SA3 - Incidence and Risk Factors for Severe Extraoral Complications of Odontogenic Infections

Oral Abstract Presenter(s)

• 

  Brendan Wu, DMD, MD, MMSc

  Resident
  Bellevue Hospital Center/NYU Langone Health
  New York, New York

Co-Author(s)

• 

  Peter Rekawek, DMD, MD

  Resident
  Bellevue Hospital Center/NYU Langone Health
  New York, New York
• 

  Vasiliki Karlis, DMD, MD

  Program Director, Associate Professor
  Bellevue Hospital Center/NYU Langone Health
  New York, New York
• 

  Kenneth E. Fleisher, DDS, FACS (he/him/his)

  Clinical Professor
  Bellevue Hospital Center/NYU Langone Health
  new york, New York

Abstract:
Statement of Problem:Odontogenic infections can spread beyond the oral cavity through fascial planes, reaching potential spaces in the head, cervical, and thoracic region. This dissemination can lead to life-threatening conditions, including intracranial abscess, septic cavernous sinus thrombosis, orbital cellulitis, Lemierre’s syndrome (septic thrombophlebitis of the internal jugular vein), descending mediastinitis, and necrotizing fasciitis. This study aims to determine the incidence and risk factors for developing these severe extraoral complications in patients presenting to United States emergency departments with odontogenic infections.
Materials and

Methods: This retrospective cohort study utilized the 2022 Nationwide Emergency Department Sample (NEDS). Patients with odontogenic infections (ICD-10-CM K12.2 and K04-) were included. Predictor variables comprised patient demographics, medical comorbidities, and social history (substance use, insurance status, income). The primary outcome was the occurrence of severe odontogenic complications, including intracranial abscess, cavernous sinus thrombosis, orbital cellulitis, Lemierre’s syndrome, mediastinitis, and necrotizing fasciitis. Secondary outcomes included inpatient admission and mortality. Univariate analyses were conducted for all predictor variables, followed by bivariate analyses to assess associations with severe complications.
Results and Outcomes: A total of 2,530 patients met the inclusion criteria, with a majority being male (55%) and an average age of 43 years. The incidence of severe odontogenic complications was 1.2%; for intracranial abscess, 0.6%; for cavernous sinus thrombosis, 3.1% for orbital cellulitis, 1.7%; for Lemierre’s syndrome, 1.2%; for mediastinitis, and 2.8%; for necrotizing fasciitis. The overall admission rate for odontogenic infections was 69%, with a mortality rate of 0.6%.

Intracranial abscesses were significantly associated with older age (48 years, P = .041), hypertension (P = .009), and alcohol use disorder (P < .001). Lemierre’s syndrome was linked to older age (49 years, P = .049), heart failure (P = .016), obesity (P = .011), opioid use disorder (P < .001), and smoking (P = .036). Mediastinitis was more likely with older age (51 years, P = .025), male gender (P = .005), immunodeficiency (P = .013), heart failure (P = .016), and polysubstance use disorder (P = .013). Necrotizing fasciitis was strongly correlated with older age (49 years, P = .005), male gender (P < .001), type 2 diabetes mellitus (P < .001), and alcohol use disorder (P < .001). Income and insurance status were not significant predictors of complications (P>0.05).

All 6 complications were significantly associated with inpatient admission (P < .05). Cavernous sinus thrombosis, Lemierre’s syndrome, mediastinitis, and necrotizing fasciitis were linked to increased mortality (P < .05).

Conclusions: Severe complications of odontogenic infections were rare but linked to increased hospitalization and mortality. Risk factors for immune dysfunction, such as older age, type 2 diabetes mellitus, obesity, and acquired immunodeficiency, appear to raise susceptibility to extraoral spread. Patients with cardiovascular, endocrine, or immunologic comorbidities, as well as those with substance use disorders, may benefit from early aggressive intervention to prevent devastating consequences.

References
1. Neal TW, Schlieve T. Complications of Severe Odontogenic Infections: A Review. Biology (Basel). 2022 Dec 8;11(12):1784.
2. Bali RK, Sharma P, Gaba S, Kaur A, Ghanghas P. A review of complications of odontogenic infections. Natl J Maxillofac Surg. 2015 Jul-Dec;6(2):136-43.
Table 2. Characteristics of Patients with Odontogenic Infections. Table 7. Odontogenic Infections Stratified by Mediastinitis. Table 8. Odontogenic Infections Stratified by Necrotizing Fasciitis.