SA1 - Factors Affecting Prolonged Intubation and Difficult Airway After Odontogenic Infection

Abstract: Odontogenic infections can become rapidly life threatening as a result of airway obstruction.² This is further complicated by severe trismus and postoperative edema.¹ The purpose of this study is to evaluate risk factors that predict the need for prolonged and advanced airway management postoperatively in patients with severe odontogenic infections.
A retrospective study was designed to evaluate difficult airways associated with odontogenic infections. Included subjects had presented to the University of Illinois Hospital with a confirmed odontogenic infection, requiring incision and drainage in the operating room between the years 2005-2024. The primary outcome was total days of intubation. Secondary outcomes were the frequency of need for surgical airway, hospital length of stay, and then evaluation of risk factors for intubation. The data were analyzed using the χ2, t-test, and regression analysis, with statistical significance set at P < .05.
After application of inclusion and exclusion criteria, 349 subjects were included in this study. The final dataset included 187 (54%) males and 162 (46%) females, with mean age of 40.9 ± 18.8 (range 3-89). Of the 349 subjects, 36 (10.3%) required intubation for their odontogenic infection in the perioperative period, and mean length of intubation was 4.0 ± 7.8 days, median 2 days. Tracheostomy was required in three subjects (0.9%). The intubated subjects had a longer mean length of stay, 7.6 ± 8.1 days, compared to those not intubated 3.6 ± 4.6 days (P < .00001). There were statistically significant differences between those intubated and those not regarding admission leukocytosis (75.0% vs 55.6%, P = .03), immunocompromised status (22.2% vs 10.2%, P = .03), and pharyngeal space affected on CT (38.9% vs 14.7%, P = .0003). Asthma was not a statistically significant risk factor for intubation. Regression analysis to determine risk factors for intubation found only pharyngeal space infection (P < .001) and leukocytosis on admission (.025) to be associated with risk for intubation.
In conclusion, airway compromise in the perioperative period of an odontogenic infection occurred at a rate of 10% in our patient population, and was associated with leukocytosis on admission and infection in a pharyngeal space on CT. Intubation resulted in a statistically significant increase in length of hospital stay.

References:
1. Iwata E, Inokuchi G, Kawakami M, Matsui T, Kusumoto J, Tachibana A, Akashi M. Predictive factors in difficult postoperative airway management of severe odontogenic deep neck infection. Odontology. 2024 Dec 14. doi: 10.1007/s10266-024-01041-w. Epub ahead of print. PMID: 39673651.

2. Mausser, G., & Nunez, M. (2017). Airway obstruction in head and neck infections. BJA Education, 17(7), 235–240. https://doi.org/10.1093/bjaed/mkx020