Emergency Treatment of Severe Odontogenic Infection Extending to the Four Maxillofacial Spaces: Case Report

Abstract

Severe odontogenic infection involving multiple maxillofacial spaces can lead to complications and even life-threatening. Immediate treatment is needed, mainly to prevent airway obstruction and sepsis. This case report aims to describe and discuss the immediate treatment of a severe odontogenic infection that extends to the submandibular, submental, buccal, and parapharyngeal spaces. Case report: A 52-year-old male patient came to the Emergency Department (IGD) Hasan Sadikin Hospital, Bandung, with complaints of swelling in the lower jaw and right neck, painful swallowing, and difficulty opening the mouth wide preceded by a history of toothache. Extraoral; facial asymmetry, right submandibular swelling, right cheek, neck, and chest, redness, warm, localized, fluctuating, and painful palpation. Intraoral; trismus generalized hyperemia of the gums, pulp necrosis of tooth 46, and impacted tooth 48. Routine blood laboratory count of leukocytes 18,280 mm3 and platelets 510,000 mm3. Neck Soft Tissue AP-Lat radiograph shows soft tissue swelling in the right submandibular with multiple air density radiolucency in it, suggesting an abscess. The patient's diagnosis was a right odontogenic submandibular abscess that extended to the right submental, buccal, parapharyngeal, and clavicle. Immediate management includes fluid regulation, administration of antibiotics, analgesics, and incision drainage. Conclusion: In this case of severe odontogenic infection, the patient was saved by prompt treatment of a pus drainage incision to prevent the expansion of infection and airway obstruction.