The Sepsis Syndrome in Odontogenic Infection

Abstract

Odontogenic infection is a common cause of sepsis in the head and neck. Infection frequently spreads in a predictable pattern within the fascial spaces of the neck and can result in airway compromise. Often the condition results in significant morbidity and a prolonged hospital stay. In this study, we assessed the incidence of sepsis syndrome in patients presenting to a regional maxillofacial unit with odontogenic infection. Six months of prospective data were collected, with sixty-seven patients included. The focus of infection was mandibular in 70.1% and maxillary in 29.9%. The mean length of stay was four days and 61.2% of patients were diagnosed with sepsis syndrome on admission. This group remained in hospital significantly longer than non-sepsis syndrome patients (sepsis=4.7 days, non-sepsis=2.9 days. p=0.0145.) The site of infection was not a significant factor in the development of the systemic inflammatory response syndrome (SIRS).

Clinical features and presentation of cervicofacial infection: a Maxillofacial Trainee Research Collaborative (MTReC) study

“…It is clear that recognition of sepsis parameters in primary care can be a means by which patients are efficiently fast-tracked to the hospital OMFS team as highlighted some years ago. 5 Involvement of more than one neck fascial space was common in this cohort. Multispace involvement was most common (41.7%) when the infection was originating from a mandibular tooth.…”

“…Even less patients had undergone other forms of treatment as shown in This study supports previous observations that CFI occur over a wide age range. 2,5 It is interesting to note that male patients accounted for a higher proportion of admissions than female patients with a ratio of 1.2:1, despite higher levels of caries in female populations. 6 This 20% sex difference requires further investigation of potential underlying factors, aiming to reduce this excess in men.…”

“…This finding lies between the previously quoted range of 16% to 61.2% in retrospective studies and the large sample size and prospective nature of this study further corroborate that a large proportion of patients with cervicofacial (and specifically odontogenic) infection are at risk of developing sepsis. 4,5 Patients with sepsis have added morbidity and typically have longer hospital admissions requiring more critical care 14 . Mortality as a result of cervicofacial sepsis is rare but preventing this clearly has resource and cost implications.…”

“…Sepsis is a recognised complication of odontogenic infection with a wide range of reported prevalence from 16% to 61.2% in retrospective analyses. 4,5 Appropriate triage and timely management require an understanding of the underlying aetiology with identification of key presenting features and markers for sepsis. The literature lacks prospectively collected data around this crucial parameter.…”

A guide to deep neck space fascial infections for the dental team

“…A rate of > 20 breaths per minute is abnormal in an adult. 7 The combination of a high respiratory rate, tachycardia, very high or very low temperature, with a very high or very low white blood cell count is the systemic inflammatory response syndrome (SIRS). Sepsis is defined as the presence of SIRS in addition to a confirmed infective process.…”