Should preoperative computed tomography be routine examination for cervicofacial space infections?

Abstract

Background Cervicofacial space infections are potentially life-threatening, which require accurate diagnosis, early incision, and adequate drainage. The utilization of computed tomography (CT) in cervicofacial space infections has significantly increased for its advantages in the evaluation of abscesses, its availability, and low cost. However, the clinical value of preoperative CT imaging in cervicofacial space infections remains controversial for its poor specificity, radiation exposure, potential complications, and extra cost. We, therefore, investigated whether CT examination should be used as a routine examination in the treatment of patients with cervicofacial space infections. Methods A retrospective study of all patients affected by cervicofacial space infections that received incision and drainage surgery from Jan 2016 to Dec 2020 was performed at West China Hospital of Stomatology at Sichuan University. Patients were divided into two groups: the group with preoperative CT and without preoperative CT. Outcomes, including reoperation rate, missed diagnosis rate, days of symptom relief, length of stay, duration of surgery, and total cost of hospitalization, were analyzed. Results Out of n = 153 patients, 108 patients underwent surgery with preoperative CT and 45 patients without preoperative CT. The reoperation rate in the preoperative CT group (6/108, 5.6%) was significantly lower (P = 0.00) than that in the group without preoperative CT (10/45, 22.2%). Significant reduction of missed diagnosis rate (P = 0.00), days of symptom relief (P = 0.01), length of stay(P = 0.03), and duration of surgery (P = 0.01) were detected in the preoperative CT group. The results demonstrated that the utilization of preoperative CT can reduce the missed diagnosis rate and repeated surgery complications. Conclusions We recommend preoperative CT as a routine examination in cervicofacial space infections.

Orofacial fascial space abscess disguised as temporomandibular disorder: a report of 3 cases and literature review

“…However, facial swelling or fever alone represents a non-specific symptom and cannot solely serve as a clear basis for diagnosing a fascial space abscess. Some fascial space abscesses can exist without evident facial swelling, and various diseases within the orofacial area, such as giant cell arteritis or autoimmune disorders like systemic lupus erythematosus, can mimic the symptoms of a fascial space abscess [ 28 , 29 ]. From this perspective, clinical symptoms to suspect fascial space abscess should be severe mouth opening limitation, considering that limited mouth opening was observed in all 24 cases of fascial space abscess.…”