• Journal of Korean Dental Science
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• v.7 no.2
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• pp.94-98
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• 2014

Numerous oral and maxillofacial surgeons have found facial space infections after tooth extraction. Most of these infections can be managed easily, but some of them could be life-threatening. Among the facial infections, temporal space infections are rare. Most temporal space infections could be observed as secondary to maxillary third molar infections, maxillary sinusitis, and maxillary sinus fractures. Note, however, that there are insufficient studies on temporal space abscess due to mandibular second molars, especially with acupuncture. A 74-year-old female came to our hospital with severe trismus and facial swelling on the right temporal, buccal, posterior auricular, and cervical regions. The patient had undergone extraction of tooth #47 secondary to dental caries by a general dentist about a month ago. After the dental procedure, the patient had been treated with acupuncture therapy around the right temporomandibular joint area at the oriental medicine clinic. We performed emergency incision and drainage under general anesthesia and started antibiotic treatment with IV ampicillin/sulbactam 3 g every 24 hours and vancomycin 1 g every 24 hours for 5 days. The patient's symptoms subsided and ultimately disappeared. Temporal space abscess after mandibular molar extraction is quite rare. In this case, the spreading mechanism against gravity is considered to be acupuncture therapy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.20 no.2
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• pp.152-157
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• 1998

Disturbances of the interrelationship among the host, environment, microorganism will cause the infection clinically. Infection can be classified into bacterial, viral, fungal origin, Bacterial infection is most common due to dental caries, periodontal disease. These infections have the potential to spread via the fascial spaces in the head and neck region. We have undertaken clinical studies on infections in the oral and maxillofacial regions by analyzing 78 hospitalized patients in the Dept. of Oral and Maxillofacial Surgery, Dong-A University Hospital from 1994 to 1997. The results were as fellows; l. Odontogenic infections were most common with the incidence of 84.6%. 2. Considering the number of involved space, single space was 83.3%, double or more space was 16.6%. The most common fascial space involved was submandibular space and followed by buccal space, 3. The most causative organism isolated from the pus cultures was streptococci group 35.4%. 4. Antibiotics were administrated in all cases, and surgical incision and drainage was performed in 87.2%. 5. Combined administration of penicillin and aminoglycoside was most common in 34.6%.. 6. 7 cases were diagnosed as Ludwig's angina and tracheostomy was done in 2 cases of them.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.2
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• pp.222-230
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• 1991

Pyogenic orofacial infections are most commonly odontogenic in origin. Although such infections are usually self-limiting and spatially confined, purulent material may occasionally borrow deeply into contiguous fascial space or planes far from the initial site of involvement. The incidence of orofacial infection remains low in this modern era of preventive dental care and antibiotic therapy, but severe orofacial infections are most frequently observed in the medically compromised patients. We experienced 5 cases of severe orofacial odontogenic infection associated with medical diseases, and then concluded as follows : 1. The average hospitalized period was about 5 weeks, and the signs that indicated that the infections were controlled usually appeared in third week after incision and drainage. 2. The involved medical diseases were diabetes mellitus iatrogenic Cushing's syndrome, rheumatoid arthritis, malnutrition, etc. 3. The medical diseases should be treated coincidently with control of infection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.1
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• pp.31-34
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• 2009

Purpose: This study compared the frequency of postoperative infections in patients for a closed mandibular fracture with that without the postoperative antibiotic prophylaxis. Patients and Methods: 48 patients without any specific medical history were divided into two groups depending on whether or not antibiotics had been applied after the surgery. The 24 patients in group 1 received only a second-generation cephalosporin ($Cefotetan^{(R)}$) intravenously from admission to immediate after the surgery. Likewise, 24 patients in group 2 received 1.0g of $Cefotetan^{(R)}$ twice daily longer than the third day after surgery. The mean (SD) duration of antibiotics administration after surgery was 6.9 (${\pm}3.56$). The patients were evaluated after surgery for any postoperative infections according to the criteria: purulent drainage from a wound, spontaneous wound dehiscence accompanied by swelling, pain, and fever around the wound. Results: Postoperative infections were encountered in 2 out of 24 patients in group 1, who received antibiotic medication until shortly after surgery, and in 3 out of the 24 patients in group 2, in whom the medication was continued even after the surgery. There was no sig nificant difference in the incidence of postoperative infections between the two groups. Conclusion: From this study, postoperative use of antibiotics seems to be unnecessary with view of the little significance of the factors that could affect the wound infection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.6
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• pp.497-503
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• 2004

One of the most difficult problems to damage in dentistry is an odontogenic infection. These infections may range from low-grade, well-localized infections that require only minimal treatment to a severe, life-threatenig fascial space infection. Although the overwhelming majority of odontogenic infections are easily managed by minor surgical procedures and supportive medical therapy that includes antibiotic administration, the practitioner must constantly bear in mind that these infections may become severe in a very short time. We made an investigation was targeting on 78 male and 47 female patients (125 patients in total) who had been hospitalized because of the fascial space abscess on the oral and maxillofacial area and gained a complete recovery in Daegu Catholic University Hospital, Oral & Maxillofacial Surgery from January 1999 to December 2003. By tracing their charts, we could grasp the characteristics such as age, gender, the time of breakout and specific areas of the attacks, making a conclusive study of the statistical analysis and finally, we could reach conclusions. Now, we report the conclusion from the investigation with the literature. The proportion of males and females was approximately 3 to 2, and in age group, patients under 10 years old marked the highest, 22.4%. The patients between the age of 10 and 40 were only 14.4%, yet those who were between 40 and 80 marked 53.6% in contrast. In the monthly distribution, the order was Dec.(13.6%)-Sep.(12%)-Jan.(10.4%) and in seasonal distribution, it was winter(30.4%)-fall(28%)- summer(24.4%)- spring(19.2%). Considering the medical history, D.M. was the highest which was 30.3%, hypertension marked 24.4%, and the patients with both D.M. and hypertension were 9.0%. The major cause of infection of oral and maxillofacial areas was odontogenic infection, which marked about 96%, and especially the cases related to dental caries occurred most frequently, which was 51.2%. In the number of relaxed fascial space, single fascial space was 81.6%, and in the degree of relaxation of fascial space, the buccal space abscess marked 40.8%, following submandibular space abscess, which was 30.4%.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.4
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• pp.176-180
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• 2015

Objectives: The increased prevalence of antibiotic resistance is an outcome of evolution. Most patients presenting with odontogenic space infections also have associated systemic co-morbidities such as diabetes mellitus resulting in impaired host defense. The present study aims to compare the odontogenic spaces involved, antibiotic susceptibility of microorganisms, length of hospital stay, and the influence of systemic comorbidities on treatment outcome in diabetic patients. Materials and Methods: A 2-year prospective study from January 2012 to January 2014 was conducted on patients with odontogenic maxillofacial space infections. The patients were divided into two groups based on their glycemic levels. The data were compiled and statistically analyzed. Results: A total of 188 patients were included in the study that underwent surgical incision and drainage, removal of infection source, specimen collection for culture-sensitivity, and evaluation of diabetic status. Sixty-one out of 188 patients were found to be diabetic. The submandibular space was the most commonly involved space, and the most prevalent microorganism was Klebsiella pneumoniae in diabetics and group D Streptococcus in the nondiabetic group. Conclusion: The submandibular space was found to be the most commonly involved space, irrespective of glycemic control. Empiric antibiotic therapy with amoxicillin plus clavulanic acid combined with metronidazole with optimal glycemic control and surgical drainage of infection led to resolution of infection in diabetic as well as nondiabetic patients. The average length of hospital stay was found to be relatively longer in diabetic individuals.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.577-581
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• 2010

Descending necrotizing mediastinitis (DNM) is a complication of odontogenic or oropharyngeal infections that can spread to the mediastinum. Such infections is serious, leading to sepsis and frequently to death. Even in this era of antibiotics, the mortality rate associated with DNM is approximately 40%. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. Delayed diagnosis is the principal reason for the high mortality in DNM. Therefore, descending necrotizing mediastinitis requires an early and aggressive surgical approach to reduce the high morbidity and mortality associated with this disease. We experienced a case of odontogenic infection followed by acute mediastinitis, so present now with the review of literatures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.1
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• pp.46-54
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• 1995

Postoperative infection following orthognatic surgery is rare. When postoperative infections occur, the initial treatment consists of incision and drainage of the affected area, culturing to identify bacterial stains and verify antibiotic sensitivity, and the institution of the appropriate antibiotic regimen. Some plates and screws may eventually require removal, the initial therapy should be attempted to retain the plates and screws until adequete healing has taken place. In orthoganthic surgery, intra-operative complications as a lesion of inferior alveolar nerve, fracture of osteomised segments, incomplete sectioning, malposition of segments, haemorrhage may occur. The surgeon should be familiar with possible complications to be caused and how to manage them. Prevention of postoperative infection following the orthognathic surgery consists of minimal periosteal reflection, aseptic management of operation field, proper surgical technique, rigid fixation, prophylactic antibiotics.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.2
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• pp.167-172
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• 2009

The maxilla rarely undergoes necrosis due to its rich vascularity. Maxillary necrosis can occur due to bacterial infections such as osteomyelitis. viral infections such as herpes zoster and fungal infections such as mucormycosis, aspergillosis etc. Herpes zoster is a common viral infection, the oral soft tissue manifestations of which are widely known and recognized. Extremely rare complications such as osteonecrosis, and secondary osteomyelitis in maxilla were observed. But, reports of spontaneous tooth exfoliation and jaw osteonecrosis following herpes zoster infection in the distribution of the trigeminal nerve are extremely rare in the literature. We report a case of maxillary necrosis by herpes zoster in an uncontrolled diabetic patient. There was extensive necrosis of the buccal and palatal mucoperiosteum and exposure of the alveolar bone. This patient was successfully treated using a removal of necrotic bone and nasolabial flap. We briefly discuss different diseases which can lead to maxillary necrosis and a review. Analysis of the pathogenesis of herpes zoster and bone necrosis are discussed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.626-635
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• 1996

Odontogenic infections are usually locally confined, self-limiting processes. However, under certain circumstances, they may break through the bony, muscular, and mucosal barriers and spread into contiguous fascial spaces or planes far from the initial site of involvement, resulting in severe life-threatening complications, such as retropharyngeal spread, suppurative mediastinal extension, airway obstruction, pleuropulmonary suppuration, and hematogenous dissemination to distant organs. The mortality arte for mediastinitis from odontogenic infection ranges from 40% to 60%. Therefore rapid evalution and treatment is essential with a combination of life support, antibiotic therapy, and surgical intervention. Recently, we experienced three cases of retropharyngeal and mediastinal abscesses secondary to odonogenic infections. In all patients, early diagnosis was possible by CT scanning and physical examination. The prognosis was good in all patients by using urgent aggressive surgical and antibiotic therapy.