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Management of complex multi-space odontogenic infections
Terrance A Bratton1, D Carl Jackson, Tania Nkungula-Howlett
1Metropolitan Nashville General Hospital, USA.
The Journal of the Tennessee Dental Association
|February 8, 2003
Summary
Effective management of multi-space orofacial odontogenic infections requires identifying the source, understanding microbial progression, and employing appropriate imaging and antibiotic strategies. Early intervention with drainage and source removal is crucial for restoring function and preventing recurrence.
Area of Science:
- Oral and Maxillofacial Surgery
- Infectious Diseases
- Radiology
Background:
- Multi-space orofacial odontogenic infections stem from dental issues like pericoronitis or carious teeth, frequently involving third molars.
- Successful management hinges on identifying infection sources, anatomical spaces, microbial patterns, and host defense impacts.
Observation:
- Diagnostic imaging, including periapical/panoramic X-rays, MRI, and CT scans, is vital for assessing soft tissue involvement, fluid collections, and airway patency.
- Early infections (≤3 days) involve aerobic streptococci sensitive to penicillin, while later infections (>3 days) feature penicillin-resistant anaerobes.
Findings:
- Antibiotic therapy should target identified microorganisms; amoxicillin with clavulanic acid broadens coverage, while clindamycin or penicillin with metronidazole are alternatives for late infections.
- The core management strategy includes bacterial culture, prompt incision and drainage, and etiological source removal, often via an extraoral approach for multi-space infections.
Implications:
- Hospitalization and expert care are recommended for patients with multi-space infections, focusing on airway management, parenteral antibiotics, and surgical complication control.
- Restoring form and function while minimizing disability and preventing recurrence are the primary therapeutic goals.