Oral health and functional outcomes following mechanical thrombectomy for ischemic stroke.

BACKGROUND: An association between poor dentition and the risk of ischemic stroke has previously been reported in the literature. In this study we assessed oral hygiene (OH), including tooth loss and the presence of dental disease, to determine if an association exists with functional outcomes following mechanical thrombectomy (MT) for large-vessel ischemic stroke. METHODS: A retrospective review was conducted of consecutive adult patients at a single comprehensive stroke center who underwent MT from 2012 to 2018. Inclusion criteria included availability of CT imaging to radiographically assess OH. A multivariate analysis was performed, with the primary outcome being 90-day post-thrombectomy modified Rankin Scale (mRS) score >2. RESULTS: A total of 276 patients met the inclusion criteria. The average number of missing teeth was significantly higher in patients with a poor functional outcome (mean (SD) 10 (11) vs 4 (6), p<0.001). The presence of dental disease was associated with poor functional outcome, including cavities (21 (27%) vs 13 (8%), p<0.001), periapical infection (18 (23%) vs 11 (6.7%), p<0.001), and bone loss (27 (35%) vs 11 (6.7%), p<0.001). Unadjusted, missing teeth was a univariate predictor of poor outcome (OR 1.09 (95% CI 1.06 to 1.13), p<0.001). After adjustment for recanalization scores and use of tissue plasminogen activator (tPA), missing teeth remained a predictor of poor outcome (OR 1.07 (95% CI 1.03 to 1.11), p<0.001). CONCLUSION: Missing teeth and the presence of dental disease are inversely correlated with functional independence following MT, independent of thrombectomy success or tPA status.

Intraoral management of odontogenic infection associated with severe trismus under local anesthesia.

Trismus is defined as a tonic contraction of the muscles of mastication. It can also refer to limited mouth opening of any cause. Trismus is a classical symptom of masticatory space infections and it can be a sign of an infection in the anterior compartment of lateral pharyngeal space. Common causes in clinical practice followed by trismus are odontogenic infection which can be periodontal or pericoronal. This article will present a clinical report on intraoral management of mandibular odontogenic infection accompanied by severe trismus under local anesthesia using modified Akinosi technique in an outpatient environment. Treatment and postoperative period were routine. This kind of approach provides access to the infection at an early stage without general anesthesia, it shortens the hospital treatment and it enables faster recovery. KEY WORDS: Local Anesthesia, Odontogenic infection, Trismus.

Bactericidal activity of a substituted thiazole against multidrug-resistant Eggerthia catenaformis isolated from patients with dental abscess.

Human infections caused by the anaerobic bacterium Eggerthia catenaformis are rare. However, a growing number of case reports have presented the bacterium as the causative agent in many serious complications. This study provides data on the isolation and antibiotic susceptibility profiles of E. catenaformis from dental abscess. Identification of isolates was performed using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). We also investigated the antibacterial activity of 5-acetyl-4-methyl-2-(3-pyridyl) thiazole (AMPT) on E. catenaformis isolates. Minimum inhibitory concentrations (MICs) were determined by an agar dilution method and bactericidal activity was evaluated by a time-kill assay. Moreover, the mechanism of action of AMPT was also explored by cell membrane disruption assay and scanning electron microscopy (SEM). MALDI-TOF MS results revealed unambiguous identification of all isolates with score values between 2.120 and 2.501. Isolates NY4 and NY9 (20% of isolates) were found resistant to multiple antibiotics judged by MIC values. As multidrug-resistant strains of E. catenaformis were not reported to date, we then confirmed the identity of NY4 and NY9 based on 16S rRNA gene sequence. Favorably, all isolates were susceptible to AMPT with an MIC range of 0.25-1 mg/L. Time-kill kinetics of AMPT indicated that it exhibited potent bactericidal activity against the multidrug-resistant isolates NY4 and NY9. Furthermore, this study also hypothesizes that AMPT exerts its antibacterial effect through damaging the cell membrane and thereby induce the release of intracellular components. AMPT could therefore be considered as a therapeutic option for infections caused by multidrug-resistant bacteria.

Odontogenic cervico-facial cellulitis during pregnancy: about 3 cases.

Pregnancy is considered as a risk factor for development, severity, and complications of odontogenic infections. Without adequate treatment, the infection can spread and threaten both the mother's and the foetus lives. We aim to analyze the predisposing factors, diagnostic and therapeutic aspects of cervico-facial cellulitis during pregnancy, through a descriptive retrospective study conducted at oral and maxillofacial surgery department of Mohamed VI university hospital center at Marrakesh, between June 2017 and June 2019. A total of three patients; all patients were at their last trimester were recruited. Every patient was immediately given intravenous antibiotics, drainage was carried out under local anesthesia, and the causing tooth was removed. During hospitalization, one patient was referred to the gynaecology department for preterm labor, while the remaining two patients were discharged after the pus drainage has stopped. The possible compromise of oral health during pregnancy is well known, however severe odontogenic infections are rarely considered in the literature. It is essential to aggressively treat the gravid patient to minimize the risk of infection spreading to the facial spaces. Moreover, poor oral health in pregnancy has been implicated in adverse birth outcomes, specifically prematurity. We recommend upgrading communication between obstetrician and dentists so that regular routine dental visits are planned for pregnant patients during early stages of pregnancy in order to identify and manage the problem as early as possible.

Dental abscess: A potential cause of death and morbidity.

BACKGROUND: Dental abscess as an end stage of dental disease is common in the community, and patients with dental abscesses are likely to seek care from their primary health provider. Once the infection has spread beyond the confines of the jaws, there is an increasing risk of airway obstruction and septicaemia. If treated with antibiotics alone, the infection will not resolve and will become progressively worse. OBJECTIVE: This article reviews the pathophysiology, demographics and management of severe odontogenic infections. It includes evidence-based studies of a large number of cases treated at a single tertiary hospital. DISCUSSION: Prompt assessment and referral to a tertiary hospital is required for cases at risk of airway compromise. The morbidity and mortality of cases is presented in this article, with discussion of risk factors and the financial burden on the health system.

Odontogenic orbital inflammation.

Objective: This study aimed to determine the most frequent clinical aspects in patients with odontogenic orbital inflammation, the computed tomography (CT) aspect, and the most appropriate treatment. Material and Methods: This is a retrospective case-series study conducted on 3 patients with ages between 16 and 55 years old, in the Ophthalmology and Oro-Maxillo-Facial Clinics of "Sf. Spiridon" Emergency Hospital, Iași, Romania. The following investigations were performed in all selected cases: visual acuity (VA), ocular motility examination, anterior segment examination at slit-lamp, fundus examination, intraoral clinical examination, sinus and orbital involvement on CT scan, pathogens involved. Results: All three patients presented swelling of the genic and periorbital regions, conjunctival chemosis, hyperemia of the conjunctiva, proptosis, pain, decreased vision and extraocular movement restriction. The CT examination identified orbital and periorbital cellulitis and ethmoidal expanded maxillary sinusitis or pansinusitis. Dental extraction, transalveolar drainage and orbital decompression were performed in all three cases. The evolution was favorable with remission of proptosis, edema of the genic and periorbital regions and conjunctival chemosis. Visual acuity remained poor in one case due to total optic nerve atrophy. Conclusions: Our study had a small number of patients, but the data was pertinent to ophthalmologists and maxillofacial surgeons who need to be aware of typical clinical features and the most common etiologies. Late treatment of dental infections can lead to severe ocular manifestations such as orbital cellulitis. Odontogenic orbital inflammation management involves a long-term and multidisciplinary approach. Abbreviations: CT = computed tomography, VA = visual acuity, CBCT = cone beam computed tomography, TED = thyroid eye disease, MRI = magnetic resonance imaging, OOC = odontogenic orbital cellulitis, RAPD = relative afferent pupillary defect.

A case report of generalized tetanus in a 42-year-old man with dental infection.

Background In the post-vaccination era, as it is today, generalized tetanus is a rare diagnosis, although mortality and morbidity continue to increase significantly throughout the world. Infection occurs when the Clostridium tetani spores are introduced into wounds, skin lesions and infections. The symptoms often begin with stiffness or spasms in the jaw muscles; they are called trismus or "lockjaw" and/or then spread to the neck and abdominal muscles. Case presentation This is a report of a 42-year-old man who was referred to the hospital with dysphagia, rigidity and trismus. He was diagnosed with generalized tetanus with a Philips score of 15. The patient was admitted to the isolation unit, received treatment that included procaine penicillin, metronidazole, diazepam, human tetanus immunoglobulin (TIG) and anti-tetanus serum (ATS). Treatment was considered according to the guidelines of the World Health Organization, and also, the drug dose has no adverse event reaction during the treatment. Conclusion The therapeutic response is related to the identification and appropriate treatment, especially in hospitalized patients with inadequate immunization so that patients recover soon.

Odontogenic sinusitis is a common cause of unilateral sinus disease with maxillary sinus opacification.

BACKGROUND: Unilateral sinus disease (USD) carries a broader differential diagnosis than bilateral sinus disease, including various inflammatory and neoplastic conditions. Odontogenic sinusitis (ODS) is a common cause of unilateral maxillary sinusitis, but few studies have examined its incidence among all USD etiologies. The main purposes of this prospective study were to determine the incidences of ODS and other etiologies causing USD with complete maxillary sinus opacification on computed tomography (CT), and to compare CT features of ODS and non-odontogenic USD patients. In addition, clinical features of the ODS cohort are described. METHODS: A prospective case series of 134 patients with USD with complete maxillary sinus opacification on CT was conducted from August 2015 to November 2018. Based on nasal endoscopy, sinus CT, and dental examination and imaging, patients were categorized as having unilateral ODS or non-odontogenic USD. Patients with non-odontogenic USD were categorized as inflammatory or neoplastic. Demographic and clinical data were reported for ODS patients. RESULTS: Of the 134 patients, 45% had ODS, 36% had non-odontogenic inflammatory conditions, 17% had inverted papilloma, and 2% had malignancies. Of the 60 ODS cases, 86.7% were associated with middle meatal purulence on nasal endoscopy. On CT, 88.3% had extramaxillary sinus disease extension, and 65.5% of CT reports made no mention of dental pathology. CONCLUSION: ODS caused nearly 50% of all USD cases with maxillary sinus opacification on CT, and was the most common individual etiology. ODS was frequently associated with anterior ethmoid and frontal sinus disease on CT, and middle meatal purulence on nasal endoscopy.

Hepatic abscess due to Dialister pneumosintes - A case report.

Dialister pneumosintes is an obligate anaerobic Gram-negative rod associated with infections of the oral cavity. We report on a previously healthy, 51-year-old woman who presented with a liver abscess caused by Dialister pneumosintes as a complication of a dental abscess. The microorganism was identified by using a broad-range bacterial 16S rRNA gene PCR in the liver exudate. The patient was cured after abscess drainage and 4-week antibiotic treatment. Our case highlights the importance of a good history and physical examination when taking care of patients admitted for pyogenic liver abscess.

Ten years of deep neck space abscesses.

BACKGROUND: The incidence of deep neck space abscesses, which can result in significant morbidity and mortality, is rising. The aetiology is thought to be dental. However, this study suggests a reduction in tonsillectomies may be associated with the rise. METHOD: In a retrospective cohort study, patients were identified by a clinical code within one hospital over 10 years. Evidence of preceding infection source, management, lifestyle risks, comorbidities and demographics were extracted. RESULTS: Fifty-two patients were included: 23 (44 per cent) had concurrent or recent tonsillitis; 11 (21 per cent) had poor dental hygiene; 22 (42 per cent) were smokers; and 9 (17 per cent) had diabetes. The incidence of deep neck space abscess cases increased from 1 in 2006, to 15 in 2015 (correlation value 0.9; p = 0.00019). CONCLUSION: The incidence of deep neck space abscess cases is increasing. Risk factors include tonsillitis, smoking and dental infection. This paper adds to the growing evidence that deep neck space abscesses are increasingly related to tonsillitis, and questions whether the threshold for tonsillectomy has been raised too high.

A retrospective analysis of the prevalence of dental diseases in patients with digestive system cancers.

The relationship between dental diseases and the prevalence of digestive system cancers remains unclear. The aim of the present study was to examine the prevalence of dental diseases in patients treated for digestive system cancers.The medical and dental records of patients treated for digestive system cancers were retrospectively reviewed, and the results obtained (decayed/filled/missing teeth [DMFT] indices and community periodontal index [CPI] codes) were compared with data from the national survey of dental diseases in order to investigate the relationship between oral health and digestive system cancers.DMFT, D, and F indices were significantly lower, while the M index was slightly higher in digestive system cancer patients than in the national survey. The proportions of individuals with more than 20 residual teeth and denture wearers were significantly lower in cancer patients than in the national survey. The prevalence of periodontitis (CPI codes 3 and 4) and severe periodontitis (CPI code 4) were significantly higher in cancer patients than in the national survey.The present results showed that digestive system cancers were closely associated with multi-tooth loss and/or a low denture-wearing rate. The prevalence of severe periodontitis was also found to be higher in cancer patients. These results suggest that periodontitis and associated multi-tooth loss play a potential role in digestive system cancers.

Exodontia-induced muscular hypofunction by itself or associated to chronic stress impairs masseter muscle morphology and its mitochondrial function.

Stress is associated with orofacial pain sensitivity and is qualified as a temporomandibular disorder risk factor. During stressful periods, painful thresholds of masticatory muscles in individuals suffering muscle facial pain are significantly lower than in controls, but the exact physiologic mechanism underlying this relation remains unclear. Our hypothesis is that chronic unpredictable stress and masticatory hypofunction induce morphologic and metabolic masseter muscle changes in rats. For test this hypothesis, adult Wistar rats were submitted to chronic unpredictable stress and/or exodontia of left molars and the left masseter muscle was removed for analysis. The parameters evaluated included ultrastructure, oxidative level, metabolism activity and morphological analysis in this muscle. Our data show by histological analysis, that stress and exodontia promoted a variation on diameters and also angled contours in masseter fibers. The masticatory hypofunction increased oxidative metabolism as well as decreased reactive species of oxygen in masseter muscle. The ultrastructural analysis of muscle fibers showed disruption of the sarcoplasmic reticulum cisterns in certain regions of the fiber in stress group, and the disappearance of the sarcoplasmic reticulum membrane in group with association of stress and exodontia. Our findings clarify mechanisms by which chronic stress and masticatory hypofunction might be involved in the pathophysiology of muscular dysfunctions. Masticatory hypofunction influenced oxidative stress and induced oxidative metabolism on masseter muscle, as well as altered its fiber morphology. Chronic stress presented malefic effect on masseter morphology at micro and ultra structurally. When both stimuli were applied, there were atrophic fibers and a complete mitochondrial derangement.

Sphenopalatine Neuralgia: An Independent Neuralgia Entity. Pooled Analysis of a Case Series and Literature Review.

BACKGROUND: Structural damage or demyelization of the sphenopalatine ganglion may cause sphenopalatine neuralgia (SN). The current International Classification of Headache Disorders, third edition (ICHD-3) regards SN as a phenotype of cluster headache. Whether SN is an independent neuralgia entity has been debated for years. METHODS: This article presents a case series of SN, a review of all published cases, and a pooled data analysis of the identified cases. RESULTS: Seven patients were identified, with a median age at symptom onset of 59 years. Six cases were secondary to structural lesions surrounding the ipsilateral sphenopalatine ganglion, and all of them experienced significant clinical improvements after removing the primary causes. In the seventh patient, no evidence of underlying disease was found. The literature review showed that SN affected patients spanning a wide range of ages and both sexes. The clinical characteristics of SN might mimic cluster headache with the exception of cluster pattern and treatment response to oxygen. The typical duration of pain episodes in SN was several hours to several days; and in some cases, pain was persistent. Sixty-seven percent (59/88) of patients with SN had structural lesions around the sphenopalatine ganglion. CONCLUSION: SN could possibly be regarded as a different clinical entity from cluster headache. Based on our patients and literature review, SN can be categorized as idiopathic SN and secondary SN. Craniofacial structural lesions should be highly rating and taken into account when SN is suspected.

Skull pathology in 10 cats with patellar fracture and dental anomaly syndrome.

CASE SERIES SUMMARY: The aim of this case series is to describe the clinical and radiological features of mandibular and maxillary abnormalities in cats diagnosed with patellar fractures and dental anomalies, a condition that we have named 'patellar fracture and dental anomaly syndrome' (PADS), also known previously as 'knees and teeth syndrome'. Where available, clinical records, skull and/or intraoral dental radiographs, head CT images, microbiology and histopathology reports were collected, and follow-up was obtained. Ten cats with mandibular or maxillary abnormalities were identified. Common clinical features included multiple persistent deciduous teeth, gingivitis and swellings of the jaw. Skull radiographs were available for 7/10 cats and head CT images were available for one cat. Findings included marked bony and periosteal proliferation, hypodontia, root resorption, root malformation and unerupted permanent teeth. Where available, microbiology and histopathology results were consistent with osteomyelitis. RELEVANCE AND NOVEL INFORMATION: Mandibular and maxillary abnormalities are an additional unreported clinical feature of the rare condition that we have termed PADS. Radiologically, these lesions can have an aggressive appearance, which can mimic neoplasia. Medical management with antibiotic and anti-inflammatory therapy improves clinical signs in the short term; however, surgical extraction of persistent deciduous and unerupted permanent teeth, and debridement of proliferative and necrotic bone appear to be necessary for an improved outcome. Additional information on long-term outcome is required.

Odontogenic rhinosinusitis and sinonasal complications of dental disease or treatment: prospective validation of a classification and treatment protocol.

PURPOSE: Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) represent a heterogeneous group of conditions that often require multidisciplinary care. The present study aims to prospectively validate a classification and treatment protocol for SCDDT patients. METHODS: One hundred twenty-eight consecutive patients (73 females and 45 males, mean age 52.4 years) affected by SCDDT not responding to dental and medical therapy were classified and surgically treated according to the proposed protocol. The protocol classified patients into three aetiology-based groups (preimplantologic, implantologic, and related to traditional dental diseases and procedures, respectively). The groups were further divided into classes according to the presence of oro-antral communications and/or dislocated dental hardware. Each condition was treated according to the class-related, protocol-defined treatment, by either a transnasal or combined transnasal/transoral approach. All patients were successfully classified according to our protocol. None of the proposed classes were redundant, and no condition fell outside the definitions. RESULTS: The surgical treatment protocol proved to be adequate and effective, in that 125 of the 128 patients completely recovered after surgical treatment. CONCLUSIONS: The term SCDDT and the consequent classification proposed by the authors appear, therefore, to be nosologically correct. Furthermore, the protocol-related proposed treatment appears to be clinically sound, with a success rate nearing 98%.

Evaluation of risk factors for oral infection with potential for spread in a 1-year cohort study.

OBJECTIVES: To determine the frequency of oral infection with potential for spread (OIPS) and behavioural risk factors in patients referred to a regional tertiary care-centre for OIPS assessment and clearance. MATERIALS AND METHODS: A database search of all referrals to the Oral and Maxillofacial Diseases unit of HUH in 2009 was performed. Of the 2807 referrals, 408 were due to a known or suspected OIPS. The electronic patient records of these patients were analysed for patient demographics, lifestyle factors, radiological findings and clinical oral findings. Risk factors for OIPS were analysed using logistic regression and using the significant factors in univariate analyses in the multivariate models. RESULTS: The mean age of the patients was 58 years. Most patients (n = 270, 66%) were referred due to upcoming cancer or other immunosuppressive therapy. The majority (n = 314, 77%) were diagnosed with one or more OIPS. In univariate analyses, smoking (OR 3.2, 95% CI 1.6-6.4; p = 0.0006), male gender (OR 1.7, 95% CI 1.1-2.8; p = 0.02), excessive alcohol use (OR 3.0, 95% 1.1-7.9; p = 0.03) and irregular dental care (OR 4.8, 95% CI 2.6-8.8; p < 0.0001) were risk factors for OIPS. However, in multivariate analyses, smoking was the only independent risk factor for OIPS (OR 3.6, 95% CI 1.2-11.8; p = 0.02). CONCLUSIONS: OIPS are common in patients referred for OIPS clearance, and smoking was identified as an independent behavioural risk factor for them. These findings highlight the burden of disease in this patient group and the importance of smoking cessation encouragement. CLINICAL RELEVANCE: To identify patients at increased risk of OIPS.

Saúde bucal de usuários de drogas institucionalizados / Salud bucal de usuarios de drogas institucionalizados / Oral health of drugs users institutionalized

Resumo O uso de drogas traz diversos malefícios para a saúde bucal, aumentando a prevalência das doenças cárie dentária e periodontal, representando um sério problema de saúde pública. Este estudo objetivou avaliar a prevalência das doenças cárie dentária e periodontal em usuários de drogas institucionalizados. Estudo epidemiológico, transversal, censitário e analítico realizado com usuários de drogas institucionalizados no período de agosto de 2016 a junho de 2017. Examinadores padronizados aplicaram um formulário para coleta de dados sociodemográficos e consumo de drogas. A cárie dentária foi avaliada através do índice CPO-D e a doença periodontal através dos indicadores clínicos: sangramento à sondagem, índice de placa, índice gengival, profundidade de sondagem e nível de inserção clínica. Foram avaliados 112 indivíduos do sexo masculino, média de idade de 36,7 anos (Dp±11,5). A droga mais consumida foi o álcool (92,0 %) por cerca de 19,4 anos (Dp±11.08), seguido do tabaco (70,95%) em média por 18,0 anos (Dp±11,66), maconha (65,2%) por 13,7 anos (Dp±8,22), cocaína (53,3%) por 8,5 anos (Dp±6,00) e crack (50,0%) por 11,1 anos (Dp±7,18). Conclui-se que a prevalência da doença de cárie foi 97,3% e da doença periodontal 51,5%. A população estudada apresentou alta prevalência de cárie dentária e doença periodontal e houve correlação entre o tempo de uso do álcool e tabaco com a doença periodontal e com maior CPO-D.

Resumen El uso de drogas trae diversos problemas para la salud bucal, aumentando la prevalencia de las enfermedades de caries y periodontales, representando un serio problema de salud pública. Este estudio tuvo como objetivo evaluar la prevalencia de las enfermedades periodontales y caries en usuarios de drogas institucionalizadas. Estudio epidemiológico, transversal, censitario y analítico realizado con usuarios de drogas institucionalizadas en el período de agosto de 2016 a junio de 2017. Los examinadores estandarizados aplicaron formulario para recolección de datos sociodemográficos y consumo de drogas. Las caries dentales fueron evaluadas a través del índice CPO-D y la enfermedad periodontal a través de los indicadores clínicos: sangrado al sondeo, índice de placa, índice gengival, profundidad de sondeo y nivel de inserción clínica. Se evaluaron 112 individuos del sexo masculino, media de edad de 36,7 años (Dp ± 11,5). La droga más consumida fue el alcohol (92,0%) por cerca de 19,4 años (Dp ± 11.08), seguido del tabaco (70,95%) en promedio por 18,0 años (Dp ± 11,66), (65,2%) por 13,7 años (Dp ± 8,22), cocaína (53,3%) por 8,5 años (Dp ± 6,00) y crack (50,0%) por 11, 1 años (Dp ± 7,18). La prevalencia de la enfermedad caries fue del 97,3% y de la enfermedad periodontal 51,5%. Se concluye que la población estudiada presentó alta prevalencia de caries y enfermedad periodontal y existió correlación entre el tiempo de uso del alcohol y tabaco con la enfermedad periodontal y con mayor CPO-D.

Abstract Drug use causes several health hazards to oral health, increasing the prevalence of dental caries and periodontal diseases, representing a serious public health problem. This study aimed to evaluate the prevalence of dental and periodontal caries in institutionalized drug users. It is an epidemiological, cross-sectional, census-based, analytical study with institutionalized drug users, carried out from August 2016 to June 2017. Standardized examiners applied a form to collect sociodemographic data and on drug consumption. Dental caries were evaluated through the DMFT index and periodontal disease through clinical indicators: bleeding at probing, plaque index, gingival index, probing depth and level of clinical insertion. A total of 112 males, mean age 36.7 years (Dp ± 11.5) were evaluated. The most commonly used drug was alcohol (92.0%) for about 19.4 years (Dp ± 11.08), followed by tobacco (70.95%) on average for 18.0 years (Dp ± 11.66), marijuana (65.2%) for 13.7 years (Dp ± 8.22), cocaine (53.3%) for 8.5 years (Dp ± 6.00) and crack (50.0%) for 11.1 year (Dp ± 7.18). It is concluded that the prevalence of caries was 97.3% and of periodontal disease 51.5%. The studied population presented high prevalence of dental caries and periodontal disease and there was a correlation between alcohol and tobacco use time with periodontal disease and with higher DMFT.

Celulitis cervical odontógena / Cervical Cellulitis of Odontogenic Origin

No disponible

Deep neck infection and descending mediastinitis as lethal complications of dentoalveolar infection: two rare case reports.

BACKGROUND: We report two cases of innocuous dentoalveolar infections which rapidly progressed to deep neck abscesses complicated by descending mediastinitis in a resource-constrained rural mission hospital in the Cameroon. CASE PRESENTATION: The clinical presentations of a 35-year-old man and a 32-year-old woman both of Fulani origin in the Northern region of Cameroon were similar with submandibular fluctuant and tender swelling and differential warmth to palpation. The patients had tachycardia, high grade pyrexia, and normal blood pressure. Further physical and neurological examinations were unremarkable. An ultrasound scan of the neck swellings showed submandibular turbid collections. Plain chest radiographs confirmed empyema thoraces. Our patients had serial drainage of the neck abscesses as well as closed thoracostomy tube drainage which were connected to pleurovac and suctioning machines, with significant amount of pus drainage. Both patients were admitted to our intensive care unit for close monitoring. The first patient continued to make satisfactory clinical progress and was discharged by the fourth week of admission. The patient who had human immunodeficiency viral infection died on the fifth postoperative day. CONCLUSIONS: The possibility of lethal complications and the associated morbidity and mortality portray this clinical entity as an important public health concern. Clinicians taking care of patients with dentoalveolar and oropharyngeal infections need to be sensitized to these potentially fatal complications. Alternatively, strategies to improve oral health and reduce the incidence of dental caries, the main cause of dental abscess, would maximize use of resources; especially in resources-constrained centers like ours in Banso Baptist Hospital.