Odontogenic-Related Head and Neck Infections: From Abscess to Mediastinitis: Our Experience, Limits, and Perspectives—A 5-Year Survey

Abstract

Background: Head and neck infections are commonly caused by affections with an odontogenic origin. Untreated or non-responsive to treatment odontogenic infections can cause severe consequences such as localized abscesses, deep neck infections (DNI), and mediastinitis, conditions where emergency procedures such as tracheostomy or cervicotomy could be needed. Methods: An epidemiological retrospective observational study was performed, and the objective of the investigation was to present a single-center 5-years retrospective analysis of all patients admitted to the emergency department of the hospital Policlinico Umberto I “Sapienza” with a diagnosis of odontogenic related head and neck infection, observing the epidemiological patterns, the management and the type of surgical procedure adopted to treat the affections. Results: Over a 5-year period, 376,940 patients entered the emergency room of Policlinico Umberto I, “Sapienza” University of Rome, for a total of 63,632 hospitalizations. A total of 6607 patients were registered with a diagnosis of odontogenic abscess (10.38%), 151 of the patients were hospitalized, 116 of them were surgically treated (76.8%), and 6 of them (3.9%) manifested critical conditions such as sepsis and mediastinitis. Conclusions: Even today, despite the improvement of dental health education, dental affections can certainly lead to acute conditions, necessitating immediate surgical intervention.

Etiology and Demographic Distribution of Odontogenic Abscesses in the Maxillofacial Area in Patients Over 18 Years of Age: A Five-Year Retrospective Study

“…The sex demographic distribution of patients with odontogenic abscesses and phlegmons was described and analyzed in 2023 by Pucci et al and according to them, the sex ratio was 54.4% for males and 45.6% for the female population [ 18 ]. According to our present study, the sex ratio of males:females is almost no different from that described by them, 54.18%:45.82%, thus proving that purulent inflammatory diseases of the head and neck of odontogenic origin occur more frequently in males than in females.…”

Sudden Death: A Practical Autopsy Approach to Unexplained Mediastinitis Due to Fatal Untreated Neck Infections—A Systematic Review

“…The primary causes of deep tissue neck infections are odontogenic infections (38.8–49%), and the latter account for89% of cases of severe multi-space infections. Many factors may be connected with the spreading of odontogenic infections: poor oral hygiene, metabolism, inadequate prevention, or antibiotic therapy [ 27 ].…”

A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results

“…The prognostic factors of DNI and descending mediastinitis, such as patient clinical data as well as laboratory findings with regard to outcome, have been discussed differently [4,6]. The concurrent diagnosis of DNI and descending mediastinitis usually requires treatment from a multidisciplinary department containing otorhinolaryngological care, infection control, thoracic surgery, and an intensive care unit for life-sustaining management [47]. In addition to effective antibiotic treatment, respiratory security and timely drainage of the deep neck space and mediastinum are mandatory [48].…”

“…In addition to effective antibiotic treatment, respiratory security and timely drainage of the deep neck space and mediastinum are mandatory [48]. The placement of drainage tubes and appropriate irrigation to prevent the possible formation of recurrent abscesses or the collection of purulent discharge are also necessary [47]. The empirical broad-spectrum antibiotic should be adjusted based on the cultured pathogen reports afterward.…”