Department of Oral & Maxillofacial Plastic Surgery, University hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
Clin Oral Investig. 2019 Jul;23(7):2921-2927. doi: 10.1007/s00784-018-02796-7. Epub 2019 Jan 8.
Aim of this study was to investigate conditions and predisposing factors for head and neck infection progress regarding the length of stay (LOS) in hospital, with special emphasis on the time of removal of the odontogenic infection focus.
A 3-year retrospective study reviewed hospital records of 248 subjects who were treated under inpatient conditions with severe odontogenic infections who received surgical incisions, drainage, and intravenous (IV) antibiotics. Outcomes measured included age, gender, involved fascial spaces, LOS, number of infected spaces, antibiotics administered, and comorbidities. We precisely recorded the time between abscess incision and focus extraction.
Removal of infection focus (tooth) in the same stay (1 stay, n = 106; group 1; mean 6.5 days ± 3) showed significantly higher (p = 0.042) LOS than extraction in a second stay (2 stays, n = 46; group 2; 5.3 ± 3.1). Group 3 patients showed infection after removal of teeth in outpatient management (1 stay ex-op, n = 96) and presented significantly lower LOS (5.6 ± 2.5) compared to group 1 (p = 0.0216). LOS of group 3 to group 2 patients showed no significance (p = 0.668). Infection expansion and diabetes showed a significant increase of LOS.
Simultaneous removal of infection focus and abscess incision leads to the lowest LOS. If tooth extraction is performed after incision, subsequent focus extraction performed in a second stay shows lower overall-LOS than extraction at the same stay at later stage.
Multiple factors tend to increase the LOS of patients with severe head and neck infections of odontogenic origin. Our data reveals the role of removal of odontogenic focus and additionally ranks further parameters that influence the LOS. Based on our findings, decisions regarding the surgical treatment can be recommended.
本研究旨在探讨头颈部感染进展的条件和诱发因素与住院时间（LOS）的关系，特别强调去除牙源性感染灶的时间。
对 248 例因严重牙源性感染而接受住院手术切开、引流和静脉（IV）抗生素治疗的患者进行了一项为期 3 年的回顾性研究。观察指标包括年龄、性别、受累筋膜间隙、住院时间、感染间隙数、使用的抗生素种类和合并症。我们精确记录了脓肿切开与病灶切除之间的时间。
同一住院期间（1 次住院，n=106；第 1 组；平均 6.5±3 天）切除感染灶（牙齿）的 LOS 明显高于第 2 次住院（2 次住院，n=46；第 2 组；5.3±3.1）（p=0.042）。第 3 组患者在门诊管理中拔牙后出现感染（1 次门诊治疗，n=96），与第 1 组相比，LOS 明显降低（5.6±2.5）（p=0.0216）。第 3 组与第 2 组患者的 LOS 无显著差异（p=0.668）。感染扩散和糖尿病使 LOS 显著增加。
同时切除感染灶和脓肿切开可获得最短的 LOS。如果在切开后拔牙，后续在第二阶段进行的病灶切除比在同一阶段晚期切除的总 LOS 更低。
多种因素往往会增加牙源性头颈部严重感染患者的 LOS。我们的数据揭示了去除牙源性病灶的作用，并对影响 LOS 的其他参数进行了排序。根据我们的发现，可以推荐针对手术治疗的决策。
