Maxillofacial infections of dental origin: risk factors for hospital admission

Aim: to evaluate the occurrence of maxillofacial infection cases, which were treated at local hospital, identifying the main risk factors that determine the need for hospitalization of patients and the factors associated with staying length. Methods: A retrospective review of 191 records of patients with maxillofacial infection of odontogenic origin was performed, statistically evaluated by frequency and percentage of involvement, p values (based on the chi-square test) and odds ratio with a 95% confidence interval. A p-value <0.05 was considered statistically significant. Results: Among all the 191 patients, 31 had some harmful habits, such as smokers (13%) and alcoholics (1%). In addition, 39 patients reported some general health problem, such as systemic arterial hypertension (8.3%), depression (6.8%), diabetes (3.6%) and some immunosuppression (1.57%). Involvement of infection in deep facial spaces was present, with 119 patients presenting a deeper infection (62.3%) and 72 patients a superficial infection (37.7%). The most prevalent clinical signs and symptoms in the initial evaluation were pain (91.1%) and edema (90.1%), followed by erythema/hyperemia (44.5%), trismus (37.7%), abscess (30.9%), cellulitis (27.7%), f istula (16.8%), fever (16.8%), dysphagia (11%), dehydration (9.9%), odynophagia (7.9% ) and dyspnea (3.7%). Pulp necrosis was considered a risk factor for treatment in a hospital environment (0.032) and root canal treatment decreases the risk of hospitalization (p=0.002). Considering the evaluated patients, 146 (76.4%) were admitted and 45 (37.7%) were not admitted for hospitalization after initial clinical evaluation. Conclusion: there is a high occurrence of maxillofacial infection cases of dental origin, considering that involvement of infection in deeper facial spaces, as well as presence of pain, edema, erythema/hyperemia, trismus, abscess, cellulitis and pulp necrosis, represent the main risk factors for hospitalization and staying length

Facial trauma followed by osteomyelitis - Case report.

INTRODUCTION: Osteomyelitis is an inflammatory-infectious state that may involve trabecular bone, cortical bone, bone marrow and periosteum. The source of the infection may be hematogenic, acquired from an adjoining infectious focus or by direct inoculation into the bone. Its treatment involves antibiotic administration and surgery, but its management remains challenging. PRESENTATION OF CASE: A 76-year-old male patient with a history of car accident 3 months earlier sought hospital care with nasal fracture and loss of substance in the right frontotemporal region, where a pectoral muscle free graft was performed to reconstruct the facial defect. The grafted region had hyperemic edges, necrotic appearance, purulent discharge and bone exposure in the nasal dorsum. The initial diagnostic hypothesis was an infectious process due to graft rejection, with likely evolution to osteomyelitis. The surgical procedure was performed by a multidisciplinary team and the patient received the antibiotic regimen according to the antibiogram, with hospital discharge after 39 days of hospitalization. DISCUSSION: Treatment of osteomyelitis requires the combination of antimicrobial therapy and surgery. Despite surgical and chemotherapeutic advances, it is a difficult condition to treat and there is no universally accepted protocol for treatment. CONCLUSION: Surgical treatment was essential for stabilization of the condition. Due to the complexity of this type of infection in the craniofacial region, planning and execution must be carried out through a multidisciplinary team.