Akinbami Babatunde Olayemi, Akadiri Oladimeji, Gbujie Daniel C
Department of Oral and Maxillofacial Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
J Oral Maxillofac Surg. 2010 Oct;68(10):2472-7. doi: 10.1016/j.joms.2010.01.019. Epub 2010 Jul 15.
Odontogenic infections constitute a substantial portion of diseases encountered by oral and maxillofacial surgeons. Infections start from dental tissues and sometimes rapidly spread to contiguous spaces. The consequence is a fulminant disease with significant morbidity and mortality. The study was aimed at studying the pattern of spread, approach to management, and outcome of these infections at a Nigerian teaching hospital.
A retrospective study of all patients with orofacial infections who presented to our center over an 18-month period was carried out. The medical records were reviewed to retrieve the following: age, gender, source of infection, anatomic fascial spaces involved, associated medical conditions, various treatment modalities, types of antibiotics administered, causative micro-organisms, length of stay in the hospital, and any complications encountered. Infections were classified into 2 categories: those that are confined to the dentoalveolar tissues belong to category I, and those that have spread into the local/regional soft tissue spaces and beyond belong to category II.
Odontogenic infections constituted 11.3% of the total oral and maxillofacial surgery cases. A total of 261 patients were treated for odontogenic infections. There were 146 female patients (59.8%) and 98 male patients (40.2%) in the first category, whereas the second category comprised 10 male patients (58.8%) and 7 female patients (41.2%). The fascial spaces involved, in descending order, were submasseteric in 10 (22.7%), submandibular in 9 (20.5%), and sublingual in 6 (13.6%). The causative micro-organisms commonly found were Klebsiella and Streptococcus spp. Incision and drainage were performed in the 17 cases with spreading infection. Amoxicillin, amoxicillin/clavulanate, and metronidazole were the most routinely administered antibiotics.
Our experience shows that delay in presentation, self-medication, aging, male gender, and unusual causative agents are some of the factors associated with spread. Therefore efforts must be made to further improve public dental awareness.
牙源性感染在口腔颌面外科医生所诊治的疾病中占相当大的比例。感染始于牙齿组织，有时会迅速蔓延至相邻间隙。其后果是一种具有显著发病率和死亡率的暴发性疾病。本研究旨在探讨尼日利亚一家教学医院中这些感染的传播模式、治疗方法及治疗结果。
对18个月内到我院就诊的所有口面部感染患者进行回顾性研究。查阅病历以获取以下信息：年龄、性别、感染源、累及的解剖筋膜间隙、相关的内科疾病、各种治疗方式、使用的抗生素类型、致病微生物、住院时间以及所遇到的任何并发症。感染分为两类：局限于牙槽骨组织的属于I类，蔓延至局部/区域软组织间隙及其他部位的属于II类。
牙源性感染占口腔颌面外科手术病例总数的11.3%。共有261例患者接受牙源性感染治疗。I类中有146例女性患者（59.8%）和98例男性患者（40.2%），而II类中有10例男性患者（58.8%）和7例女性患者（41.2%）。累及的筋膜间隙按发生率从高到低依次为：咬肌下间隙10例（22.7%）、下颌下间隙9例（20.5%）、舌下间隙6例（13.6%）。常见的致病微生物为克雷伯菌属和链球菌属。17例感染扩散的患者进行了切开引流。阿莫西林、阿莫西林/克拉维酸和甲硝唑是最常使用的抗生素。
我们的经验表明，就诊延迟、自行用药、年龄、男性以及不常见的致病因素是与感染扩散相关的一些因素。因此，必须努力进一步提高公众的口腔卫生意识。
