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The primary aim of this study was to assess the incidence of a difficult airway and emergency tracheostomy in patients with orofacial infections originating in the mandible, and a secondary aim was to determine the potential predictors of difficult intubation. This retrospective single-center study included all patients who were referred between 2015 and 2022 with an orofacial infection originating in the mandible and who were surgically drained under intubation anesthesia. The incidence of a difficult airway regarding ventilation, laryngoscopy, and intubation was analyzed descriptively. Associations between potential influencing factors and difficult intubation were examined via multivariable analysis. A total of 361 patients (mean age: 47.7 years) were included in the analysis. A difficult airway was present in 121/361 (33.5%) patients. Difficult intubation was most common in patients with infections of the massetericomandibular space (42.6%), followed by infections of the mouth floor (40%) and pterygomandibular space (23.5%). Dyspnea and stridor were not associated with the localization of infection (p = 0.6486/p = 0.4418). Multivariable analysis revealed increased age, restricted mouth opening, higher Mallampati scores, and higher Cormack–Lehane classification grades as significant predictors of difficult intubation. Higher BMI, dysphagia, dyspnea, stridor and a non-palpable mandibular rim did not influence the airway management. Patients with a difficult airway were more likely to be admitted to the ICU after surgery than patients with regular airway were (p = 0.0001). To conclude, the incidence of a difficult airway was high in patients with orofacial infections originating in the mandible. Older age, limited mouth opening, a higher Mallampati score, and a higher Cormack–Lehane grade were reliable predictors of difficult intubation.

В ходе исследования, был проведен ретроспективный анализ 4020 медицинских карт стационарных больных, госпитализированных в отделение челюстно-лицевой хирургии (ЧЛХ) в период с 1 января 2020 года по 1 января 2021 года. В исследуемую группу включено 713 человек с одонтогенными поражениями в виде абсцессов и флегмон. Проведен статистический анализ заболеваемости, распространенности по районам края, а также гендерного состава пациентов с одонтогенными абсцессами и флегмонами, помимо этого, выполнен сравнительный анализ данных, полученных за указанный период. Проведенное исследование позволило выявить значимое увеличение удельного веса данной патологии в 2021 году в общем числе госпитализируемых в отделение ЧЛХ больных в сравнении с 2020 годом. Гендерных различий в частоте возникновения данной патологии выявлено не было. В 2021 году превалируют госпитализированные из районов края. Распределение мест локализации воспалительного процесса в зависимости от частоты поражения в исследуемых годах разлилось. Кроме того, анализ полученных данных показал, что поражение нескольких клетчаточных пространств при одонтогенных флегмонах встречается чаще, чем одного., During the study, a retrospective analysis of 4020 medical records of inpatients hospitalized in the Department of Oral and Maxillo-facial Surgery (OMS) between 1 January 2020 and 1 January 2021 was performed. The study group included 713 people with odontogenic lesions in the form of abscesses and phlegmons. A Statistical analysis of morbidity, prevalence by region, and gender composition of patients with odontogenic abscesses and phlegmons was carried out, and a comparative analysis of the data obtained during this period was performed. The study revealed a significant increase in the proportion of this pathology in 2021 in the total number of patients hospitalized in the Department of Chest Surgery compared to 2020. There were no gender differences in the incidence of this pathology. In 2021 there is a predominance of patients hospitalized from the districts of the region. The distribution of the sites of localization of the inflammatory process according to the frequency of the lesions differed in the years studied. In addition, the analysis of the data obtained showed that lesions of more than one cellular space in odontogenic phlegmons occur more frequently than in one cellular space., Международный научно-исследовательский журнал, Выпуск 4 (130) 2023

In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes.

Made available in DSpace on 2022-10-10T13:56:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-08-29. Added 1 bitstream(s) on 2022-10-10T15:40:16Z : No. of bitstreams: 1 S0100-736X2022000100504.pdf: 1960506 bytes, checksum: 592797b999dd18ab2f947b088d2c393d (MD5) As doenças bucais são limitantes para as práticas de saúde, bem-estar e conservação, especialmente no caso de animais ameaçados de extinção. Neste estudo retrospectivo, realizou-se um levantamento sobre condições relacionadas à saúde bucal observadas nos registros clínicos de 261 cervídeos que compunham uma população ex situ do Centro de Conservação do Cervo-do-Pantanal durante um período de 30 anos (1990-2020). Destes, 49 (18,77%) cervos-do-pantanal (31 fêmeas (63,27%) e 18 machos (36,73%)) apresentavam afecções clínicas bucais; e a idade média dos cervídeos afetados foi de 8,9 anos. Realizou-se a análise de regressão logística e a variável idade mostrou associação significativa com a presença de afecções dentárias. Assim, com a mudança de categoria de idade, um cervídeo teve oito vezes mais chances de manifestar afecções bucais; portanto, a idade pode ser considerada como fator de risco para manifestação de afecções bucais na espécie. Aumento de volume facial (65,3%), acúmulo de alimentos na boca (36,7%), perda dentária (22,4%), fístulas (22,4%), lesões nas mucosas ou palatinas (22,4%), desgaste dentário (20,4%) e exposição de raiz (18,3%) foram as lesões mais registradas. A ocorrência relativamente alta de afecções bucais em Blastocerus dichotomus reitera a importância dos cuidados com a saúde bucal quando os cervídeos são mantidos sob cuidados humanos. Oral diseases are limiting to health, welfare, and conservation practices, especially in the case of endangered animals. In this retrospective study, a survey on oral health-related conditions noted in the clinical records for 261 deer comprised in an ex situ population of the Marsh Deer Conservation Center (CCCP) over 30 years (1990-2020) was carried out. Of these, 49 (18.77%) marsh deer (31 females - 63.27% and 18 males - 36.73%) had clinical oral affections; the affected deer’s mean age was 8.9 years. Logistic regression analysis was performed, and the variable age was significantly associated with the presence of dental affections. Thus, with a change in the age category, a deer had eight times the chance of manifesting oral affections; therefore, age can be considered a risk factor for the manifestation of oral affections in the species. Increased facial volume (65.3%), accumulation of food in the mouth (36.7%), tooth loss (22.4%), fistulas (22.4%), mucosal or palatal lesions (22.4%), tooth wear (20.4%), and tooth root exposure (18.3%) were the most frequently recorded lesions. The relatively high occurrence of oral affections in Blastocerus dichotomus reiterates the importance of oral health care when deer are kept in human care. Universidade Federal de Goiás, Escolha de Veterinária e Zootecnia Universidade Estadual Paulista (UNESP), Faculdade de Ciências Agrárias e Veterinárias Universidade Estadual Paulista (UNESP), Faculdade de Medicina Veterinária Tijoá Participações e Investimentos S/A, Centro de Conservação do Cervo-do-Pantanal Universidade Estadual Paulista (UNESP), Faculdade de Ciências Agrárias e Veterinárias Universidade Estadual Paulista (UNESP), Faculdade de Medicina Veterinária

Simple Summary Odontogenic infections are very common. The course of disease ranges from mild to severe and sometimes even life-threatening infections. Optimal therapy is based on rapid abscess incision and, especially in severe cases, on adjuvant antibiotic therapy that ideally targets the culprit bacteria. In order to identify these bacteria, clinicians usually perform cultural analysis from smears of pus and aim for antibiotic susceptibility testing. In recent years, using new molecular methods, it has become possible to carry out a much more detailed analysis of the bacterial colonization of different parts of the human body by determining a microbiome. In our study, we have, for the first time, compared such a microbiome of odontogenic abscesses with cultural bacterial determination carried out in the clinical routine of a university hospital. The key finding of the study is not only that considerably more bacteria can be detected in the abscess in this way but also that easily cultivated bacteria dominate over the actual fastidious pathogenic bacteria. Thus, routine clinical culture probably only provides a distorted picture of reality and should be supplemented by molecular methods in the future. Abstract Odontogenic abscesses are usually caused by bacteria of the oral microbiome. However, the diagnostic culture of these bacteria is often prone to errors and sometimes fails completely due to the fastidiousness of the relevant bacterial species. The question arises whether additional pathogen diagnostics using molecular methods provide additional benefits for diagnostics and therapy. Experimental 16S rRNA gene analysis with next-generation sequencing (NGS) and bioinformatics was used to identify the microbiome of the pus in patients with severe odontogenic infections and was compared to the result of standard diagnostic culture. The pus microbiome was determined in 48 hospitalized patients with a severe odontogenic abscess in addition to standard cultural pathogen detection. Cultural detection was possible in 41 (85.42%) of 48 patients, while a pus-microbiome could be determined in all cases. The microbiomes showed polymicrobial infections in 46 (95.83%) cases, while the picture of a mono-infection occurred only twice (4.17%). In most cases, a predominantly anaerobic spectrum with an abundance of bacteria was found in the pus-microbiome, while culture detected mainly Streptococcus, Staphylococcus, and Prevotella spp. The determination of the microbiome of odontogenic abscesses clearly shows a higher number of bacteria and a significantly higher proportion of anaerobes than classical cultural methods. The 16S rRNA gene analysis detects considerably more bacteria than conventional cultural methods, even in culture-negative samples. Molecular methods should be implemented as standards in medical microbiology diagnostics, particularly for the detection of polymicrobial infections with a predominance of anaerobic bacteria.

Background: Clostridium difficile (CD) is the major cause of nosocomial antibiotic-associated infections, having as main manifestation diarrhea and life-threatening inflammation of the colon. Surgery may be necessary in up to 80% of patients due to the frequent complications associated with this condition. The mortality rate of this devastating disease could reach 50% even after proper treatment. Case report: We report a case of a 24-year-old female who was admitted with clinical signs of an odontal inflammatory process. After repeated surgical treatments and antibiotic therapy, she presented acute abdominal pain on the 14th postoperative day. The explorative laparotomy was negative. Clostridium difficile was isolated from her stool, and she was transferred to the Department of Infectious Diseases. After a few days without any favorable clinical outcome, she was transferred to the intensive care unit (ICU), where she developed acute respiratory distress syndrome. Despite the immediate surgical intervention and ICU care, she died within 15 days after admission. Conclusions: CD infection is considered a complication of antibiotic treatment, having as main cause the combination of fluoroquinolones with antisecretory drugs. In the first phase, the changes of the colon can be minimal with the manifestation of a false acute surgical abdomen, but toxic colon can develop in evolution, leading to multi-system organ failure and death.

Background Oral Health-Related Quality of Life (OHRQoL) is an important aspect of quality of life. Acute illnesses, as well as chronic diseases, can have a strong, persisting impact on an individual’s quality of life. This study evaluates OHRQoL of patients with odontogenic fascial space abscesses, the underlying conditions, and its consequences for clinical routines. Methods The research group consisted of patients presenting themselves to the emergency room or elective clinic of the Department for Cranio-Maxillofacial and Plastic Surgery (n = 94). The validated German version of the Oral Health Impact Profile (OHIP-G) and additional questions (including habits and routines in oral hygiene) with an anamnestic recall period of 1 month was used to evaluate OHRQoL shortly after emergency treatment (baseline) and again after 3–6 months’ follow-up. Ninety-four patients completed the questionnaire at baseline, 54 completed both questionnaires. Additionally, OHIP-G scores were compared to those of the non-impacted general German population. Results Results showed a significant difference in OHIP-G scores from baseline to follow-up (p = 0.001). Overall a mean of 55.24 (±37.02) points was scored at baseline and a mean of 37.02 (±35.79) points was scored at follow-up. Patients scored higher than participants of a representative study of the general German population. Conclusion Overall results suggest an increase in OHRQoL 3–6 months after acute treatment. Nevertheless, OHRQoL of patients suffering from odontogenic fascial space abscesses seems to remain generally lower than the OHRQoL of the general German population. Trial registration Trial registration: Central Study Register of the University Hospital Duesseldorf, Registration-ID: 2016085405. Registered 24 August 2016.

Severe odontogenic abscesses are regularly caused by bacteria of the physiological oral microbiome. However, the culture of these bacteria is often prone to errors and sometimes does not result in any bacterial growth. Furthermore, various authors found completely different bacterial spectra in odontogenic abscesses. Experimental 16S rRNA gene next-generation sequencing analysis was used to identify the microbiome of the saliva and the pus in patients with a severe odontogenic infection. The microbiome of the saliva and the pus was determined for 50 patients with a severe odontogenic abscess. Perimandibular and submandibular abscesses were the most commonly observed diseases at 15 (30%) patients each. Polymicrobial infections were observed in 48 (96%) cases, while the picture of a mono-infection only occurred twice (4%). On average, 31.44 (±12.09) bacterial genera were detected in the pus and 41.32 (±9.00) in the saliva. In most cases, a predominantly anaerobic bacterial spectrum was found in the pus, while saliva showed a similar oral microbiome to healthy individuals. In the majority of cases, odontogenic infections are polymicrobial. Our results indicate that these are mainly caused by anaerobic bacterial strains and that aerobic and facultative anaerobe bacteria seem to play a more minor role than previously described by other authors. The 16S rRNA gene analysis detects significantly more bacteria than conventional methods and molecular methods should therefore become a part of routine diagnostics in medical microbiology.

The purpose of this study is to describe the Minimally Invasive Intraoral Approach (MIIA) performed on selected cases of abscesses and neck phlegmons of odontogenic origin when the infection has not spread beyond the inferior mandibular margin. This technique allows us to avoid cervicotomy by a direct approach to the abscess, draining it through the oral cavity. If the limits have already been crossed, then cervicotomy is necessary. The aim of the study is to show the surgical outcomes that we have achieved during a time span of two years, and to show the effectiveness of the MIIA and its results. We selected 66 patients with abscesses and neck phlegmons, from January 2018 to June 2020. Among these cases, five patients were excluded as it was not possible to recover medical records from database. The MIIA technique has been performed on 16 patients (26.2%) when a successful dental extraction and drainage of the submandibular lodge were accomplished. The patients who underwent the MIIA surgery have all perfectly healed and did not suffer from relapses during the follow-up. The results show the achievement of excellent healing, underlining the lower impact required by MIIA when compared to a more traditional approach through cervicotomy.

Background Cervical fasciitis is a group of severe infections with high morbimortality. Reports in the literature of patients with cases evolving with mediastinal dissemination of deep cervical abscess are common. However, cases of abdominal dissemination by contiguity are much rarer. Case presentation A 34-year-old Caucasian man presented to the emergency department with a 15-day history of left neck edema, local pain, and fever. Seventeen days prior to presentation, he had undergone odontogenic surgical treatment in a dental clinic. Laboratory examinations did not show meaningful changes. He underwent computed tomography of the neck, thorax, and abdomen, which showed evidence of left collection affecting the retromandibular, submandibular, parapharyngeal, vascular, and mediastinal spaces, bilateral pleural effusion, right subphrenic collection and a small amount of liquids between intestinal loops. A cervical, thoracic, and abdominal surgical approach at the same surgery was indicated for odontogenic cervical abscess, descending necrotizing mediastinitis, and subphrenic abscess. The patient remained in the intensive care unit for three days, and he was discharged on the 22nd day after surgery with no drains and no tracheostomy. His outpatient discharge occurred after 6 months with no sequelae. Conclusions Aggressive surgical treatment associated with antibiotic therapy has been shown to be effective for improving the clinical course of cervical fasciitis. Despite the extension of the infection in our patient, a surgical approach of all infectious focus associated with a broad-spectrum antibiotic therapy led to a good clinical evolution and has significant implications for aggressive treatment.

For more than 2000 years physicians in daily practice assume a correlation between odontogenic infections and meteorologic parameters. Although a small number of studies supported this association, it is, so far, insufficiently enlightened. The aim of this study, therefore, was to investigate the relationship between the incidence of odontogenic abscess and the outdoor temperature or atmospheric pressure. Patients with odontogenic abscesses, who presented themselves in the rescue center of the Clinic for Oral and Maxillofacial Surgery at the Charité Campus Virchow Clinic from 31/03/2013 – 31/03/2015, were analyzed. Inpatient and outpatient patients were included in the study. Subsequently, a subgroup of patients was formed, who had neither been surgically nor antibiotically pretreated and who were resident in Berlin/Brandenburg at the time of the study; they were referred to as "weather cohort". The incidence of odontogenic abscesses was correlated with the outside temperature and air pressure by Poisson regression analysis, starting 14 days prior to the initial presentation of the patient at the rescue site. Additional clinical parameters were collected and analyzed. 1026 patients with 1052 cases were included (mean age: 38.6 years; age range 1 - 102 years). The weather cohort included 535 patients with 538 cases (mean age: 39.4 years; age range 1 - 95 years). Of the 1052 cases, 521 were treated as inpatients and 531 as outpatients. A significant quadratic correlation between the incidence of odontogenic abscesses and the mean daytime temperature (p = 0.033) or maximum daytime temperature (p = 0.015) was observed on the day of presentation. A correlation was also observed in the “weather cohort”. This was significant with respect to the mean daytime temperature (p = 0.032), and highly significant regarding the maximum daytime temperature (p = 0.008). The incidence of odontogenic abscesses in both the “weather cohort” and the overall cohort is slightly higher at comparatively low temperatures than at higher temperatures. Furthermore, a significant quadratic correlation could be shown for two days before presentation, but only in relation to the “weather cohort” and only in relation to the maximum day temperature. In the group as a whole, a correlation (p = 0.05) was found six days before the first presentation at the rescue site, but there was no correlation between incidence and air pressure. The present study supports the thesis that outdoor temperature may have an influence on the genesis of odontogenic abscesses. A significantly higher number of odontogenic abscesses could be observed Abstract 9 on days with comparatively cold or warm outside temperatures. However, this correlation could primarily be demonstrated for the day of presentation. Thus, other reasons for the frequent occurrence of odontogenic abscesses must also be responsible, such as an increased sensation of pain. In addition, we found that on days with comparatively cold temperatures, there were more cases of abscesses compared to warm days. One possible cause could be a stronger change in the oral microflora or a change in the immune response on colder days due to the greater temperature difference between the outside and body temperature., Seit mehr als 2000 Jahren vermuten Ärzte und Wissenschaftler einen Zusammenhang zwischen odontogenen Infektionen und meteorologischen Parametern. Obwohl bereits einzelne Studien existieren, die mögliche Korrelationen aufzeigen, ist der wissenschaftliche Beweis bisher nicht erbracht. Das Ziel dieser Studie ist es einen möglichen Zusammenhang zwischen der Inzidenz odontogener Abszesse und der Außentemperatur bzw. dem Luftdruck aufzuzeigen. Es erfolgte eine Analyse von Patienten mit odontogenen Abszessen, die sich im Zeitraum vom 31.03.2013 – 31.03.2015 in der Rettungsstelle der Klinik für Mund-, Kiefer- und Gesichtschirurgie am Charité Campus Virchow Klinikum vorstellten. Es wurden stationäre und ambulante Patienten in die Studie eingeschlossen. Anschließend wurde eine Subgruppe der Patienten gebildet, welche weder chirurgisch noch antibiotisch vorbehandelt worden ist und welche zum Zeitpunkt der Studie ihren Wohnsitz in Berlin/Brandenburg hatte, genannt „Wetterkohorte“. Die Inzidenz odontogener Abszesse wurde mit der Außentemperatur und dem Luftdruck mittels einer Poisson- Regressionsanalyse korreliert, beginnend 14 Tage vor der Erstvorstellung des jeweiligen Patienten in der Rettungsstelle. Es wurden zusätzlich weitere klinische Parameter erhoben und analysiert. Es wurden 1026 Patienten mit 1052 Fällen eingeschlossen (Altersmittelwert: 38,6 Jahren; Spannweite 1 – 102 Jahre). In die Wetterkohorte wurden 535 Patienten mit 538 Fällen eingeschlossen (Altersmittelwert: 39,4 Jahren; Spannweite 1 – 95 Jahre). Von den 1052 Fällen wurden 521 stationär und 531 ambulant behandelt. In der Gesamtgruppe konnte eine signifikante quadratische Korrelation zwischen Inzidenz odontogener Abszesse und der mittleren Tagestemperatur (p = 0,033) bzw. der Tageshöchsttemperatur (p = 0,015) am Aufnahmetag in die Rettungsstelle beobachtet werden. Eine Korrelation wurde ebenso in der Wetterkohorte beobachtet. In Bezug auf die mittlere Tagestemperatur war diese in der Wetterkohorte signifikant (p = 0,032), bezüglich der Tageshöchsttemperatur hochsignifikant (p = 0,008). Die Inzidenz odontogener Abszesse ist hierin sowohl in der Wetterkohorte, als auch in der Gesamtkohorte bei vergleichsweise tiefen Temperaturen gering höher als bei hohen Temperaturen. Des Weiteren konnte eine signifikante quadratische Korrelation für zwei Tage vor dem Tag der Erstvorstellung aufgezeigt werden, jedoch nur in Bezug auf die Wetterkohorte und nur in Relation zur Tagehöchsttemperatur. In der Gesamtgruppe konnte sechs Tage vor der Erstvorstellung in der Rettungsstelle eine Korrelation (P = 0,05) in der linearen Poisson-Regression nachgewiesen werden, des Weiteren konnte jedoch keine Korrelation zwischen der Inzidenz und dem Luftdruck festgestellt werden. Diese Studie unterstützt die These, dass die Außentemperatur einen Einfluss auf die Genese odontogener Abszesse haben kann. Eine signifikant höhere Anzahl odontogener Abszesse konnte an Tagen mit vergleichsweise kalten bzw. warmen Außentemperaturen beobachtet werden. Die genannte Korrelation konnte jedoch primär nur für den Aufnahmetag in beiden Kohorten dargelegt werden. Damit müssen auch andere Gründe für das gehäufte Auftreten odontogener Abszesse verantwortlich sein, wie beispielsweise ein gesteigertes Schmerzempfinden. Außerdem konnten wir feststellen, dass an Tagen mit vergleichsweise kalten Temperaturen mehr Vorstellungen erfolgten als an vergleichsweise warmen Tagen. Eine mögliche Ursache könnte aufgrund der größeren Temperaturdifferenz zwischen der Außen- und Körpertemperatur eine stärkere Veränderung der oralen Mikroflora oder eine veränderte Immunantwort an kälteren Tagen sein.

The assessment of fangs is a fundamental part of clinical examination of viperid snakes. The long curved venom fang is carried by short, highly mobile maxilla. Short anaesthesia is advised for safe physical examination and radiography of the mouth cavity. The fangs are gently forced outside the fang pocket by passing the bar or forceps on the palato-maxillary arch, and rotating them rostrally shifting the mucosal fold. Functional fangs are periodically shed and several generations of replacement teeth lie behind and beneath each fang. In case of fang fracture, therapy should be limited to flushing with a solution of chlorhexidine or povidone iodine, and topical application of pro-coagulant and antibacterial cream. Therapy of chronic fang inflammation is based on removal of necrotized fang and repeated abundant irrigation of the fang pocket. Treatment of chronic stomatitis consists of flushing with chlorhexidine or povidone iodine, physical removal of the plaques, administration of analgesics and antibiotics (marbofloxacin, enrofloxacin or ceftazidime). Extra-oral surgical approach is the best method for odontogenic abscess removal. A vigorous flushing with sterile saline solution, chlorhexidine and povidone iodine and topical application of antibiotics (antibiotic embedded surgical sponge) is advised. Force feeding of the anorectic patient suffering from fang inflammation is a mandatory part of the standard treatment protocol.

Background: Brain abscess is a life-threatening entity which requires prompt and long-term antibiotic therapy, generally associated with surgical drainage, and eradicating the primary source of infection. Parvimonas micra (Pm) has only been reported once before as the lone infecting organism of an orally originated, solitary brain abscess. Diagnosing brain abscesses caused by this Gram-positive anaerobic coccus, constituent of the oral cavity flora, is challenging, and an optimal treatment regimen has not been well established. We report the diagnosis and successful treatment of a Pm caused odontogenic brain abscess. Case Description: A 62-year-old immunocompetent male with a right-parietal brain abscess presented with headache and seizures. He was started on empirical antibiotic therapy and subsequently underwent surgical drainage. The only source of infection found was severe periodontitis with infected mandibular cysts. Thus, tooth extraction and cyst curettage were performed 1 week after brain surgery. Cultures of brain abscess fluid were negative, but amplification of bacterial 16S ribosomal RNA (rRNA) with polymerase chain reaction demonstrated Pm. After 3 weeks of intravenous ceftriaxone and metronidazole, the patient was switched to oral metronidazole and moxifloxacin for 6 weeks. Conclusions: This case highlights the potential risk of untreated dental infections causing brain abscesses. Pm should be considered as a possible pathogen of odontogenic brain abscesses despite its presence usually not being detected by standard bacterial cultures. Therefore, 16S rRNA gene sequencing analysis is strongly recommended for bacterial identification before defining brain abscesses as cryptogenic.

Die chirurgische Inzision und das Einlegen einer Drainage gelten bei fortgeschrittenen odontogenen Abszessen auch heute noch als Goldstandard. Oftmals wird der Patient zusätzlich mit einer begleitenden Antibiotikatherapie behandelt. Diese erfolgt jedoch aus zeitlichen Gründen nicht gezielt nach einem Erregernachweis, sondern vielmehr kalkuliert. Es stellt sich die Frage, ob die adjuvante Antibiotikatherapie zu einer schnelleren Genesung des Patienten führt und somit eine Verkürzung der Gesamttherapie zur Folge hat oder gar den Krankheitsverlauf verlangsamt. Im Rahmen dieser retrospektiven Studie wurden im Zeitraum vom 01.01.2008 bis zum 05.08.2014 alle Patienten der Mund-Kiefer-Gesichtschirurgie des Universitätsklinikums Gießen mit einem in Narkose inzidiertem dentogenem Logenabszess ermittelt. Mit Hilfe des klinischen Informationssystems KAOS und der ambulanten Akten wurden die Parameter Abszessart, Art des Pusflusses, Krankenhausverweildauer, CRP, Zeit bis zur Drainagenentfernung und zur Streifenentfernung erhoben. Somit ergaben sich bezüglich der adjuvanten Antibiotikatherapie 2 Gruppen. Eine Versuchsgruppe, welche ohne eine adjuvante Antibiotikatherapie behandelt wurde und eine Kontrollgruppe, welche eben diese erhielt. Diese 2 Gruppen wurden hinsichtlich der Liegedauer und der ambulanten Nachbehandlung miteinander verglichen. Unterschiede zwischen den Gruppen wurden mit dem Chi-Quadrattest nach Pearson, dem Mann-Whitney-U-Test und dem Kruskal-Wallis-Test ermittelt, die in Zusammenarbeit mit dem Institut für medizinische Statistik durchgeführt wurden. Es konnten 206 Patienten ermittelt werden, von denen 68 Patienten die Versuchsgruppe bildeten, welche ohne begleitende i.v. Antibiotikatherapie behandelt wurden und 138 Patienten die Kontrollgruppe, welche eben diese erhielt. Im gesamten Patientenkollektiv kam der submandibuläre Logenabszess gefolgt vom perimandibulären Logenabszess am häufigsten vor. Dies spiegelte sich sowohl in der Versuchs- als auch in der Kontrollgruppe wider. Um einen Anhalt für die Erkrankungsschwere zu ermitteln wurden die CRP-Werte der beiden Patientengruppen miteinander verglichen. Hierbei konnte kein signifikanter Unterschied zwischen den beiden Gruppen ermittelt werden. Somit gab es laborbiochemisch keinen Anhalt für eine stärkere Ausprägung der Erkrankung in einer der beiden Gruppen. Der Median der Krankenhausverweildauer betrug insgesamt fünf Tage. Betrachtet man die Versuchs- und die Kontrollgruppe jeweils gesondert, fällt auf, dass die Versuchsgruppe mit lediglich 4 Tagen deutlich früher entlassen werden konnte, als die Kontrollgruppe, welche 6 Tage auf Station verbracht hat. Bei den Variablen der ambulanten Nachbehandlung (Entfernung der EasyflowDrainage, Entfernung der Streifendrainage) zeigte sich kein signifikanter Unterschied zwischen den beiden Patientengruppen. Den Patienten der Versuchsgruppe wurde im medianen Schnitt 13 Tage nach der chirurgischen Inzision die Easyflow-Drainage und nach 20 Tagen der Streifen entfernt. In der Kontrollgruppe sind sehr ähnliche Werte zu finden. 12 Tagen nach chirurgischer Inzision wurde die Drainage entfernt und nach ebenfalls 20 Tagen postoperativ der Streifen. Auch im Hinblick auf die Art des Pusflusses gab es keinen signifikanten Unterschied was die Krankenhausverweildauer anbelangt. Die Untergruppen Pus , putrides/bröckliges Sekret und kein Pus zeigten keine signifikanten Unterschiede bezüglich der Krankenhausverweildauer. Die Studie untermauert die Hypothese, dass in vielen Fällen nach erfolgter chirurgischer Inzision eines Abszesses im Kopf-Hals-Bereich auf eine adjuvante Antibiotikatherapie verzichtet werden kann. So hat die Untersuchung gezeigt, dass eine adjuvante, intravenös verabreichte Antibiotikatherapie nach erfolgter chirurgischer Abszessinzision nicht zu einer Verkürzung der weiteren Therapie geführt hat. Es konnte sogar beobachtet werden, dass die Patienten, die eine adjuvante Antibiotikatherapie erhielten eine signifikant längere Aufenthaltsdauer im Krankenhaus zeigten. Damit muss die zusätzliche intravenös verabreichte Antibiotikatherapie bei Patienten mit ausgedehnten odontogenen Infektionen nach der erfolgreichen Durchführung einer Abszessinzision kritisch gesehen werden. Die Ergebnisse dieser retrospektiven Studie sollten durch eine folgende prospektive Studie untermauert werden., Surgical incision and the insertion of a drainage are still today considered the gold standard in case of advanced dental abscesses. However, the patient´s therapy is often also accompanied by antibiotics, which, due to timely reasons, is carried out on a calculated basis rather than by targeting a detected pathogen. The question rises if the adjuvant antibiotics therapy results in the patient´s faster recovery, and thus in a timely reduction of the overall therapy, or if it actually slows down the etiopathology. Within the framework of this retrospective study, all patients were determined who were treated at the department of oral and maxillofacial surgery at the university medical center Giessen between January 1, 2008 and August 5, 2014 and suffered from a dental submucous abscess indicated under anesthesia. By using the clinical information system KAOS and the outpatient files, the following parameters were collected: type of abscess, type of pus flow, period of hospitalization, CRP and the time passed until the drainage and strips were removed. Thus, the adjuvant antibiotics therapy, and one control group, whose members received those antibiotics. Those two groups were compared with each other as regards the length of the hospital stay and ambulant post-treatment. Differences between the groups were determined by means of Pearson´s chi-squared test, the Mann-Whitney U test and the Kruskal-Wallis test that were all performed in cooperation with the Department of Medical Statistics. Altogether 206 patients could be determined, of which 68 were classified as patients without concomitant intravenous antibiotic therapy (trial group), and 138 as patients who received antibiotics (control group). Within the entire patient population, the submandibular submucous abscess and the perimandibular submucous abscess were found to be most common. This was reflected in both the trial and the control group. In order to collect evidence for the severity of the disease, the patients´ CRP values in both groups were compared to each other. No significant difference could be determined here, thus delivering no laboratory-biochemical proof for a stronger development of the disease in one of the two groups. The median of the hospital stay was five days. Looking at both groups individually, it can be noticed that the trial group that spent only 4 days at the hospital could be released significantly earlier than the control group, which stayed 6 days. Regarding the variables of out-patient post-treatment (removal of Easy-flow drainage and strip drainage) did not show a significant difference between the two groups of patients. The patients of the trial group had the Easy-Flow drainage removed after a median of 13 days, and the strip drainage after 20 days after being released from the hospital. Those values are very similar to those found in the control group: the drain was removed 12 days post-surgery and the strips also 20 days after surgery. Looking at the type of pus flow delivers similar results: there was no significant difference regarding the length of the hospital stay; a finding that also holds true for the sub-groups "pus", "sanious/crumbly secretion" and "no pus". The study supports the hypothesis that in many cases an adjuvant antibiotics therapy indicated after the surgical incision of an abscess in the head and neck area is deemed unnecessary. Thus, the study shows that an adjuvant, intravenous antibiotics therapy following a surgical abscess incisions did not shorten the therapy. On the contrary - it was observed that patients receiving an adjuvant antibiotics therapy were hospitalized for a significantly longer period. This makes the additional intravenous antibiotics therapy for patients with extensive dental infections following the successful execution of an abscess incision a critical issue. The results of the retrospective study should be supported by a following prospective study.

Die chirurgische Inzision und das Einlegen einer Drainage gelten bei fortgeschrittenen odontogenen Abszessen auch heute noch als Goldstandard. Oftmals wird der Patient zusätzlich mit einer begleitenden Antibiotikatherapie behandelt. Diese erfolgt jedoch aus zeitlichen Gründen nicht gezielt nach einem Erregernachweis, sondern vielmehr kalkuliert. Es stellt sich die Frage, ob die adjuvante Antibiotikatherapie zu einer schnelleren Genesung des Patienten führt und somit eine Verkürzung der Gesamttherapie zur Folge hat oder gar den Krankheitsverlauf verlangsamt. Im Rahmen dieser retrospektiven Studie wurden im Zeitraum vom 01.01.2008 bis zum 05.08.2014 alle Patienten der Mund-Kiefer-Gesichtschirurgie des Universitätsklinikums Gießen mit einem in Narkose inzidiertem dentogenem Logenabszess ermittelt. Mit Hilfe des klinischen Informationssystems KAOS und der ambulanten Akten wurden die Parameter Abszessart, Art des Pusflusses, Krankenhausverweildauer, CRP, Zeit bis zur Drainagenentfernung und zur Streifenentfernung erhoben. Somit ergaben sich bezüglich der adjuvanten Antibiotikatherapie 2 Gruppen. Eine Versuchsgruppe, welche ohne eine adjuvante Antibiotikatherapie behandelt wurde und eine Kontrollgruppe, welche eben diese erhielt. Diese 2 Gruppen wurden hinsichtlich der Liegedauer und der ambulanten Nachbehandlung miteinander verglichen. Unterschiede zwischen den Gruppen wurden mit dem Chi-Quadrattest nach Pearson, dem Mann-Whitney-U-Test und dem Kruskal-Wallis-Test ermittelt, die in Zusammenarbeit mit dem Institut für medizinische Statistik durchgeführt wurden. Es konnten 206 Patienten ermittelt werden, von denen 68 Patienten die Versuchsgruppe bildeten, welche ohne begleitende i.v. Antibiotikatherapie behandelt wurden und 138 Patienten die Kontrollgruppe, welche eben diese erhielt. Im gesamten Patientenkollektiv kam der submandibuläre Logenabszess gefolgt vom perimandibulären Logenabszess am häufigsten vor. Dies spiegelte sich sowohl in der Versuchs- als auch in der Kontrollgruppe wider. Um einen Anhalt für die Erkrankungsschwere zu ermitteln wurden die CRP-Werte der beiden Patientengruppen miteinander verglichen. Hierbei konnte kein signifikanter Unterschied zwischen den beiden Gruppen ermittelt werden. Somit gab es laborbiochemisch keinen Anhalt für eine stärkere Ausprägung der Erkrankung in einer der beiden Gruppen. Der Median der Krankenhausverweildauer betrug insgesamt fünf Tage. Betrachtet man die Versuchs- und die Kontrollgruppe jeweils gesondert, fällt auf, dass die Versuchsgruppe mit lediglich 4 Tagen deutlich früher entlassen werden konnte, als die Kontrollgruppe, welche 6 Tage auf Station verbracht hat. Bei den Variablen der ambulanten Nachbehandlung (Entfernung der EasyflowDrainage, Entfernung der Streifendrainage) zeigte sich kein signifikanter Unterschied zwischen den beiden Patientengruppen. Den Patienten der Versuchsgruppe wurde im medianen Schnitt 13 Tage nach der chirurgischen Inzision die Easyflow-Drainage und nach 20 Tagen der Streifen entfernt. In der Kontrollgruppe sind sehr ähnliche Werte zu finden. 12 Tagen nach chirurgischer Inzision wurde die Drainage entfernt und nach ebenfalls 20 Tagen postoperativ der Streifen. Auch im Hinblick auf die Art des Pusflusses gab es keinen signifikanten Unterschied was die Krankenhausverweildauer anbelangt. Die Untergruppen „Pus“, „putrides/bröckliges Sekret“ und „kein Pus“ zeigten keine signifikanten Unterschiede bezüglich der Krankenhausverweildauer. Die Studie untermauert die Hypothese, dass in vielen Fällen nach erfolgter chirurgischer Inzision eines Abszesses im Kopf-Hals-Bereich auf eine adjuvante Antibiotikatherapie verzichtet werden kann. So hat die Untersuchung gezeigt, dass eine adjuvante, intravenös verabreichte Antibiotikatherapie nach erfolgter chirurgischer Abszessinzision nicht zu einer Verkürzung der weiteren Therapie geführt hat. Es konnte sogar beobachtet werden, dass die Patienten, die eine adjuvante Antibiotikatherapie erhielten eine signifikant längere Aufenthaltsdauer im Krankenhaus zeigten. Damit muss die zusätzliche intravenös verabreichte Antibiotikatherapie bei Patienten mit ausgedehnten odontogenen Infektionen nach der erfolgreichen Durchführung einer Abszessinzision kritisch gesehen werden. Die Ergebnisse dieser retrospektiven Studie sollten durch eine folgende prospektive Studie untermauert werden. Surgical incision and the insertion of a drainage are still today considered the gold standard in case of advanced dental abscesses. However, the patient´s therapy is often also accompanied by antibiotics, which, due to timely reasons, is carried out on a calculated basis rather than by targeting a detected pathogen. The question rises if the adjuvant antibiotics therapy results in the patient´s faster recovery, and thus in a timely reduction of the overall therapy, or if it actually slows down the etiopathology. Within the framework of this retrospective study, all patients were determined who were treated at the department of oral and maxillofacial surgery at the university medical center Giessen between January 1, 2008 and August 5, 2014 and suffered from a dental submucous abscess indicated under anesthesia. By using the clinical information system KAOS and the outpatient files, the following parameters were collected: type of abscess, type of pus flow, period of hospitalization, CRP and the time passed until the drainage and strips were removed. Thus, the adjuvant antibiotics therapy, and one control group, whose members received those antibiotics. Those two groups were compared with each other as regards the length of the hospital stay and ambulant post-treatment. Differences between the groups were determined by means of Pearson´s chi-squared test, the Mann-Whitney U test and the Kruskal-Wallis test that were all performed in cooperation with the Department of Medical Statistics. Altogether 206 patients could be determined, of which 68 were classified as patients without concomitant intravenous antibiotic therapy (trial group), and 138 as patients who received antibiotics (control group). Within the entire patient population, the submandibular submucous abscess and the perimandibular submucous abscess were found to be most common. This was reflected in both the trial and the control group. In order to collect evidence for the severity of the disease, the patients´ CRP values in both groups were compared to each other. No significant difference could be determined here, thus delivering no laboratory-biochemical proof for a stronger development of the disease in one of the two groups. The median of the hospital stay was five days. Looking at both groups individually, it can be noticed that the trial group that spent only 4 days at the hospital could be released significantly earlier than the control group, which stayed 6 days. Regarding the variables of out-patient post-treatment (removal of Easy-flow drainage and strip drainage) did not show a significant difference between the two groups of patients. The patients of the trial group had the Easy-Flow drainage removed after a median of 13 days, and the strip drainage after 20 days after being released from the hospital. Those values are very similar to those found in the control group: the drain was removed 12 days post-surgery and the strips also 20 days after surgery. Looking at the type of pus flow delivers similar results: there was no significant difference regarding the length of the hospital stay; a finding that also holds true for the sub-groups "pus", "sanious/crumbly secretion" and "no pus". The study supports the hypothesis that in many cases an adjuvant antibiotics therapy indicated after the surgical incision of an abscess in the head and neck area is deemed unnecessary. Thus, the study shows that an adjuvant, intravenous antibiotics therapy following a surgical abscess incisions did not shorten the therapy. On the contrary - it was observed that patients receiving an adjuvant antibiotics therapy were hospitalized for a significantly longer period. This makes the additional intravenous antibiotics therapy for patients with extensive dental infections following the successful execution of an abscess incision a critical issue. The results of the retrospective study should be supported by a following prospective study.

Odontogenic orbital abscess is a rare but well-documented complication of sinusitis and infections spreading from dental apical lesion. We report a case of orbital abscess with periorbital cellulitis, in a 35-year-old man with positive recent dental history of a periapical dental infection arising from the second upper left premolar spread into maxillary sinus. The patient has shown facial edema, ocular pain, ophthalmoplegia, proptosis, and initial visual symptoms. A surgical intervention to drain the abscess and a revision of the dental lesion and maxillary sinus were required. A review of literature is also reported focusing on etiology and treatment options dealing with odontogenic orbital abscess and cellulitis.

Deep neck infections are rare but potentially fatal complication of pulpal abscess of the teeth. If an infection can progress rapidly from a toothache to a life threatening infection, then it is critical that dentists be able to recognize the danger signs and identify the patients who are at risk. Mediastinitis is a severe inflammatory process involving the connective tissues that fills the intracellular spaces and surrounds the organs in the middle of the chest. This pathology has both an acute and a chronic form and, in most cases, it has an infectious etiology. This study want to expose the experience acquired in the Oral and Maxillo-facial Sciences Department, Policlinico Umberto I, "Sapienza" University of Rome, regarding two clinical cases of disseminated necrotizing mediastinitis starting from an odontogenic abscess.We report two clinical cases of disseminated necrotic mediastinitis with two different medical and surgical approaches. The radiographic and photographic documentation of the patients was collected in the pre-and post-operatively. All patients underwent a CT scan and MRI.Mediastinitis can result from a serious odontogenic abscess, and the extent of its inflammation process must be never underestimated. Dental surgeons play a key role as a correct diagnosis can prevent further increasing of the inflammation process.A late diagnosis and an inadequate draining represent the major causes of the elevated mortality rate of disseminated necrotizing mediastinitis.

Background Anecdotal reports assert a relationship between weather and lunar activity and the odontogenic abscess (OA) incidence, but this relationship has not been validated. Therefore, the present study investigated the relationship between oral pain caused by OA and a variety of meteorological parameters and cyclic lunar activity. Methods The records of all dental emergency patients treated at the AllDent Zahnzentrum Emergency Unit in Munich, Germany during 2012 were retrospectively reviewed. Patients with oral pain who were diagnosed with OA and treated surgically (n = 1211) were included in the analysis. The OA incidence was correlated to daily meteorological data, biosynoptic weather analysis, and cyclic lunar activity. Results There was no seasonal variation in the OA incidence. None of the meteorological parameters, lunar phase, or biosynoptic weather class were significantly correlated with the OA incidence, except the mean barometric pressure, which was weakly correlated (rho = -0.204). The OA incidence showed a decreasing trend as barometric pressure increased (p

Potaknuti podacima i spoznajom da akutne odontogene infekcije maksilofacijalne regije još i danas u eri vrlo razvijene antibakterijske kemoterapije predstavljaju velik problem, željeli smo odrediti pogodan način uzimanja uzorka za mikrobiološku pretragu i određivanje antibiograma kod akutnih odontogenih infekcija. Ispitivanju je podvrgnuto dvadeset četiri bolesnika s odontogenim apscesima koji prethodno nisu bili tretirani niti medikamentno niti kirurški. Uzorci su uzeti punkcijom u količini od 0,5 do 1 ccm3 i stavljeni u transportnu hranjivu podlogu, te pomoću sterilne eze (putem brisa). Nasađivani su na hranilišta u roku od 4, 24 i 48 sati nakon uzimanja. U tvrdili smo da je uzimanje uzorka punkcijom u količini od 0,5 do 1 ccm gnjojnog sadržaja i inokulacija uzetog uzorka u transportnu hranjivu podlogu pogodan način, jer se tako osjetljive bakterijske vrste očuvaju i do 48 sati nakon uzimanja uzorka., We embarked upon this study to find an appropriate method of sampling for microbiological testing and determination of antibiogram in acute odontogenic infections, of maxillofacial region since they have been documented to cause considerable problems, in face of advanced antibacterial chemotherapy. Twenty-four patients with odontogenic abscesses, not previously treated either medicinally or surgically, were included in the study. Samples of 0.5 to 1 ccm3 were taken either biopsy and placed in a nutrient transport medium, or by means of a sterile wire loop (by a swab). They were cultured in a medium with in 4, 24 and 48 h after sampling. Sampling of 0.5 to 1 ccm 3 of the purulent matter and its inoculation in a nutrient transport medium was found to be quite appropriate, since sensitive strains of bacteria can thus be preserved up to 48 h after sampling. Mixed aerobic-anaerobic cultures were found to prevail in the samples under study.

U radu smo ispitivali šezdeset i tri bolesnika s odontogenim apscsima, koji prethodno nisu bili tretirani niti medikamentno niti kirurški. Uzorci za mikrobiološku pretragu uzimani su iz apscesa ispitivanih bolesnika u količini od 0,5—1 ccm gnojnog sadržaja, te nasađivani na po­godna hranilišta za aerobe i anaerobe. Na taj način očuvane su na životu gotovo sve vrste aerobnih i anaerobnih bakterija koje su bile zastupljene u ispitivanim uzorcima. Mikrobiološkom obradom utvrđeno je da u ispitivanim uzorcima pre­vladavaju miješane aerobno-anaerobne kulture. Među aerobnnim bakte­rijskim vrstama dominiraju gram pozitivni koki i to alfa-hemolitički streptokoki. Od anaeroba najzastupljeniji su bili gram-negativni štapići (Bacteroides melaninogenicus i Fusobacterium nucleatum) i gram-pozitivni koki anaerobnog tipa (Peptostreptococcus anaerobius i Peptococcus prevotii). Stafilokoke smo izolirali samo u tragovima., A group of 63 patients with odontogenic abscesses, not previously treated with either medication or surgery, was studied. Samples for mi­crobiology were taken from abscesses, in the amount of 0.5—1 ccm of the suppurative content, and cultured in appropriate media for aerobes, respectively, so that almost all strains of both aerobic and anaerobic bacteria present in the study samples were kept alive. Microbiological examinations revealed the mixed aerobic-anaerobic cultures to predominate in the samples uner study. Among aerobic bac­terial strains, gram-positive cocci, i. e. alpha-hemolytic streptococci, were found to prevail, whereas among anaerobes gram-negative bacilli (Bacte- riodes melaninogenicus and Fusobacterium nucleatum) and gram-positive cocci of anaerobic type (Peptostreptococcus anaerobius and Peptococcus prevotii) were most frequently detected. Staphylococci were isolated in traces only.