Hematologic and inflammatory parameters for determining severity of odontogenic infections at admission: a retrospective study.

BACKGROUND: Severe odontogenic infections in the head and neck region, especially necrotizing soft tissue infection (NSTI) and deep neck abscess, are potentially fatal due to their delayed diagnosis and treatment. Clinically, it is often difficult to distinguish NSTI and deep neck abscess in its early stage from cellulitis, and the decision to perform contrast-enhanced computed tomography imaging for detection is often a challenge. This retrospective case-control study aimed to examine the utility of routine blood tests as an adjunctive diagnostic tool for NSTI in the head and neck region and deep neck abscesses. METHODS: Patients with severe odontogenic infections in the head and neck region that required hospitalization were classified into four groups. At admission, hematologic and inflammatory parameters were calculated according to the blood test results. In addition, a decision tree analysis was performed to detect NSTI and deep neck abscesses. RESULTS: There were 271 patients, 45.4% in Group I (cellulitis), 22.5% in Group II (cellulitis with shallow abscess formation), 27.3% in Group III (deep neck abscess), and 4.8% in Group IV (NSTI). All hematologic and inflammatory parameters were higher in Groups III and IV. The Laboratory Risk Indicator for Necrotizing Fasciitis score, with a cut-off value of 6 and C-reactive protein (CRP) + the neutrophil-to-lymphocyte ratio (NLR), with a cut-off of 27, were remarkably useful for the exclusion diagnosis for Group IV. The decision tree analysis showed that the systemic immune-inflammation index (SII) of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 suggests Group III + IV and the classification accuracy was 89.3%. CONCLUSIONS: Hematologic and inflammatory parameters calculated using routine blood tests can be helpful as an adjunctive diagnostic tool in the early diagnosis of potentially fatal odontogenic infections. An SII of ≥ 282 or < 282 but with a CRP + NLR of ≥ 25 can be useful in the decision-making for performing contrast-enhanced computed tomography imaging.

Can four-dimensional computed tomography support diagnosis and treatment planning?: a case report before and after coronoidectomy.

INTRODUCTION: Elongated mandibular coronoid process is a rare condition defined as enlargement of the coronoid process. The only useful way to treat the mouth-opening limitation is resection of the elongated coronoid process. Four-dimensional CT (4DCT; three spatial dimensions plus time axis) is a novel imaging technique. Its usefulness of for evaluation of dynamic movements such as joint motion has been reported. Here, we show the potential usefulness of 4DCT evaluation in a patient with elongated mandibular coronoid process. CASE PRESENTATION: A 59-year-old female who suffered from mouth-opening difficulty and pressure during mouth opening was referred to our department. Elongation of the right coronoid process was evident in a panoramic X-ray image. The mandibular movement and temporal muscle motility before and after coronoidectomy in this patient on 4DCT could be evaluated. CONCLUSIONS: 4DCT is useful in the diagnosis and surgical outcome of elongated coronoid process.