Cervicofacial infection in a Nigerian tertiary health institution: a retrospective analysis of 77 cases

Abstract

ObjectivesInfection involving the orbit, zygomatic space, lateral pharyngeal space, or hemifacial and oral floor phlegmon is referred to as cervicofacialvinfection (CFI). When diagnosis and/or adequate treatment are delayed, these infections can be life-threatening. Most cases are the result of odontogenic infections. We highlight our experiences in the management of this life-threatening condition.Materials and MethodsThis was a retrospective study of patients who presented with CFI from December 2005 to June 2012 at the Oral and Maxillofacial Surgery Clinic or the Accident and Emergency Unit of Ahmadu Bello University Teaching Hospital (Zaria, Nigeria). The medical records of all patients who presented with either localized or diffuse infection of the maxillofacial soft tissue spaces were retrospectively collected. Data collected was analyzed using SPSS version 13.0 and are expressed as descriptive and inferential statistics.ResultsOf the 77 patients, 49 patients (63.6%) were males, a male to female ratio of 1:7.5. The ages ranged from two years to 75 years with a mean of 35.0±19.3 years, although most patients were older than 40 years. The duration of symptoms prior to presentation ranged from 6 to 60 days, with a mean of 11.0±9.4 days. More than 90% of the patients presented to the clinic within the first 10 days. The most commonly involved anatomical space was the submandibular space (n=29, 37.7%), followed by hemifacial space (n=22, 28.6%) and buccal space (n=7, 9.1%). Ludwig angina accounted for about 7.8% of the cases.ConclusionCFI most commonly involves the submandibular space, typically affects individuals with a low level of education, and is influenced by traditional medical practices. Despite improved health care delivery, CFI remains a significant problem in developing countries.

Pattern of Odontogenic Fascial Space Infections among a Sample of Sudanese Patients

“…[4] The present findings showed that the most common site was Mandible (85.3%). This was similar to study carried by Fating NS, Osunde OD (43.9%), Dvori S, Marioni G (85.9%), Rao DD, Fomete (37.7%), Alotaibi N (29%), Kamat RD, Lin RH(40.9%), Singh M, Mathew GC, Zhang C(37.5%), Sato FR(81.9), Kinzer S. [3][4][5][6]8,10,12,13,16,18,20,[24][25][26].The most affected side in this study was left side (29%), there was no previous studies that discussed the side of infection.…”

“…This findings agreed with Osunde OD (32.8± 18.3years) [4], disagreed from the findings of Fating NS (30-40) years [3], Igoumenakis [15] and Fomete B. [10] In the present study the disease affect male more than female (56%) which in line with the findings of the studies by Fating NS. [3] and Osunde OD(63.4%).…”

Empyema thoracis of odontogenic origin: experience from a maxillofacial unit

“…Previous reports indicate that thoracic complications of odontogenic infections have no age preference. Nigerian cases [3][4][5] have been young adults; all our five patients were between 21-29 years old. Most cervicofacial infections that descend into the neck and chest are caused by tooth infections, especially dental and periodontal abscesses [2,6].…”

New laboratory predictive tools in deep neck space infections

“…CNF represent only 3.5% 15 of total DNSIs, but they dramatically affect the prognosis of these patients, with a mortality rate of 7-22%, increasing to 41% in case of thoracic involvement and up to 64% if associated with DNM and septic complications 17 . This wide range is probably explained by the fact that early diagnosis requires relevant diagnostic instruments, not always available in poor resource countries, where the prognosis is obviously worse 10 . Hence, it has been stated that prompt diagnosis and surgical treatment within 12 hours 8 , 18 from admission are strongly advisable in order to lower the mortality rate.…”

“…Anaerobic bacteria (Prevotella 4%, Fusobacterium 5%) 7 have been demonstrated to play an important role in the development of cervical necrotising fasciitis (CNF) 7,8 due to the production of specific enzymes involved in the necrotising process 8 . Bacterial cultures can be polymicrobial in 20.8% 5 of cases and negative in 10.74% 6 of patients, probably due to the wide use of prehospitalisation antibiotic therapy or to technical difficulty in isolating anaerobic pathogens 9,10 . Especially when involving para-and retro-pharyngeal spaces, DNSI may extend by continuity and contiguity to the mediastinal and thoracic spaces.…”