Computer-Aided Fracture Size Measurement in Orbital Fractures-An Alternative to Manual Evaluation.

OBJECTIVE: We aimed to present a novel semiautomated tool for orbital fracture size measurement and to compare the variability of the proposed method with traditional manual measurements. METHODS: Maximal anteroposterior (AP) and mediolateral (ML) dimensions of orbital fractures from computed tomography images were measured for 15 patients with unilateral orbital fractures by 2 surgeons manually and with a semiautomatic software. Variability was assessed with Bland-Altman limits of agreement plots and intra-class correlation coefficients (ICCs). RESULTS: The intra-observer ICCs in manual and automatic measurements were high, >0.9. The inter-observer ICCs in manual measurements were 0.926 (AP) and 0.631 (ML) and in automatic measurements 0.989 (AP) and 0.989 (ML). The ICCs for manual and semiautomated variability were 0.899 (AP) and 0.669 (ML). The differences were thus particularly pronounced in the ML dimensions. In addition, with the semiautomated technique, a total fracture area could be measured and compared with the total area of the bony orbit and a 3-dimensional reformatted image could be generated. CONCLUSIONS: Intra- and inter-observer variability proved to be very low for measuring fracture maximal AP length and ML width, making both the manual and the semiautomatic methods feasible clinically. The semiautomatic fracture size analysis allows better observer-independent repeatability for fracture size measurements and provides the possibility for total fracture area measurements at any orbital bony site, even in challenging nonplanar topography.

Health status in patients hospitalised for severe odontogenic infections.

OBJECTIVE: Previous findings refer to certain predisposing medical conditions that compound the risk of developing severe and potentially lethal acute odontogenic infections (OI). The objective of this study was to clarify this rationale and infection severity in general. MATERIAL AND METHODS: Records of patients aged ≥18 years requiring hospital care for deep OI were retrospectively investigated. The main outcome variable was need for intensive care unit (ICU) treatment. Additional outcome variable was occurrence of infection complications and/or distant infections. Several parameters describing patients' prior health and recent dental treatment were set as independent variables. RESULTS: Of the 303 acute OI patients included, 71 patients (23%) required treatment in the ICU, with no significant difference between previously healthy and patients with disease history. OIs originating from teeth in the mandible compared with maxilla had 7.8-fold risk (p = .007) for ICU treatment in binary logistic regression analyses. Elevated levels of infection parameters at hospital admission predicted further ICU stay. Infection complications and/or distant infections occurred in 7.6% of patients, of which septicaemia and pneumonia were the most common. The mortality rate was 0.3%. Infection complications and/or distant infections occurred significantly more often in smokers (p = .001) and in patients with excessive consumption of alcohol or drugs (p = .025), however smoking showed 3.5-folded independent risk for infection complications and/or distant infections (p = .008) in logistic regression. CONCLUSIONS: Severe OIs often occur in previously healthy patients. Smokers in particular are prone to the most serious OIs.

Prevalence of bacteraemia following dental extraction - efficacy of the prophylactic use of amoxicillin and clindamycin.

OBJECTIVES: To evaluate the efficacy of single-dose antibiotic prophylaxis (AP) in the prevention of bacteraemia following tooth extractions at our clinic. MATERIAL AND METHODS: Fifty patients undergoing tooth extractions were enrolled. The need of AP was determined according to the health status and possible allergies of the patients. Blood culture samples were collected at baseline, 5 min after the first tooth extraction and 20 min after the last extraction. RESULTS: The majority (76%) received prophylactic oral amoxicillin or intravenous ampicillin (AMX/AMP) (2 g), 12% received clindamycin (CLI) (600 mg) and 12% received no prophylaxis (NO AP). All baseline blood cultures were reported negative. The prevalence of bacteraemia was significantly higher in the CLI and NO AP groups compared to the AMX/AMP group 5 min after the first tooth extraction (p < .0001 and p = .015, respectively). Twenty minutes after the last extraction positive blood cultures were reported only for CLI (p = .0015) and NO AP groups. There was no significant difference in the prevalence of positive blood cultures between CLI and NO AP groups. CONCLUSIONS: Appropriately administered AMX/AMP proved its efficacy in reducing both the prevalence and duration of bacteraemia following tooth extractions whereas CLI was not effective in preventing bacteraemia following tooth extractions.

Deep odontogenic infections-identifying risk factors for nosocomial pneumonia.

OBJECTIVES: To evaluate occurrence and risk factors for pneumonia in patients with deep odontogenic infection (OI). MATERIALS AND METHODS: All patients treated for deep OIs and requiring intensive care and mechanical ventilation were included. The outcome variable was diagnosis of nosocomial pneumonia. Primary predictor variables were re-intubation and duration of mechanical ventilation. The secondary predictor variable was length of hospital stay (LOHS). The explanatory variables were gender, age, current smoking, current heavy alcohol and/or drug use, diabetes, and chronic pulmonary disease. RESULTS: Ninety-two patients were included in the analyses. Pneumonia was detected in 14 patients (15%). It was diagnosed on postoperative day 2 to 6 (median 3 days, mean 3 days) after primary infection care. Duration of mechanical ventilation (p = 0.028) and LOHS (p = 0.002) correlated significantly with occurrence of pneumonia. In addition, re-intubation (p = 0.004) was found to be significantly associated with pneumonia; however, pneumonia was detected in 75% of these patients prior to re-intubation. Two patients (2%) died during intensive care unit stay, and both had diagnosed nosocomial pneumonia. Smoking correlated significantly with pneumonia (p = 0.011). CONCLUSION: Secondary pneumonia due to deep OI is associated with prolonged hospital care and can predict the risk of death. Duration of mechanical ventilation should be reduced with prompt and adequate OI treatment, whenever possible. Smokers with deep OI have a significantly higher risk than non-smokers of developing pneumonia. CLINICAL RELEVANCE: Nosocomial pneumonia is a considerable problem in OI patients with lengthy mechanical ventilation. Prompt and comprehensive OI care is required to reduce these risk factors.