 weeks pregnancy with Ludwig's angina complicated by acute renal failure.

Descending necrotizing mediastinitis: a clinical analysis based on 10 years of published data in China / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.

Infección de los espacios profundos del cuello de origen dentario / Odontogenic deep neck infections

RESUMEN Antecedentes: los pacientes con infecciones cervicales pueden presentar cuadros de extrema gravedad que ponen en riesgo su vida. Parece increíble que en pleno siglo XXI alguien muera por la infección de una muela, pero es real. Objetivo: describir los resultados con el diagnóstico y tratamiento de una serie de pacientes con infecciones de los espacios profundos del cuello de origen dentario, y establecer criterios para su manejo. Material y métodos: se realizó un estudio descriptivo y retrospectivo a partir de los registros en nuestra base datos entre septiembre de 2006 y junio de 2022. Se incluyeron sólo pacientes con infecciones cervicales de origen dentario. Se evaluaron las variables demográficas, las relacionadas al origen de la complicación, el tratamiento realizado y la evolución de los pacientes. Resultados: la muestra quedó conformada por 499 pacientes, con promedio de edad de 29 años (12- 70); 288 (57.7%) eran hombres. Consultaron en forma tardía 269 (53,9%) y se automedicaron en forma inicial 271 pacientes (54.3%). La mayoría no había recibido tratamiento de la pieza dentaria en el centro de atención primaria. Se realizó tratamiento quirúrgico 267 casos (53.5%), y el resto pudo tratarse de forma conservadora. La evolución fue favorable en 497 pacientes (99.6 %), y dos fallecieron por mediastinitis. Conclusión: las infecciones odontógenas deben ser diagnosticadas y tratadas apropiadamente en forma precoz a fin de evitar cuadros de extrema gravedad. Las campañas de educación poblacional y la instrucción de los médicos/odontólogos de centros de atención primaria y servicios de guardia podría mejorar esta problemática.

ABSTRACT Background: Patients with deep infections may present with extremely serious and life-threatening conditions. It is unbelievable that someone could die from a molar infection in the 21st century, but it is real. Objective: The aim of the present study is to describe the diagnosis and treatment results of a series of patients with odontogenic deep neck infections, and to establish criteria for the management of these infections. Material and methods: We conducted a retrospective and descriptive study based on records from a database from September 2006 to June 2022. Only patients with odontogenic deep neck infections were included. The demographic variables, those related to the origin of the complication, the treatment performed, and the patients' progress were evaluated. Results: The sample was made up of 499 patients; mean age was 29 years (12-70) and 288 (57.7%) were men. Late visits and self-medication were recorded in 269 patients (53.9%) and 271 patients (54.3%), respectively. Most of them had not received treatment for the affected tooth at the primary healthcare center. Surgical treatment was performed in 267 cases (53.5%), and the rest were managed with conservative approach. The disease had a favorable course in 497 patients (99.6%) and two patients died of mediastinitis. Conclusion: Odontogenic infections should be adequately diagnosed and treated correctly and early to avoid extremely serious complications. Population-based educational campaigns and training for physicians and dentists working in primary care centers and emergency departments could improve this issue.

Case Analysis and Systematic Review of Aspergilloma

Introduction: Aspergillus fumigatus is the most prevalent fungal pathogen reported to cause diseases such as aspergilloma or aspergillosis in humans. Aspergillomas are commonly seen in a poorly drained and avascular cavitary space. Paranasal sinuses are most commonly involved, especially maxillary sinus. In the past two decades, the incidence of aspergillosis has increased substantially. Aims: To evaluate cases reported as aspergilloma of the maxillary sinus and to determine the percentage of cases involving aspergilloma of the maxillary sinus in healthy individuals. Materials and Methods: After the final full-text review,16 articles were included in this systematic review. Data extracted from these full-text articles was reviewed. Results: 83 % of cases had a history of dental procedures, with 42 % of those being due to infection from previous extraction sockets and 41 % due to root canal therapy (RCT). About 43% of the patients were immunocompromised, while 56% were healthy without any predisposing conditions. Conclusion: Aspergillus fungal infections of the paranasal sinuses are common and can occur in apparently healthy as well as immunocompromised individuals. Aspergilloma is the most common fungal infection involving the maxillary sinus with iatrogenic-dentogenic factors being predominant for initiation and progression of the infection. About 43% of the patients in this review were immunocompromised patients whereas 56% of the patients were healthy without any known predisposing condi- tions. The progression and prognosis of this disease depends on the location and immunologic status of the patient. So, it is very important for dentists to be cautious while performing any dental procedures so as not to initiate any iatrogenic infections.

Infecções odontogênicas - patogênese e repercussões sistêmicas: revisão de literatura / Odontogenic infections pathogenesis and systemic repercussions

A região de cabeça e pescoço pode ser acometida por doenças infecciosas de origem não odontogênica ou odontogênica - sendo essa geralmente de causa endodôntica. A saúde bucal faz parte do sistema corporal de um indivíduo, desse modo, a negligência com seus cuidados gera um impacto sistêmico. Sendo assim, o objetivo do presente trabalho é analisar o desenvolvimento das infecções odontogênicas desde a necrose pulpar às possíveis repercussões sistêmicas, como: Angina de Ludwing, Mediastinite Necrosante, Fasceíte Necrosante, Endocardite Bacteriana, Sinusite do Seio Maxilar e Osteomielite. É de suma importância que o profissional cirurgião dentista conheça a patogênese dessas infecções, para que este seja capaz de elaborar um diagnóstico precoce e preciso, bem como saiba utilizar os protocolos de prevenção e condutas, a fim de evitar graves complicações sistêmicas. A partir dessa elucidação, será possível evitar o adoecimento do corpo gerado por uma doença da cavidade oral.

The head and neck region can be affected by infectious diseases of non-odontogenic or odontogenic origin - the latter usually having an endodontic cause. Oral health is part of an individual's body system, thus, neglecting its care generates a systemic impact. Therefore, the aim of this study is to analyze the development of odontogenic infections from pulpal necrosis to possible systemic repercussions, such as: Ludwing's Angina, Necrotizing Mediastinitis, Necrotizing Fasciitis, Bacterial Endocarditis, Maxillary Sinusitis and Osteomyelitis. It is extremely important that the dental surgeon knows the pathogenesis of these infections, so that he is able to make an early and accurate diagnosis, as well as know how to use prevention protocols and conducts, in order to avoid serious systemic complications. From this elucidation, it will be possible to avoid the illness of the body generated by a disease of the oral cavity.

Cervical Necrotizing Fasciitis: An Uncommon Fulminant Disease Entity

Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.

Guía de práctica clínica para el tratamiento de infecciones odontogénicas en el Seguro Social de Salud del Perú (EsSalud) / Clinical practice guidelines for the treatment of odontogenic infection of the Peruvian Health Social Security (EsSalud)

Introducción. El presente artículo resume las recomendaciones basadas en evidencias de la guía de práctica clínica (GPC) para el tratamiento de los pacientes con infecciones odontogénicas (absceso dentoalveolar, celulitis facial y absceso cervicofacial) en el Seguro Social de Salud del Perú (EsSalud). Objetivo. Brindar recomendaciones clínicas basadas en evidencia para el tratamiento de pacientes con infecciones odontogénicas en EsSalud. Métodos. Se conformó un grupo elaborador de la guía (GEG) que incluyó cirujanos dentistas, especialistas y metodólogos. El GEG formuló cuatro preguntas clínicas a ser respondidas en la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y cuando fue considerado pertinente­ estudios primarios en PubMed y CENTRAL durante el año 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y el flujo- grama de tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 067­IET- SI-ESSALUD-2020. Resultados. La presente GPC abordó cuatro preguntas clínicas, divididas en dos temas: manejo farmacológico y manejo quirúrgico de las infecciones odontogénicas. En base a dichas preguntas se formularon seis recomendaciones fuertes, dos recomendaciones condicionales, 11 puntos de buena práctica clínica, y un flujograma. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para tratamiento de las infecciones odontogénicas (absceso dentoalveolar, celulitis facial y absceso cervicofacial) en EsSalud.

Introduction. This article summarizes the evidence-based recommendations of the clinical practice guide (CPG) for the treatment of patients with odontogenic infections (dentoalveolar abscess, facial cellulitis and cervicofacial abscess) in the Social Security of Health of Peru (EsSalud). Objective. To provide evidence-based clinical recommendations for the treatment of patients with odontogenic infections in EsSalud. Methods. A guideline development group (GEG) was formed that included dental surgeons, specialists, and methodologists. The GEG formulated four clinical questions to be answered in this CPG. We conducted systematic searches for systematic reviews and when deemed relevant - primary studies in PubMed and CENTRAL during 2019. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and the treatment flow chart. Finally, the CPG was approved with Resolution No. 067 ­ IETSI-ESSALUD-2020. Results. This CPG addressed four clinical questions, divided into two topics: pharmacological management and surgical management of odontogenic infections. Based on these questions, six strong recommen- dations were formulated, two conditional recommendations, 11 points of good clinical practice, and a flow chart. Conclusion. This article summarizes the methodology and evidence-based conclusions of the CPG for the treatment of odontogenic infections (dentoalveolar abscess, facial cellulitis and cervicofacial abscess) in EsSalud.

Angina de Ludwig durante el embarazo. Reporte de caso / Ludwig's angina during pregnancy. Case report

RESUMEN Los cambios fisiológicos, hormonales e inmunes causados por el embarazo pueden predisponer a mayor riesgo de complicaciones infecciosas, en especial en infecciones odontogénicas. La angina de Ludwig es una complicación infecciosa rápidamente progresiva que afecta al suelo de la cavidad bucal, generalmente secundaria a abscesos de segundos y terceros molares mandibulares que posteriormente se extiende a los espacios submandibular, sublingual y submentoniano. Si no es tratada rápida y adecuadamente puede tener consecuencias mortales, como obstrucción de las vías aéreas altas y sepsis. Su aparición durante el embarazo está asociada a mayor riesgo de morbilidad perinatal severa, en la mayoría de los casos secundaria a hipoxia tisular. El tratamiento es la administración de antibióticos de amplio espectro y, en algunos casos, descompresión quirúrgica de las zonas afectadas. Pero es necesario considerar los potenciales efectos adversos fetales del manejo. Es fundamental reforzar la importancia de la buena salud bucodental de la embarazada para evitar esta complicación. Se presenta un caso de angina de Ludwig durante el embarazo.

ABSTRACT Physiological, hormonal and immune changes caused by pregnancy may predispose to increased risk of infectious complications, especially in odontogenic infections. Ludwig's angina is a rapidly progressive infectious complication affecting the floor of the oral cavity, usually secondary to abscesses of mandibular second and third molars that subsequently spreads to the submandibular, sublingual and submental spaces. If not treated quickly and adequately it can have fatal consequences, such as upper airway obstruction and sepsis. Its occurrence during pregnancy is associated with an increased risk of severe perinatal morbidity, in most cases secondary to tissue hypoxia. Treatment consists of the administration of broad-spectrum antibiotics and, in some cases, surgical decompression of the affected areas. But it is necessary to consider the potential adverse fetal effects of management. It is essential to reinforce the importance of good oral health of the pregnant woman to avoid this complication. A case of Ludwig's angina during pregnancy is presented.

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

Resumen Introducción: El tratamiento inoportuno e ineficaz de las infecciones odontogénicas puede causar complicaciones potencialmente mortales como la mediastinitis necrotizante descendente (MND). La MDN es una infección grave que afecta al cuello-tórax, con una alta tasa de mortalidad por sepsis e insuficiencia orgánica si no se trata de manera rápida y efectiva. Objetivo: Describir un caso de MND de origen odontogénico y su manejo médico-quirúrgico. Caso clínico: Presentamos un paciente de sexo masculino de 34 años que ingresa con un cuadro infeccioso agudo de origen odontogénico, que compromete espacios de la cabeza, cuello y tórax (mediastino superior), el cual se trata exitosamente. Discusión: Las infecciones odontogénicas son generalmente localizadas y que se pueden tratar mediante terapias convencionales. A pesar de esto, si estas infecciones no pueden controlarse, ya sea por no realización de tratamientos oportunos o por estados inmunosuprimidos del paciente, se pueden desarrollar diferentes complicaciones como la MND. Conclusión: Un diagnóstico rápido, el tratamiento quirúrgico agresivo, la terapia antibiótica adecuada y la atención de apoyo son los pilares fundamentales para el manejo de la MND.

Introduction: Inappropriate and ineffective treatment of odontogenic infections can cause life-threatening complications such as Descending Necrotizing Mediastinitis (MND). MDN is a serious infection that affects the neck-thorax, with a high mortality rate from sepsis and organ failure if it is not treated quickly and effectively. Aim: To describe a case of MND of odontogenic origin and its medical-surgical management. Case report: We present a 34-year-old male patient who is admitted with an acute infectious condition of odontogenic origin, which compromises spaces of the head, neck and thorax (upper mediastinum), which is treated successfully. Discussion: Odontogenic infections are generally localized and can be treated by conventional therapies. In spite of this, if these infections cannot be controlled, either by not carrying out appropriate treatments or by immunosuppressed states of the patient, different complications such as MND can develop. Conclusion: A rapid diagnosis, aggressive surgical treatment, adequate antibiotic therapy and supportive care are the fundamental pillars for the management of MND.

Clinical Management of Orofacial Odontogenic Infection: A Four Year Retrospective Study

ABSTRACT@#Orofacial odontogenic infection, although arises from dental origin, can extend into the facial spaces and lead to debilitating complications. This study analysed the clinical pattern and management of orofacial odontogenic infection in a tertiary hospital namely Hospital Raja Permaisuri Bainun in Perak, Malaysia. We investigated any associations between socio-demographic factors, diabetic, comorbidities, smoking, pregnancy, antibiotic resistance, number and type of space infected towards prolonged hospital stay. All adult patients with orofacial odontogenic infections treated by Department of Oral and Maxillofacial Surgery from 2014 to 2018 were included. Clinical patterns were evaluated. Statistical analysis was performed to measure various variables towards prolonged hospital stay. A total of 154 patients (78 male, 76 female) were included in this study with mean age of 37.95 ± 14.9 years. Key factors of orofacial odontogenic infection requiring admissions were swelling, pain, trismus, odynophagia, reduced oral intake, raised floor of mouth and dyspnea. Among inpatients, three factors were significantly associated with prolonged hospital stay, namely antibiotic resistance, multiple space and secondary space infection. Local prevalence data was reported. Pus culture and sensitivity tests were recommended for all inpatients with multiple space and secondary space involvement, in order to rule out antibiotic resistance and to improve recovery rate.

Retrospective analysis of 59 patients with descending necrotizing mediastinitis from oral and maxillofacial space infection / 口腔疾病防治

Objective@# A retrospective analysis aimed to identify the clinical features of patients with descending necrotizing mediastinitis (DNM) to improve the effects of treatment and prognosis.@*Methods@#The clinical data of 59 patients with DNM who were treated in the Department of Oncology of Oral and Maxillofacial Surgery of the Affiliated Stomatology Hospital of Xinjiang Medical University and transferred to the intensive care unit (ICU) were retrospectively analyzed from March 2010 to March 2020. Statistical analysis was performed to identify the risk factors that were associated with mortality.@*Results @# A total of 59 patients were identified: 21 cases of DNM typeⅠ (35.6%), 19 cases of DNM typeⅡA (32.2%), and 19 cases of DNM type ⅡB (32.2%). All patients with DNM received emergency surgery. Patients with typeⅠ and ⅡA underwent anterior mediastinal xiphoid incision and drainage combined with thoracic drainage. The thoracic mediastinum was completely debrided, and postoperative drainage was performed in type ⅡB patients. Pus samples from all 59 DNM patients were cultured for bacteria, and 19 of them were positive. Systemic antiinflammatory therapy was administered. Five patients died (8.5%), and 54 patients survived (91.5%). Compared with the survival group, the mortality group had a higher proportion of patients aged ≥ 65 years, with diabetes, with an interval from admission to ICU ≥ 6 days, with an APACHE Ⅱ score ≥ 20 days, with a duration of ICU treatment ≥ 10 days, and with septic shock, with statistically significant differences (P < 0.05). @*Conclusions@#Timely transfer to the intensive care unit for treatment combined with early active surgery and timely treatment of systemic diseases and systemic antimicrobial therapy is the key to reducing DNM mortality.

Odontogenic Maxillofacial Infections in a High-level Hospital: Orofacial Pain and Related Conditions

ABSTRACT Objective: Odontogenic infection is a common condition in America; the aim of this research was to determine the profile of odontogenic maxillofacial infections and to identify the link between these and the pain felt by patients admitted to the emergency dental service of the Hernân Henriquez Aravena Hospital in Temuco, Chile. Methods: A cross-sectional, double-blind study analysed 49 individuals admitted for emergency dental care. Included were admissions associated with odontogenic infection identified by clinical examination, establishing a relation to pain through a survey. The diagnosis was made clinically using the fascial spaces involved in the infection, presence of self-medication prior to admission, need for surgical treatment and the patient 's systemic conditions. The data were analysed using descriptive statistics, Chi-squared, ANOVA, considering a value of p < 0.05 as significant. Results: The average pain level measured by visual analogue scale (VAS) in emergency admission was 8.1. There was no association between the diagnosis (pulp infection, periodontal infection or pericoronitis) and the VAS (p = 0.078), but there was association between age and the diagnosis (p = 0.022), and the VAS was associated with pain compared to other types of pathologies or traumas (p = 0.011). Conclusion: Odontogenic infection is frequent and linked to age and high-pain values. New public policies should be adopted based on these results. New studies are needed to assess new variables associated with these pathologies.

Angina de ludwig de foco amigdaliano evoluindo para mediastinite - Um caso de sucesso / Amigdalian focus of ludwig's angina expanding to mediastinitis - A success case

Objetivo: relatar e descrever a evolução satisfatória de uma Angina de Ludwig decorrente de uma infecção amigdaliana, que evoluiu para mediastinite e choque séptico. O trabalho visa detalhar os aspectos clínicos e diagnósticos desta grave doença, além da terapêutica empregada neste caso. Método: as informações foram obtidas do prontuário do paciente, bem como dos laudos dos exames de imagem realizados. A revisão da literatura foi feita na base de dados PUBMED. Considerações finais: o caso estudado relata um raro desfecho favorável de uma Angina de Ludwig que evoluiu para mediastinite, cuja taxa de mortalidade é de até 50% dos casos. A abordagem cirúrgica combinada com antibioticoterapia precoce se mostra ser a melhor conduta para estes casos.

Objective: report and describe the satisfactory evolution of Ludwig's Angina due to a tonsillary infection, which evolved to mediastinitis and sept shock. The work aims to detail the clinical and diagnostic aspects of this serious illness, in addition to the therapy used in this case. Method: the information was obtained from the patient's medical record, as well as from the reports of the imaging tests performed. The literature review was carried out in the PUBMED database. Final considerations: the case studied has great importance for the medical community, since it reports a rare favorable outcome for a case of Ludwig's Angina complicated with an mediastinitis, whose mortality is described up to 50% of the cases. The surgical approach combined with early antibiotic therapy is shown to be the best approach for these cases.

Evaluation of the Involvement of Facial and Cervical Spaces in Odontogenic Infections in Patients Referred to Shahid Rahnemoon Hospital from 2014 to 2018

Odontogenic infections are recognized as one of the most common diseases in the world. Organisms that cause dental infection and are a part of the oral normal flora include dental plaque bacteria, mucosal surface bacteria, and gingival bacteria. This study aimed to investigate the prevalence of odontogenic infections by involving the facial and cervical spaces in patients referred to Shahid Rahnemoon Hospital from 2014 to 2018. METHODSThis was a descriptive cross-sectional study. The sampling method was census and 308 patients with all types of odontogenic infections associated with the involvement of the facial and cervical spaces referred to Shahid Rahnemoon Hospital from 2014 to 2018 were included in the study. Questionnaire was used for data collection. The data was entered into SPSS version 23 software and analysed using statistical tests. RESULTSThe mean age of participants was 31.10 ± 14.48; the mean number of hospitalization days was 4.83 ± 2.52 days; the mean body temperature was 37.45 ± 0.54. Of the 308 patients studied, 221 (71.8 %) had no history of systemic disease. Also, 294 (5 %) had no airway involvement. The most commonly prescribed antibiotic was penicillin + metronidazole with a frequency of 54.9 %, The most common tooth that was the source of infection was mandibular tooth no. 6 with a frequency of 22.7 %, the most common type of treatment was incision + drainage + antibiotic therapy with a frequency of 44.2 %; the most common involved area was the submandibular + buccal space with a frequency of 20.1 % and the most common age range of involvement was 20 - 29 years. CONCLUSIONSIn odontogenic infections, penicillin + metronidazole is the most commonly used antibiotic and buccal + submandibular space is the most common area involved.

Odontogenic Infection and dental Pain negatively impact Schoolchildrens Quality of Life / Infecção odontogênica e odontalgia impactam negativamente a qualidade de vida de crianças escolares

ABSTRACT The aim of this study is to assess the prevalence of odontogenic infection in lowincome Brazilian schoolchildren and evaluate its association with the subjective variables of oral healthrelated quality of life and dental pain. In this crosssectional study, 230 schoolchildren aged eight to ten years old underwent a clinical oral survey in which the DMFT/dmft and PUFA/pufa indexes were measured. Afterward, children responded individually to the Child Perceptions Questionnaire (CPQ810) and selfreports of dental pain were collected. Data were statistically analyzed using MannWhitney or KruskalWallis test with a posttest by Dunn's and Pearson correlation. Of the children evaluated, 42.6% had odontogenic infection and 80% reported experiencing dental pain. Children's age (p = 0.034) and past experience of dental pain (p < 0.002) were associated with odontogenic sepsis, in addition to impairment of their emotional wellbeing (p = 0.008), social welfare (p = 0.009) and overall impact on quality of life (p = 0.019). Toothache intensity (p < 0.001), frequency (p < 0.001) and duration (p < 0.001) were correlated to the overall impact on children's quality of life. The prevalence of odontogenic infection remains high among lowincome Brazilian schoolchildren. Pediatric infection and its related pain induce not only various biological disorders but also impair children's selfperception of quality of life.

RESUMO O objetivo deste estudo foi avaliar a prevalência de infecção odontogênica em crianças escolares brasileiras de baixa renda e analisar a sua associação com as variáveis subjetivas da autopercepção de qualidade de vida relacionada à saúde bucal e dor dentária. Neste estudo transversal, 230 crianças escolares com 8 a 10 anos de idade realizaram exame clínico bucal no qual os índices CPOD/ ceod e PUFA/pufa foram mensurados. Com isso, as crianças responderam individualmente ao Child Perceptions Questionnaire (CPQ810) e relatos de dor dentária foram coletados. Os dados foram estatisticamente analisados utilizandose o teste MannWhitney ou KruskalWallis, com posterior teste da correlação de Dunn e Pearson. Dentre as crianças examinadas, 42,6% apresentavam infecção odontogênica e 80% reportou experiência de dor dentária. A idade (p=0,034) e experiência de dor dentária (p<0,002) das crianças foram associadas à infecção odontogênica, bem como o seu bemestar emocional (p=0,008) e social (p=0,009) e impacto geral na qualidade de vida (p=0,019). Além disso, a intensidade (p<0,001), frequência (p<0,001) e duração (p<0,001) da odontalgia foram correlacionadas com o impacto geral na qualidade de vida da criança. A prevalência de infecção odontogênica permanece elevada em crianças escolares brasileiras. Infecção pediátrica e sua dor relacionada induzem não apenas diversas desordens biológicas, mas também afetam negativamente a autopercepção de qualidade de vida das crianças.

Clinical analysis of 5 cases of odontogenic maxillofacial-neck-mediastinal infection treated with negative pressure sealing drainage / 口腔疾病防治

Objective @#To explore the effect of negative pressure sealing drainage on the treatment of maxillofacial-neck-mediastinal infection in multiple spaces.@*Methods@# Vacuum sealing drainage (VSD) was applied in five patients with maxillofacial-neck-mediastinal infection caused by odontogenic infection accompanied by diabetes or renal failure and other systemic diseases. After extensive debridement, a negative pressure drainage sponge was placed in the pus cavity and then the wound was closed. Continuous negative pressure drainage was continued after the operation. At the same time, multidisciplinary consultation was applied to control basic diseases and, strengthen anti-inflammatory responses, and nutrition and other systemic treatments were applied.@*Results@#Four patients underwent continuous negative pressure drainage and successful removal of the negative pressure sponge after inflammatory symptoms subsided. One patient′s inflammatory symptoms became more serious after the operation, and we performed another operation to change the placement of the negative pressure sponge. All 5 patients underwent VSD with negative pressure sponge replacement ranging from 1 to 3 times during treatment. After multidisciplinary consultation, they were all cured and discharged from the hospital.@*Conclusion@#For infection of the mediastinum, maxillofacial region and neck, local treatment and systemic treatment are emphasized, as well as the treatment of infected lesions and basic diseases. Negative pressure closure and drainage technology promotes the alleviation of inflammation, and multidisciplinary combined treatment is beneficial for the control of basic diseases.

​Clinical Profile and Outcome of Ludwig’s Angina in Tertiary Care Hospital in Tamil Nadu

Background: Ludwig’s angina is a lethal infectious cellulitis of the submandibular space, which always makes a difficult situationfor treating surgeons.Objectives: The objective of this study was to study about the presentation, management, and clinical outcome of Ludwig’sangina.Materials and Methods: A study made in the Department of ENT - Head and Neck Surgery, Tirunelveli Medical College,Tirunelveli, for a period of 1 year from July 2016 to July 2017, a total of 41 patients - 33 males and 8 females were includedin the study.Results: Majority of the patients were having a dental infection before the episode - 85%. Pseudomonas aeruginosa is the mostcommon among the isolated pathogens. Six patients presented with stridor and needed tracheostomy. With early incision anddrainage, proper antibiotics and supportive measures, 37 patients survived without any morbidities. Despite all of our greatestefforts, four patients expired. Although comorbidities such as diabetes and chronic kidney disease are seen in few, majoritywere not having any other systemic illness.Conclusion: Prompt diagnosis and surgical drainage with broad-spectrum antibiotics and if needed tracheostomy often givemuch better results in the treatment of Ludwig’s angina. An early intervention of dental infection in early stages may be helpfulin avoiding progression into Ludwig’s angina.

Definition and management of odontogenic maxillary sinusitis / 대한악안면성형재건외과학회지

BACKGROUND: Maxillary sinusitis of odontogenic origin, also known as maxillary sinusitis of dental origin or odontogenic maxillary sinusitis (OMS), is a common disease in dental, otorhinolaryngologic, allergic, general, and maxillofacial contexts. Despite being a well-known disease entity, many cases are referred to otorhinolaryngologists by both doctors and dentists. Thus, early detection and initial diagnosis often fail to detect its odontogenic origin. MAIN BODY: We searched recent databases including MEDLINE (PubMed), Embase, and the Cochrane Library using keyword combinations of “odontogenic,” “odontogenic infection,” “dental origin,” “tooth origin,” “sinusitis,” “maxillary sinus,” “maxillary sinusitis,” “odontogenic maxillary sinusitis,” “Caldwell Luc Procedure (CLP),” “rhinosinusitis,” “functional endoscopic sinus surgery (FESS),” “modified endoscopy-assisted maxillary sinus surgery (MESS),” and “paranasal sinus.” Aside from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) trial, there have been very few randomized controlled trials examining OMS. We summarized the resulting data based on our diverse clinical experiences. CONCLUSION: To promote the most efficient and accurate management of OMS, this article summarizes the clinical features of rhinosinusitis compared with OMS and the pathogenesis, microbiology, diagnosis, and results of prompt consolidated management of OMS that prevent anticipated complications. The true origin of odontogenic infections is also reviewed.

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.