MRSA infection of masticatory spaces in a paediatric patient

Diagnosis of source of maxillofacial infection in paediatric patients can be challenging due to difficulty in eliciting a proper history and multiple potential sources of infection. Identification and removal of the nidus of infection with decompression and institution of antibiotic therapy as per the culture-sensitivity report form the mainstay treatment of the infection. Deviation from it may result in persistence or even progression of infection, resulting in significant morbidity and mortality. In the past decade, the incidence of community-acquired methicillin-resistant Staphylococcus aureus infection in the oral cavity has seen an upward trend. This has further led to an increase in complexity in the diagnosis of maxillofacial infections. In this case, the authors want to bring to light the challenges faced in managing a paediatric patient with persistent fascial space infection even after removal of the offending tooth, which signifies the importance of managing the infection by the time-tested protocol.

Clinical utility of procalcitonin in severe odontogenic maxillofacial infection

Background Most of the maxillofacial infections are bacterial infections, and there is a possibility that systemic infections occur by maxillofacial infections. The aim of this study was to investigate the diagnostic value of procalcitonin in patients with odontogenic bacterial infections of the maxillofacial region. Methods We enrolled sixty patients, who were admitted with odontogenic maxillofacial infection from September 2018 to March 2020. White blood cell counts, C-reactive protein, and procalcitonin concentrations were evaluated. Sixty patients were classified into two groups, sepsis and non-sepsis groups, based on systemic inflammatory response syndrome. A Student t test was performed to statistically analyze the difference in inflammatory markers between sepsis and non-sepsis groups. Results The mean procalcitonin values on admission were 7.24 ng/mL (range, 0.09–37.15 ng/mL) and 0.40 ng/mL (range, 0.02–4.94 ng/mL) in the sepsis group and non-sepsis group, respectively. The procalcitonin values between the two groups showed a significant difference (P < 0.05). The area under the curve of procalcitonin was 0.927 (P < 0.001), and the cutoff value of procalcitonin that maximizes the area under the curve was calculated to be 0.87 ng/mL. Conclusions According to our study, routine laboratory tests have insufficient accuracy in diagnosing sepsis syndrome. Therefore, it is strongly recommended to perform the procalcitonin test in patients with maxillofacial infection in addition to the conventional laboratory tests to diagnose the systemic inflammatory condition of the patients.

Tratamento cirúrgico de abscesso odontogênico em nível hospitalar

A infecção odontogênica é um grave problema de saúde pública. O atendimento hospitalar fica basicamente direcionado a atenção aos casos mais graves que requerem tratamento imediato de antibioticoterapia endovenosa bem como remoção urgente da causa. Sendo assim, o objetivo é apresentar um caso de paciente de 43 anos de idade, sexo feminino, queixando-se de dor em região de dente 24 com aumento volumétrico evidente assim como drenagem espontânea de exsudato via sulco gengival. O tratamento após exames complementares de rotina foi a exodontia do elemento dentário sob anestesia local em atenção hospitalar associado a drenagem da coleção purulenta. Após eliminação da causa bem como a drenagem, 48 horas destas a paciente recebeu alta hospitalar com retorno programado. Segue sem queixas e sem outras afecções semelhantes.Descritores: Abscesso Periapical; Cirurgia; Terapêutica.ReferênciasMardini S, Gohel A. Imaging of Odontogenic Infections. Radiol Clin North Am. 2018;56(1):31-44.DeAngelis AF, Barrowman RA, Harrod R, Nastri AL. Review article: Maxillofacial emergencies: oral pain and odontogenic infections. Emerg Med Australas. 2014;26(4):336-42. Vasconcelos BEC, Cauás M, Albert DGM, Nascimento GJF, Holanda GZ. Disseminação de infecção odontogênica através das fáscias cervicais profundas: relato de caso clínico. Rev Cir Traumat Bucomaxilofac. 2002;2(1):21- 25.Ramos S, Ramos RF, Ramos HF, Ramos BF. O Uso da Tomografia Computadorizada no Diagnóstico do Abscesso Peritonsilar Arq Int. Otorrinolaringol/Intl Arch Otorhinolaryngol. 2006;10(1):67-70.Wang J, Ahani A, Pogrel MA. A five-year retrospective study of odontogenic maxillofacial infections in a large urban public hospital. Int J Oral Maxillofac Surg. 2005;34(6):646-49.Manor Y, Garfunkel AA. Brain abscess following dental implant placement via crestal sinus lift - a case report. Eur J Oral Implantol. 2018;11(1):113-17.Lima FGGP, Rios LGC, Cunha LTMQ, Rocha LF, Batista JD. Abordagem clínico-cirúrgica de infecção complexa em região maxilo-facial: relato de caso. Rev Odontol Bras Central. 2018;27(81): 112-16.Jundt JS, Gutta R. Characteristics and cost impact of severe odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5):558-66.

A sticky situation: a case of <i>Actinomyces viscosus</i> vertebral osteomyelitis

Actinomyces viscosus is an oral bacterium that is rarely virulent in humans, with most case presentations involving dental and maxillofacial infections. We describe the first reported case of A. viscosus vertebral osteomyelitis in a patient who had a significant response to penicillin after minimal response to cephalosporin therapy.

Epidemiologic evaluation of maxillofacial infections and their risk factors and associated complications in a one year period in Shariati hospital in 2013-2014

Purpose: Maxillofacial infections (MIs) commonly occur in patients of all ages, representing a life-threatening challenge when reaching deep facial spaces. The epidemiologic studies of MIs and their characteristics are very important and beneficial for both patients and clinicians. Therefore, the aim of this prospective study was to determine the annual incidence, etiology, risk factors and complications of MIs in all patients who were admitted to the department of oral and maxillofacial surgery of the Shariati hospital during a 1-year period. Material and methods: The demographic data, levels of some serum markers on day of admission, such aserythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), bandemia, serum albumin, predisposing factors for each patient referred for treatment of MI were recorded by one researcher in November 2013 to November 2014. The linear regression test was used to evaluate whether there was a relationship between the amount of changes in ESR, CRP and albumin levels and age of the patients, pregnancy, gender and severity of infection. Panoramic radiography as well as axial and coronal CT scans with soft tissue window were performed for all cases, except pregnant participants. The origin of MIs, including odontogenic, pathologic and foreign body, was identified for each patient. Results:During the study period, a total of 157 patients (87 female, 70 male), with an age range of 3 to 74 years (mean, 23.5±13.2 years), were admitted to the department of maxillofacial surgery. Regardless of the gender, the most frequent cause of MIs was odontogenic sources (128 cases, 81.5%). The most common affected area was the buccal space with 106 positive cases (67.5%). The most common teeth responsible for maxillofacial fascial space infection were mandibular third molars. A positive association was found between CRP and ESR levels and the severity of infections. Serum albumin and ESR levels were significantly reduced and increased in the patients with severe infection and pregnant patients, respectively. Conclusion: The results of this study indicated that odontogenic origins were the main cause of MIs and the most common involved space was the buccal space. Diabetes mellitus was the most commonly found systemic disease among the participants of this study. The findings of this study suggest that dentists should consider that the most appropriate treatment of odontogenic infections involves surgical intervention and selection of a suitable antibiotic as an adjunct.