Presence of Air in Odontogenic Infections: Implications and Outcomes

With early surgical intervention and targeted antibiotics, most head and neck odontogenic infections resolve with low morbidity and mortality. However, these infections can be life-threatening due to airway obstruction, necrotizing fasciitis, mediastinitis, cerebral abscess, and sepsis among other severe complications.

The study purpose was to measure the association of gas within an odontogenic infection on computed tomography (CT) with patient outcomes.

A retrospective cohort study of patients at the University of Illinois Health Hospital Emergency Department, with confirmed odontogenic abscesses, from 2005 to 2024. Those included required incision and drainage (I&D) in the operating room. Subjects were excluded for incomplete records, if they had already undergone I&D elsewhere, or if they were diagnosed with necrotizing fasciitis.

The predictor variable was radiographic evidence of gas on CT, coded as present or absent.

The main outcome variable was patient outcome measured as total length of hospital stay, in days, after initial index I&D procedure. Secondary outcome variables were need for intensive care unit (ICU) admission, need for secondary I&D procedures, need for intubation, and duration of intubation.

The covariates were age, sex, alcohol use, tobacco use, uninsured proportion, admission white blood cell count, American Society of Anesthesiologists status, and diabetes status.

The data were analyzed using the χ² test, t-test, and regression analysis, with statistical significance set at P < .05.

The sample included 321 subjects with a mean age of 41.1 ± 18.6 (range 6 to 89) and 176 (54.8%) were males. Of the 321 subjects, 86 (26.8%) had gas on CT imaging. The mean length of hospital stay was higher in the gas cohort, 5.9 ± 7.8 days compared to 3.3 ± 3.1 days (P = .003). There was a higher rate of ICU admission, with 16.3% of the gas cohort admitted compared to 10.2% (P = .135). The need for multiple I&D procedures was higher in the gas cohort, 16.3% compared to 8.1% (P = .033). After adjusting for insurance status and admission white blood cell count, ICU admission and the need for secondary I&D procedures were statistically associated with hospital length of stay (P ≤ .01).

Presence of gas within an odontogenic infection on CT imaging correlates to increased severity based on length of stay and the need for multiple I&D procedures. Gas within an infection should be recognized as a negative prognostic clinical sign and when present it needs to be suspected that these patients could have rapidly progressing severe odontogenic infections.