Acute Odontogenic Maxillofacial Infections: How Early Do Patients Present for Surgical Treatment?

Objective: To determine the presentation stage and association between delayed presentation and treatment outcomes for patients with acute odontogenic maxillofacial infections (AOMIs). Background: Anecdotal evidence suggests that patients with AOMIs present late, leading to poor treatment outcomes. Methods: A prospective, observational clinical study composed of patients with AOMIs treated at Wits Oral Health Centre was conducted. Data captured included the period from onset of symptoms to presentation and demographic variables (age and sex). The primary predictor was the stage of presentation (early or delayed). The primary outcome was either resolution or reoperation. Secondary outcome variables included the occurrence of complications, such as mediastinitis. Associations between outcomes and categorical factors were analyzed using the χ2 test and the Fisher exact tests. The level of statistical significance was set at 5%. Results: A total of 116 patients with AMFOIs were included in the study, with the submandibular space (58.62%) being the most affected. Most patients with AOMIs presented late (n = 112), with a median of 7 days (interquartile range: 5–10 d). Of these 95, 36, and 65 had trismus, dyspnoea, and dysphagia, respectively. Nonresponse to prior antibiotic treatment (n = 63) was the common reason for delayed presentation. Most patients presented with multiple fascial spaces 69 (59.48%). A 15.56% reoperation rate (n= 18) was observed. Conclusion: Delayed presentation observed in this study does not appear to be an independent predictor for poor outcomes. Comorbidities, multiple space infections, Ludwig’s angina, and deep neck space infections are associated with poor outcomes. Morbidity and mortality in AOMIs can be reduced by early diagnosis and surgical intervention.