Major maxillofacial infections. An evaluation of 107 cases

Abstract

A review of 107 cases of acute maxillofacial infections managed at the Royal Melbourne Hospital was undertaken, and details of the presentations, demography, management, and outcomes of these patients are presented. The results indicated that many of the patients had sought treatment from dentists in general practice, and that a significant proportion had received sub-optimal management prior to referral. Thus a review of the principles of management and guidelines for the referral of patients with maxillofacial infections is also presented.

Severe odontogenic infections

“…In general, these findings were similar to other large Australian series in which 56 pulpal or pericoronal causes were treated in 57 months. 5 Comparison of the two studies, which were performed a decade apart, supports the anecdotal view that severe odontogenic infections are on the increase. The inclusion criteria were similar but the Melbourne series had 56 as compared to 48 cases gathered from a much larger population of 3.5 million (Melbourne) to 1.1 million (Adelaide).…”

“…Most patients have had multiple warning signs and symptoms prior to the onset of symptoms. Bridgeman et al 5 in their study of 107 Australian patients seen over a 57 month period found that all (100 per cent) of the patients had experienced pain prior to presentation. Commonly this had been intermittent and the patient had failed to act or obtained inadequate primary treatment.…”

“…This was described by Hippocrates 1 and is reinforced in the modern surgical but pre-antibiotic era. 2 In the antibiotic era the use of antibiotics, intravenous fluids to re-hydrate the patient and appropriate pain management have been well described [4][5][6][7]12 and taught to dental and medical undergraduates for decades. [17][18][19][20][21] The primary practitioner, whether dental or medical, has a key role in the management of odontogenic infection.…”

“…Antibiotics are a predisposing factor in most published series of severe infections. [4][5][6][7] A different source of odontogenic infection may occur from dental treatment when practitioners try to conserve a tooth. It would be in the best interests of the patient to recognize that conservative management has been unable to resolve the presenting problem and extract the involved tooth.…”

“…Although there are many other causes of head and neck infection, odontogenic infections are the most common type. Huang et al 4 found 50 per cent of 185 cases of deep neck infections were odontogenic in origin, Bridgeman et al 5 found 53 per cent in their 107 cases, Bross-Soriano et al 6 89 per cent in their 121 cases and Juang et al 7 86 per cent in their study of 14 true Ludwig's angina cases.…”