Skip to main content
SpringerLink
Log in

Usefulness of preoperative computed tomography findings for airway management in patients with acute odontogenic infection: a retrospective study

  • Original Article
  • Published:
Odontology Aims and scope Submit manuscript

Abstract

Odontogenic infection is more likely to affect the airway and interfere with intubation than non-odontogenic causes. Although anesthesiologists predict the difficulty of intubation and determine the method, they may encounter unexpected cases of difficult intubation. An inappropriate intubation can cause airway obstruction due to bleeding and edema by damaging the pharynx and larynx. This study was performed to determine the most important imaging findings indicating preoperative selection of an appropriate intubation method. This retrospective study included 113 patients who underwent anti-inflammatory treatment for odontogenic infection. The patients were divided into two groups according to the intubation method: a Macintosh laryngoscope (45 patients) and others (video laryngoscope and fiberscope) (68 patients). The extent of inflammation in each causative tooth, the severity of inflammation (S1–4), and their influence on the airway were evaluated by computed tomography. The causative teeth were mandibular molars in more than 90%. As the severity of inflammation increased, anesthesiologists tended to choose intubation methods other than Macintosh laryngoscopy. In the most severe cases (S4), anesthesiologists significantly preferred other intubation methods (33 cases) over Macintosh laryngoscopy (9 cases). All patients with S4 showed inflammation in the parapharyngeal space, and the airway was affected in 41 patients. The mandibular molars were the causative teeth most likely to affect the airway and surrounding region. In addition to clinical findings, the presence or absence of inflammation that has spread to the parapharyngeal space on preoperative computed tomography was considered an important indicator of the difficulty of intubation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Velhonoja J, Lääveri M, Soukka T, Irjala H, Kinnunen I. Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol. 2020;277:863–72. https://doi.org/10.1007/s00405-019-05742-9.

    Article  PubMed  Google Scholar 

  2. Tapiovaara L, Bäck L, Aro K. Comparison of intubation and tracheotomy in patients with deep neck infection. Eur Arch Otorhinolaryngol. 2017;274:3767–72. https://doi.org/10.1007/s00405-017-4694-5.

    Article  PubMed  Google Scholar 

  3. Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N. Deep neck infections: a retrospective review of 112 cases. Eur Arch Otorhinolaryngol. 2009;266:273–7. https://doi.org/10.1007/s00405-008-0734-5.

    Article  PubMed  Google Scholar 

  4. Qu L, Xu H, Liang X, Cai X, Zhang W, Qian W. A retrospective cohort study of risk factors for descending necrotizing mediastinitis caused by multispace infection in the maxillofacial region. J Oral Maxillofac Surg. 2020;78:386–93. https://doi.org/10.1016/j.joms.2019.11.017.

    Article  PubMed  Google Scholar 

  5. Wabik A, Hendrich BK, Nienartowicz J, Guziński M, Sąsiadek MJ. Odontogenic inflammatory processes of head and neck in computed tomography examinations. Pol J Radiol. 2014;79:431–8. https://doi.org/10.12659/PJR.890808.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Flynn TR, Shanti RM, Levi MH, Adamo AK, Kraut RA, Tringer N. Severe odontogenic infections, part 1: prospective report. J Oral Maxillofac Surg. 2006;64:1093–103. https://doi.org/10.1016/j.joms.2006.03.015.

    Article  PubMed  Google Scholar 

  7. Orrett OE. Odontogenic infections. Dent Clin N Am. 2017;61:235–52. https://doi.org/10.1016/j.cden.2016.11.004.

    Article  Google Scholar 

  8. Haug RH, Hoffman MJ, Indresano AT. An epidemiologic and anatomic survey of odontogenic infection. J Oral Maxillofac Surg. 1991;49:976–80. https://doi.org/10.1016/0278-2391(91)90063-R.

    Article  PubMed  Google Scholar 

  9. Yonetsu K, Izumi M, Nakamura T. Deep facial infections of odontogenic origin: CT assessment of pathways of space involvement. AJNR Am J Neuroradiol. 1998;19:123–8.

    PubMed  PubMed Central  Google Scholar 

  10. Kim HJ, Park ED, Kim JH, Kim JH, Hwang EG, Chung SH. Odontogenic versus nonodontogenic deep neck space infections: CT manifestations. J Korean Radiol Soc. 1995;33:853–60. https://doi.org/10.3348/jkrs.1995.33.6.853.

    Article  Google Scholar 

  11. Gholami M, Mohammadi H, Amiri N, Khalife H. Key factors of odontogenic infections requiring hospitalization: a retrospective study of 102 cases. J Oral Maxillofac Surg Med Pathol. 2017;29:395–9. https://doi.org/10.1016/j.ajoms.2017.03.016.

    Article  Google Scholar 

  12. Uluibau IC, Januay T, Goss AN. Severe odontogenic infections. Aust Dent J. 2005;50(4 Suppl 2):S74-81. https://doi.org/10.1111/j.1834-7819.2005.tb00390.x.

    Article  PubMed  Google Scholar 

  13. Cho SY, Woo JH, Kim YJ, Chun EH, Han JI, Kim DY, Baik HJ, Chang RK. Airway management in patients with deep neck infections: a retrospective analysis. Medicine (Baltimore). 2016;95:e4125. https://doi.org/10.1097/MD.0000000000004125.

    Article  PubMed  Google Scholar 

  14. Karkos PD, Leong SC, Beer H, Apostolodou MT, Pararese A. Challenging airways in deep neck space infections. Am J Otolaryngol. 2007;28:415–8. https://doi.org/10.1016/j.amjoto.2006.10.012.

    Article  PubMed  Google Scholar 

  15. Tom MB, Rice DH. Presentation and management of neck abscess: a retrospective analysis. Laryngoscope. 1988;98:877–80. https://doi.org/10.1288/00005537-198808000-00017.

    Article  PubMed  Google Scholar 

  16. Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngo scopes in the adult airway management: a topical review of the literature. Acta Anaesthesiol Scand. 2010;54:1050–61. https://doi.org/10.1111/j.1399-6576.2010.02285.x.

    Article  PubMed  Google Scholar 

  17. Taub D, Yampolsky A, Diecidue R, Gold L. Controversies in the management of oral and maxillofacial infections. Oral maxillofac Surg Clin N Am. 2017;29:465–73. https://doi.org/10.1016/j.coms.2017.06.004.

    Article  Google Scholar 

  18. Potter JK, Herford AS, Ellis E 3rd. Tracfeotomy versus endotracheal intubation for airway management in deep neck space infections. J Oral Maxillofac Surg. 2002;60:349–54. https://doi.org/10.1053/joms.2002.31218.

    Article  PubMed  Google Scholar 

  19. Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103:33–9. https://doi.org/10.1097/00000542-200507000-00009.

    Article  PubMed  Google Scholar 

  20. Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: results of the fourth national audit project of the royal college of anaesthetists and the difficult airway society. Part 1: anaesthesia. Br J Anaesth. 2011;106:617–31. https://doi.org/10.1093/bja/aer058.

    Article  PubMed  Google Scholar 

  21. Berkow L, Ariyo P. Preoperative assessment of the airway. Trends Anaesth Crit Care. 2015;5:28–35. https://doi.org/10.1016/j.tacc.2014.11.003.

    Article  Google Scholar 

  22. Dowdy RAE, Emam HA, Conelius BW. Ludwig’s agina: anesthetic magement. Anesth Prog. 2019;66:103–10. https://doi.org/10.2344/anpr-66-01-13.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yildiz TS, Korkmaz F, Solak M, Toker K, Erciyes N, Bayrak F, Ganidagli S, Takin M, Kizilkaya M, Karsli B, Turan A, Ozcan U. Prediction of difficult tracheal intubation in Turkish patients: a multi-center methodological study. Eur J Anaesthesiol. 2007;24:1034–40. https://doi.org/10.1017/S026502150700052X.

    Article  PubMed  Google Scholar 

  24. Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188064 patients registerered in the Danish anaesthesia database. Anaesthesia. 2015;70:244–9. https://doi.org/10.1111/anae.12955.

    Article  Google Scholar 

  25. Cook TM, Woodall N, Harper J, Benger J, Fourth National Audit Project. Major complications of airway management in the UK: results of the fourth national audit project of the royal college of anaesthetists and the difficult airway society. Part 2: anaesthesia. Br J Anaesth. 2011;106:632–42. https://doi.org/10.1093/bja/aer059.

    Article  PubMed  Google Scholar 

  26. Ohshima A, Ariji Y, Goto M, Izumi M, Naitoh M, Kurita K, Shimozato K, Ariji E. Anatomical considerations for the spread of odontogenic infection originating from the pericoronitis of impacted mandibular third molar: computed tomographic analyses. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2004;98:589–97. https://doi.org/10.1016/j.tripleo.2004.07.012.

    Article  Google Scholar 

  27. Ariji Y, Gotoh M, Kimura Y, Naitoh M, Kurita K, Natsume N, Ariji E. Odontogenic infection pathway to the submandibiular space: imaging assessment. Int J Oral Maxillofac Surg. 2002;31:165–9. https://doi.org/10.1054/ijom.2001.0190.

    Article  PubMed  Google Scholar 

  28. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  PubMed  Google Scholar 

  29. Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threateining deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003;24:111–7. https://doi.org/10.1053/ajot.2003.31.

    Article  PubMed  Google Scholar 

  30. Hansen BW, Ryndin S, Mullen KM. Infections of deep neck spaces. Semin Ultrasound CT MR. 2020;41:74–84. https://doi.org/10.1053/j.sult.2019.10.001.

    Article  PubMed  Google Scholar 

  31. Wang B, Gao BL, Xu GP, Xiang C. Images of deep neck space infection and the clinical significance. Acta Radiol. 2014;55:945–51. https://doi.org/10.1177/0284185113509093.

    Article  PubMed  Google Scholar 

  32. Boeddinghaus R, Whyte A. Current concepts in maxillofacial imaging. Eur J Radiol. 2008;66:396–418. https://doi.org/10.1016/j.ejrad.2007.11.019.

    Article  PubMed  Google Scholar 

  33. Santos Gorjón P, Blanco Pérez P, Morales Martín AC, Pozo D, de Dios JC, Estévez Alonso S, de Callela Cabanillas MI. Deep neck infections. Review of 286 cases. Acta Otorrinolaringol Esp. 2012;63:31–41. https://doi.org/10.1016/j.otoeng.2012.01.006.

    Article  PubMed  Google Scholar 

  34. Craig FW, Schunk JE. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and recurrent management. Pediatrics. 2003;111:1394–8. https://doi.org/10.1542/peds.111.6.1394.

    Article  PubMed  Google Scholar 

  35. Sakaguchi M, Sato S, Asawa S, Taguchi K. Computerized tomographic findings in peritonsillar abscess and cellulitis. J Laryngol Otol. 1995;109:449–51. https://doi.org/10.1017/s0022215100130415.

    Article  PubMed  Google Scholar 

  36. Storoe W, Haug RH, Lillich TT. The changing face of odontogenic infections. J Oral Maxillofac Surg. 2001;59:739–48. https://doi.org/10.1053/joms.2001.24285.

    Article  PubMed  Google Scholar 

  37. Bratton TA, Jackson DC, Nkungula-Howlett T, Williams CW, Bennett CR. Management of complex multi-space odontogenic infections. J Tenn Dent Assoc. 2002;82:39–47.

    PubMed  Google Scholar 

  38. Ohshima A, Ariji Y, Gotoh M, Izumi M, Naitoh M, Kurita K, Shimozato K, Ariji E. Computed tomographic anatomy of the mandibular first and second molars and their surrounding structures in the spread of odontogenic infection. Oral Radiol. 2009;25:99–107. https://doi.org/10.1007/s11282-009-0016-y.

    Article  Google Scholar 

  39. Parker GD, Hansberger HR, Jacobs JM. The pharyngeal mucosal space. Semin Ultrasound CT MR. 1990;11:460–75.

    PubMed  Google Scholar 

  40. Chen SL, Young CK, Tsai TY, Chien HT, Kang CJ, Liao CT, Huang SF. Factors affecting the necessity of tracheostomy in patients with deep neck infection. Diagnostics (Basel). 2021;11:1536. https://doi.org/10.3390/diagnostics11091536.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Peterson LJ. Contemporary management of deep infections of the neck. J Oral Maxillofac Surg. 1993;51:226–31. https://doi.org/10.1016/S0278-2391(10)80162-4.

    Article  PubMed  Google Scholar 

  42. Krishnan V, Johnson JV, Helfrick JF. Management of maxillofacial infections: a review of 50 cases. J Oral Maxillofac Surg. 1993;51:868–74. https://doi.org/10.1016/s0278-2391(10)80105-3.

    Article  PubMed  Google Scholar 

  43. Kiernan PD, Hernandez A, Byrne WD, Bloom R, Dicicco B, Hetrick V, Graling P, Vaughan B. Descending cervical mediastinitis. Ann Thorac Surg. 1998;65:1483–8. https://doi.org/10.1016/s0003-4975(98)00142-8.

    Article  PubMed  Google Scholar 

  44. Britt JC, Josephson GD, Gross CW. Ludwig’s angina in the pediatric population: report of a case and review of the literature. Int J Pediatr Otorhinolaryngol. 2000;52:79–87. https://doi.org/10.1016/s0165-5876(99)00295-5.

    Article  PubMed  Google Scholar 

  45. Japanese Society of Anesthesiologists. JSA airway management guideline 2014: to improve the safety of induction of anesthesia. J Anesth. 2014;28:482–93. https://doi.org/10.1007/s00540-014-1844-4.

    Article  Google Scholar 

  46. Mencke T, Echternach M, Kleinschmids S, Lux P, Barth V, Plinkert PK, Fuchs-Buder T. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology. 2003;98:1049–56. https://doi.org/10.1097/00000542-200305000-00005.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan

    Madoka Nagaura & Taisuke Kawai

  2. Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan

    Madoka Nagaura, Keisuke Saitoh & Taisuke Kawai

  3. Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan

    Gentaro Tsujimoto, Asako Yasuda & Yoshiki Shionoya

  4. Department of Dental Anesthesiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan

    Katsuhisa Sunada

Authors
  1. Madoka Nagaura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keisuke Saitoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gentaro Tsujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Asako Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshiki Shionoya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsuhisa Sunada
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Taisuke Kawai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Madoka Nagaura.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ethical Review Committee of the School of Life Dentistry at Tokyo, Nippon Dental University (NDU-T2020-18). For this type of study formal consent is not required.

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nagaura, M., Saitoh, K., Tsujimoto, G. et al. Usefulness of preoperative computed tomography findings for airway management in patients with acute odontogenic infection: a retrospective study. Odontology 111, 499–510 (2023). https://doi.org/10.1007/s10266-022-00756-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10266-022-00756-y

Keywords

Search

Navigation