The role of immediate versus secondary removal of the odontogenic focus in treatment of deep head and neck space infections. A retrospective analysis of 248 patients

  • Nils HeimEmail author
  • Felix Benjamin Warwas
  • Valentin Wiedemeyer
  • Christian Timm Wilms
  • Rudolf H. Reich
  • Markus Martini
Original Article



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.

Material and methods

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.

Clinical relevance

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.


Odontogenic abscess Head and neck infection Length of stay in hospital LOS 


Compliance with ethical standards

Conflict of interest

The authors declare that they no conflict of interest.

Ethical approval

This article is a retrospective analyses and does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Nils Heim
    • 1
    Email author
  • Felix Benjamin Warwas
    • 1
  • Valentin Wiedemeyer
    • 1
  • Christian Timm Wilms
    • 1
  • Rudolf H. Reich
    • 1
  • Markus Martini
    • 1
  1. 1.Department of Oral & Maxillofacial Plastic SurgeryUniversity hospital BonnBonnGermany

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