Management of fascial space infections in a Nigerian teaching hospital: A 4-year review

BACKGROUND: Fascial space infections of the head and neck region, usually odontogenic in origin, are routinely treated as an out-patient procedure. Untreated or rapidly spreading odontogenic infections can be potentially life threatening. The present study is a review of patients with orofacial infections who required emergent incision and drainage in the maxillofacial unit of our institution. The need for early presentation is highlighted. MATERIALS AND METHODS: This is a retrospective study of patients with orofacial space infections between January 2007 and December 2010. Patients’ case files were retrieved and demographic as well as clinical characteristics were obtained and analyzed. A P value of <0.05 was considered significant. RESULTS: A total of 53 patients with fascial space infection were seen over the period of study. Of the 41 patients reviewed, males accounted for 26 (63.4%) and females 15 (36.6%). Their ages ranged from 4 months to 80 years (mean 32.8± 18.3 years). There was no statistical difference between the mean age of male and female patients (t=-962, P=0.342). Submandibular space was the most frequently involved single space and accounted for 43.9% of the cases. This was followed by multiple space involvement (Ludwig angina) which accounted for 36.6%. Buccal space and submasseteric space infection represented 7.3% each. Sources of infections were of odontogenic origin in 92.7% of cases and were unknown in the remaining 7.3%. The outcome was satisfactory with complete resolution in 48.8% of cases. Resolution with some morbidities in the form of persistent limitation of mouth opening, orocutaneus fistula, and necrotising fascitis were seen in an almost equal proportion of 46.3% of cases. The outcome was observed to be significantly associated with the presence of underlying systemic conditions (χ(2) =21.66; r=0.73; P=0.0001), time of presentation (χ(2) =12.28; r=0.55; P=0.002), and age (χ(2) =54.48; r=0.69; P=0.0001). CONCLUSION: Fascial space infections of the head and neck region, though potentially life threatening, can be prevented by regular dental visits. Early recognition and treatment of established cases are necessary to prevent considerable morbidity and mortality, especially in older patients with an underlying systemic condition.