Are Deep Odontogenic Infections Associated With an Increased Risk for Sepsis?

BACKGROUND: Quick Sequential Organ Failure Assessment (qSOFA) is recommended to identify sepsis. Odontogenic infection (OI) can progress to sepsis, causing systematic inflammatory complications or organ failure. PURPOSE: The purpose of the study was to measure the association between OI location and risk for sepsis at admission. STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study included subjects treated for OI at Baylor University Medical Center in Dallas, TX, from January 9, 2019 to July 30, 2022. Subjects > 18 years old who were treated under general anesthesia were included. OI limited to periapical, vestibular, buccal, and/or canine spaces were excluded from the sample. PREDICTOR VARIABLE: The primary predictor variable was OI anatomic location (superficial or deep). Superficial OI infection includes submental, submandibular, sublingual, submasseteric, and/or superficial temporal spaces. Deep OI includes pterygomandibular, deep temporal, lateral pharyngeal, retropharyngeal, pretracheal, and/or prevertebral. MAIN OUTCOME VARIABLES: The primary outcome variable was risk for sepsis measured using a qSOFA score (0 to 3). A higher score (>0) indicates the patient has a high risk for sepsis. COVARIATES: Covariates were demographics, clinical, laboratory, and radiological findings, antibiotic route, postoperative endotracheal intubation, tracheostomy, intensive care unit, admission, and length of stay. ANALYSES: Descriptive and bivariate analyses were performed. A χ2 test was used for categorical variables. The Mann-Whitney U test was used for continuous variables. Statistical significance was P < .05. RESULTS: The sample was composed of 168 subjects with a mean age of 42.8 ± 21.5 and 69 (48.6%) subjects were male. There were 11 (6.5%) subjects with a qSOFA score > 0. The relative risk of a qSOFA > 0 for a deep OI is 5.4 times greater than for a superficial OI (136 (95.8) versus 21 (80.8%): RR (95% confidence interval): 5.4 (1.51 to 19.27), P = .004). After adjusting for age, sex, American Society of Anesthesiologists score, and involved anatomical spaces, there was a significant correlation between laterality and the number of involved anatomical spaces and qSOFA score (odd ratio = 9.13, 95% confidence interval: 2.48 to 33.55, adjusted P = <.001). CONCLUSION AND RELEVANCE: The study findings suggest that the OI location is associated with the qSOFA score >0.

The Clinical Observership Program: A Valuable Experience for Oral & Maxillofacial Surgery Residents.

PURPOSE: Training during oral and maxillofacial surgery residency must include exposure to the scope of the specialty, but success in practice often requires particular experience and knowledge of complex oral regenerative procedures such as bone grafting and implant surgery, as well as practice management. Osteo Science Foundation created the Clinical Observership Program (COP) in 2017 to provide residents the opportunity to spend several weeks in an established oral and maxillofacial surgery practice to increase experience in these areas. The purpose of this study is to report the results of a survey of all resident participants in the COP from 2017 to 2021 in which participants were asked to rate their experience numerically. MATERIALS AND METHODS: This is an institutional retrospective case series completed via an electronic survey sent to all participants in the COP from 2017 to 2021. The primary outcome is the subjective assessment of the COP based on six questions in which the respondent was asked to rate the program on a scale of 1 to 10 (10 being best). Categories included: 1) Did the program achieve expectations? 2) Was adequate time spent with the mentor? 3) Did you observe/participate in a variety of procedures? 4) Did the mentor provide additional didactic education? 5) Did you learn about practice management? and 6) How would you rate the overall experience? Descriptive statistics including mean score and standard deviation of each question were calculated, and no other covariates were analyzed. RESULTS: All 55 participants in the COP from 2017 to 2021 were contacted and 55 complete responses were received. The overall mean score for all categories rated by the residents was 9.63, the mean rating for questions 1 to 6 were 9.55, 9.89, 9.21, 9.60, 9.69, and 9.86 respectively, and the range of scores was 7 to 10. CONCLUSION: Overall, residents rated the COP experience highly. This survey indicates that the COP is a valuable supplemental experience in oral and maxillofacial surgery resident education.

Orthognathic Surgery of the Mandible.

Orthognathic surgery performed in conjunction with orthodontic treatment is commonly performed to correct skeletal irregularities and realign the maxillomandibular relationship to improve occlusal function and facial esthetics. A thorough understanding of soft tissue esthetics, skeletal and occlusal relationships, and surgical techniques is required to obtain successful results. Surgical techniques have evolved greatly throughout history, as technological advances such as virtual surgical planning have become available and widely used to obtain predictable movements with minimized complications. The aim of this article is to review the orthognathic surgical procedures of the mandible, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.

The Use of Allogeneic Cartilage for Grafting in Functional and Reconstructive Rhinoplasty.

PURPOSE: Allogeneic cartilage grafting has multiple uses in rhinoplasty. Autogenous cartilage is frequently used in cases of nasal obstruction or reconstruction, but harvesting grafts can cause complications or might be contraindicated. Rhinoplasties on the patient with a cleft might require costochondral grafts. Allogeneic rib is an effective and safe alternative to autogenous grafts, prevents complications, and obviates postoperative admission after rib harvest. MATERIALS AND METHODS: Patients who had allogeneic cartilage placed during functional or reconstructive rhinoplasty were studied from 2 institutions, including 19 who had functional rhinoplasty using allogeneic Cartiform patellar cartilage grafts and 15 patients who underwent reconstructive cleft rhinoplasty with allogeneic rib cartilage. Postoperative follow-up was at least 6 months, and graft handling characteristics and improvement in breathing were assessed. Internal and external nasal valve (INV and ENV, respectively) patencies were evaluated in patients who received the Cartiform grafts, and cosmetic outcomes were rated for patients with reconstructed clefts. RESULTS: The average age of patients who underwent functional rhinoplasty was 57.3 years, and all were men with compromised nasal breathing. Cartiform cartilage was used to repair INV or ENV collapse. Postoperatively, all patients had patent INVs and ENVs and reported improved nasal breathing. Patients who received the rib allograft had an average age of 18 years and 40% were male; all had severe nasal deformities secondary to cleft or craniofacial conditions. Patients rated their preoperative nasal breathing as 4 of 10 on average and cosmetic appearance as 3 of 10; postoperatively, these were rated as 9 of 10. Complications were not noted, except for 1 superficial infection (unrelated to the graft) and 1 hypertrophic scar. There were no postoperative admissions. The mechanical and handling properties of the Cartiform and allogeneic rib were appropriate. CONCLUSION: Allogeneic cartilage is an acceptable alternative to autologous cartilage in functional and reconstructive rhinoplasty.

Necrotizing fasciitis of the scalp stemming from odontogenic infection.

Necrotizing fasciitis is a severe, rapidly progressive infectious process characterized by rapid spread and extensive tissue destruction. This condition stems from a variety of sources, may affect any area of the body, and requires rapid diagnosis and aggressive intervention. We present a rare case of odontogenic infection progressing to acute cervicofacial necrotizing fasciitis of the scalp and neck.

Fatal deep neck infection and respiratory arrest.

Despite the wide availability of antibiotics and medical care, deep neck infections requiring hospitalization are associated with significant morbidity and mortality. Thus, early recognition and aggressive treatment are key in preventing unfavorable outcomes. We present the case of a patient who rapidly progressed from nonspecific upper respiratory symptoms to obstructive airway loss and death due to a swiftly worsening deep neck infection.

Problems and complications of full-face carbon dioxide laser resurfacing for pathological lesions of the skin.

OBJECTIVE: Facial resurfacing with a CO2 laser has been used for treatment of pathologic lesions and for cosmetic purposes. Postoperative complications and problems after laser resurfacing include infections, acneiform lesions, and pigment changes. This retrospective study describes the most common problems and complications in 105 patients and assesses postoperative pain in 38 patients. STUDY DESIGN: All patients received CO2 laser resurfacing for treatment of malignant/premalignant lesions and had postoperative follow-up to assess problems and complications. Some had follow-up to assess postoperative pain. All patients had Fitzpatrick I-III skin types and underwent the same perioperative care regimen. RESULTS: There were 11 problems and 2 complications. Problems included infection, acneiform lesion/milia, and uncontrolled postoperative pain. Complications included hyperpigmentation. Among the postoperative pain group, 53% reported no pain and the rest had mild or moderate pain. CONCLUSION: Complications are rare. Infection and acneiform lesions/milia were the most common problems, as previously reported. Most patients do not experience postoperative pain.