Presence of Air in Odontogenic Infections: Implications and Outcomes.

BACKGROUND

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.

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

STUDY DESIGN, SETTING, SAMPLE: 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.

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

MAIN OUTCOME VARIABLE: 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.

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

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

RESULTS

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).

CONCLUSION AND RELEVANCE: 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.