Odontogenic infections in the head and neck: a case series

Introduction Odontogenic infections (OIs) are potentially severe complications resulting from untreated dental pathologies or incorrect dentistry procedures. They may involve paranasal sinuses and cervico-fascial spaces. Clinical picture can be misleading and relation with dental pathology unapparent, making their diagnosis challenging.

Material and methods Data of 44 patients referred to San Raffaele Hospital (Milan) for acute severe or recalcitrant sinonasal/deep cervical OIs between January 2008 and January 2017 were retrospectively collected. Clear odontogenic origin was proved in all cases. Patient characteristics, etiopathogenesis, surgical approach and medical therapy were individually assessed.

Results Main causes of OIs were implant placement (13/44, 29.6%) and caries (12/44, 27.3%), followed by dysodontiasis (8/44, 18.2%), tooth extraction (7/44, 15.9%), endodontic procedures (2/44, 4.5%) and sinus lift (2/44, 4.5%). A clear etiology was detectable in 27 patients (61.4%). Odontogenic maxillary sinusitis (32/44, 72.7%) was typically tackled by a multiportal approach, with transnasal endoscopic approaches combined with transoral ones. Cervico-fascial infections (12/44, 27.3%), instead, always required cervicotomic surgical drainage, frequently in urgent/emergent settings. A case of descending mediastinal spread was recorded.

Conclusions High index of suspicion and effective collaboration between dental and ENT specialists are essential to promptly diagnose and treat OIs. Antibiogram-driven therapies and multiportal approaches are key elements of the current therapeutic strategy.