Advertisement

Oral and Maxillofacial Surgery

, Volume 18, Issue 2, pp 201–206 | Cite as

Patterns of cervicofacial infections: analysis of the use of computed tomography

  • Sunil Dutt Sharma
  • Sri Mahalingam
  • Leandros Vassiliou
  • Stephen Connor
  • Kathleen Fan
Original Article

Abstract

Objective

The aim of this study was to determine which clinical, microbiological and radiological factors contribute to the need for repeated computed tomography (CT) imaging and surgical drainage.

Methods

In this retrospective study, medical records of all patients who underwent surgical drainage of cervicofacial infections between January 2006 and August 2010 at a London tertiary referral centre were analysed. Patients who underwent CT due to a clinical suspicion of deep cervicofacial infection were divided into two groups: (1) single CT only and (2) repeated CT imaging. These groups were then compared using Fisher’s exact test. Patients requiring return to theatre for additional exploration and drainage of collection were also analysed.

Results

Four hundred and forty-five patients were admitted with cervicofacial infections, of whom 78 patients had a CT scan. The most frequent site of infection was the submandibular space, involving 54 % of patients. Among the patients who underwent repeated imaging compared to those who underwent a single CT scan, the parapharyngeal space was involved significantly more frequently (5/24 vs 2/54, p = 0.03), as was the presence of multiple-space infections (13/24 vs 15/54, p = 0.04) and osteomyelitis (4/24 vs 0/54, p = 0.007). Multiple-space infection was also more frequent in the group who required repeat visits to theatre as compared to those who had a single drainage (7/9 vs 23/69, p = 0.02).

Conclusions

The majority of cervicofacial infections are managed without the need for CT scanning. Presence of infection in multiple cervicofacial spaces and in the parapharyngeal space and presence of osteomyelitis result in persistent sepsis necessitating repeat imaging and drainage.

Keywords

Cervicofacial infections Computed tomography Imaging Neck abscesses 

Notes

Acknowledgments

The authors are gratefully thankful to Taija Nicoli for her technical help.

Conflict of interest

There are no conflicts of interest.

References

  1. 1.
    Carter L, Starr D (2006) Alarming increase in dental sepsis. Br Dent J 200:11CrossRefGoogle Scholar
  2. 2.
    Cousin GCS, Alam P, Alcock J, Palmer DP (2006) Dying to get to the dentist: fatal oro-facial infections. Br J Oral Maxillofac Surg 44:432Google Scholar
  3. 3.
    Thomas SJ, Atkinson C, Hughes C, Revington P, Ness AR (2008) Is there an epidemic of admissions for surgical treatment of dental abscesses in the UK? BMJ 336:1219–1220PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Carter LM, Layton S (2009) Cervicofacial infection of dental origin presenting to maxillofacial surgery units in the United Kingdom: a national audit. Br Dent J 206(2):73–78PubMedCrossRefGoogle Scholar
  5. 5.
    Lindner HH (1986) The anatomy of the fasciae of the face and neck with particular reference to the spread and treatment of intraoral infections (Ludwig’s) that have progressed into adjacent fascial spaces. Ann Surg 204(6):705–714PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    McClay JE, Murray AD, Booth T (2003) Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg 129(11):1207–1212PubMedCrossRefGoogle Scholar
  7. 7.
    Karnath B, Siddiqi A (2002) Acute mediastinal widening. South Med J 95(10):1222–1225PubMedCrossRefGoogle Scholar
  8. 8.
    Crespo AN, Chone CT, Fonesca AS, Montenegro MC, Pereira R, Milani JA (2004) Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection. Sao Paulo Med J 122(6):259–263PubMedCrossRefGoogle Scholar
  9. 9.
    Lee JK, Kim HD, Lim SC (2007) Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J 48(1):55–62PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    GraphPad Software, Inc (2013) http://www.graphpad.com/quickcalcs/contingency1.cfm. Accessed 17 Apr 2011
  11. 11.
    Adekeye EO, Adekeye JO (1982) The pathogenesis and microbiology of idiopathic cervicofacial abscesses. J Oral Maxillofac Surg 40(2):100–106PubMedCrossRefGoogle Scholar
  12. 12.
    Osborn TM, Assael LA, Bell RB (2008) Deep space neck infection: principles of surgical management. Oral Maxillofac Surg Clin North Am 20(3):353–365PubMedCrossRefGoogle Scholar
  13. 13.
    Köndell PA, Granström M, Heimdahl A, Möllby R, Nord CE (1986) Experimental mandibular Staphylococcus aureus osteomyelitis; antibody response and treatment with dicloxacillin. Int J Oral Maxillofac Surg 15(5):620–628PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sunil Dutt Sharma
    • 1
  • Sri Mahalingam
    • 1
  • Leandros Vassiliou
    • 1
  • Stephen Connor
    • 2
  • Kathleen Fan
    • 1
  1. 1.Department of Oral and Maxillofacial SurgeryKing’s College HospitalLondonUK
  2. 2.Department of NeuroradiologyKing’s College HospitalLondonUK

Personalised recommendations