Analysis of Risk Factors of Oral and Maxillofacial Space Infection Originated from Third Molar

doi:10.3969/j.issn.1005-4979.2020.04.008

Abstract

Abstract:

Objective: To investigate the risk factors of the third molars related to oral and maxillofacial space infections. Methods: A total of 103 patients with oral and maxillofacial space infection originated from malposed third molars were included in this study. The clinical characteristics and correlation were analyzed by descriptive analysis and Spearman rank respectively. Results: The descriptive analysis showed that male patients were more than female patients, and the male-female ratio was 1.64∶1. The youth group has the largest number of patients (70.87%). Multi-spaces infection was a common type of infection. The most common cause of maxillofacial space infection from the third molars was pericoronitis (69.90%). The mandibular third molars were the most frequently infected teeth (92.23%), and the type of impacted teeth were likely to be vertical and mesioangular/high and median. Summer was the onset season for space infection. Farmers were more susceptible. Serious complications occurred in 17 cases (16.50%). Spearman rank correlation coefficient method analysis showed that the correlation between age and inclination or depth of the third molars was P<0.047 and P<0.018, respectively. And the correlation between inclination and depth of the third molar was P<0.003, showing significant differences. Conclusion: Age and the inclination and ambush depth of the third molars are the risk factors of oral and maxillofacial space infections originated from the third molars.

Key words: odontogenic, third molar, oral and maxillofacial space infection, risk factors

摘要：

目的：研究第三磨牙来源的口腔颌面部间隙感染的危险因素。方法：选取103例第三磨牙来源的口腔颌面部间隙感染患者，描述性统计分析其临床特点并采用Spearman秩相关系数法分析其相关性。结果：描述性分析结果显示，男性患者较女性多，男女比例为1.64∶1；青年组患者人数最多，占70.87%；多间隙感染是常见的感染类型；第三磨牙来源的颌面部间隙感染最常见的病因是冠周炎（69.90%）；下颌第三磨牙是感染好发牙位（92.23%），且阻生类型以垂直、近中阻生，高位、中位阻生多见；好发季节为夏季；农民是最常见的感染人群；有17例患者（16.50%）出现严重并发症。Spearman秩相关系数分析结果显示，年龄与第三磨牙倾斜向、埋伏深度相关性分别为P<0.047和P<0.018，倾斜向与埋伏深度相关性为P<0.003，差异均有统计学意义。结论：年龄与第三磨牙的倾斜向和埋伏深度是第三磨牙来源的口腔颌面部间隙感染的危险因素。

关键词: 牙源性, 第三磨牙, 口腔颌面部间隙感染, 危险因素

CLC Number:

R782

HUANG Fangfang, TIAN Ling, WEI Qian, ZHOU Nuo. Analysis of Risk Factors of Oral and Maxillofacial Space Infection Originated from Third Molar[J]. 《Journal of Oral and Maxillofacial Surgery》, 2020, 30(4): 234-238.

黄芳芳, 田玲, 韦倩, 周诺. 第三磨牙来源的口腔颌面部间隙感染危险因素分析[J]. 《口腔颌面外科杂志》, 2020, 30(4): 234-238.

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URL: https://journal06.magtech.org.cn/Jweb_joms/EN/10.3969/j.issn.1005-4979.2020.04.008

https://journal06.magtech.org.cn/Jweb_joms/EN/Y2020/V30/I4/234

Figures/Tables 4

References 15

[1]	Zhang C, Tang Y, Zheng M, et al. Maxillofacial space infection experience in West China: a retrospective study of 212 cases[J]. Int J Infect Dis, 2010, 14(5): e414-e417.
[2]	Han X, An J, Zhang Y, et al. Risk factors for life-threatening complications of maxillofacial space infection[J]. J Craniofac Surg, 2016, 27(2): 385-390. doi: 10.1097/SCS.0000000000002416 pmid: 26967077
[3]	Taub D, Yampolsky A, Diecidue R, et al. Controversies in the management of oral and maxillofacial infections[J]. Oral Maxillofac Surg Clin North Am, 2017, 29(4): 465-473. doi: 10.1016/j.coms.2017.06.004 URL
[4]	Iwanaga J, Watanabe K, Anand MK, et al. Air dissection of the spaces of the head and neck: a new teaching and dissection method[J]. Clin Anat, 2020, 33(2): 207-213. doi: 10.1002/ca.23454 pmid: 31444831
[5]	Khawaja NA, Khalil H, Parveen K, et al. A retrospective radiographic survey of pathology associated with impacted third molars among patients seen in oral & maxillofacial surgery clinic of college of dentistry, Riyadh[J]. J Int Oral Health, 2015, 7(4): 13-17.
[6]	Rasteniene R, Pūriene A, Aleksejūniene J, et al. Odontogenic maxillofacial infections: a ten-year retrospective analysis[J]. Surg Infect (Larchmt), 2015, 16(3): 305-312. doi: 10.1089/sur.2013.264 URL
[7]	Katoumas K, Anterriotis D, Fyrgiola M, et al. Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department[J]. J Craniomaxillofac Surg, 2019, 47(8): 1292-1299. doi: S1010-5182(19)30171-4 pmid: 31331847
[8]	Indresano AT, Haug RH, Hoffman MJ. The third molar as a cause of deep space infections[J]. J Oral Maxillofac Surg, 1992, 50(1): 33-36. doi: 10.1016/0278-2391(92)90190-B URL
[9]	Chaparro-Avendaño AV, Pérez-García S, Valmaseda-Castellón E, et al. Morbidity of third molar extraction in patients between 12 and 18 years of age[J]. Med Oral Patol Oral Cir Bucal, 2005, 10(5): 422-431.
[10]	Keswani ES, Venkateshwar G. Odontogenic maxillofacial space infections: a 5-year retrospective review in navi Mumbai[J]. J Maxillofac Oral Surg, 2019, 18(3): 345-353. doi: 10.1007/s12663-018-1152-x
[11]	Chuang SK, Perrott DH, Susarla SM, et al. Age as a risk factor for third molar surgery complications[J]. J Oral Maxillofac Surg, 2007, 65(9): 1685-1692. doi: 10.1016/j.joms.2007.04.019 URL
[12]	Kamat RD, Dhupar V, Akkara F, et al. A comparative analysis of odontogenic maxillofacial infections in diabetic and nondiabetic patients: an institutional study[J]. J Korean Assoc Oral Maxillofac Surg, 2015, 41(4): 176-180. doi: 10.5125/jkaoms.2015.41.4.176 pmid: 26339575
[13]	Celebi N, Kütük MS, Tas M, et al. Acute fetal distress following tooth extraction and abscess drainage in a pregnant patient with maxillofacial infection[J]. Aust Dent J, 2013, 58(1): 117-119. doi: 10.1111/adj.12025 pmid: 23441802
[14]	Ghaeminia H, Perry J, Nienhuijs ME, et al. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth[J]. Cochrane Database Syst Rev, 2016(8): CD003879.
[15]	Babu VR, Ikkurthi S, Perisetty DK, et al. A prospective comparison of computed tomography and magnetic resonance imaging as a diagnostic tool for maxillofacial space infections[J]. J Int Soc Prev Community Dent, 2018, 8(4): 343-348. doi: 10.4103/jispcd.JISPCD_315_17 pmid: 30123768

变量	分类	单间隙（n=30）	多间隙（n=73）	合计(n=103)
性别	男	17/26.56	47/73.43	64/62.14
	女	13/33.33	26/66.67	39/37.86
年龄分组	青年组	24/32.88	49/67.12	73/70.87
	中年组	3/12.50	21/87.50	24/23.30
	老年组	3/50.00	3/50.00	6/5.83
感染原因	冠周炎	23/31.94	49/68.06	72/69.90
	龋坏	4/28.57	10/71.43	14/13.59
	根尖周炎	3/18.75	13/81.25	16/15.54
	牙周炎	0	1/100.00	1/0.97
感染牙位	18	0	0	0
	28	2/25.00	6/75.00	8/7.77
	38	20/36.36	35/63.64	55/53.40
	48	8/20.00	32/80.00	40/38.83
Pell-Gregory	高位阻生	21/39.59	38/64.41	59/57.28
分类	中位阻生	7/18.42	31/81.58	38/36.80
	低位阻生	2/33.33	4/66.67	6/5.82
Winter分类	垂直阻生	16/29.09	39/70.91	55/53.40
	水平阻生	2/25.00	6/75.00	8/7.77
	近中阻生	12/30.00	28/70.00	40/38.83
	远中阻生	0	0	0
	倒置阻生	0	0	0
	颊侧阻生	0	0	0
	舌向阻生	0	0	0

变量	分类	单间隙（n=30）	多间隙（n=73）	合计(n=103)
性别	男	17/26.56	47/73.43	64/62.14
	女	13/33.33	26/66.67	39/37.86
年龄分组	青年组	24/32.88	49/67.12	73/70.87
	中年组	3/12.50	21/87.50	24/23.30
	老年组	3/50.00	3/50.00	6/5.83
感染原因	冠周炎	23/31.94	49/68.06	72/69.90
	龋坏	4/28.57	10/71.43	14/13.59
	根尖周炎	3/18.75	13/81.25	16/15.54
	牙周炎	0	1/100.00	1/0.97
感染牙位	18	0	0	0
	28	2/25.00	6/75.00	8/7.77
	38	20/36.36	35/63.64	55/53.40
	48	8/20.00	32/80.00	40/38.83
Pell-Gregory	高位阻生	21/39.59	38/64.41	59/57.28
分类	中位阻生	7/18.42	31/81.58	38/36.80
	低位阻生	2/33.33	4/66.67	6/5.82
Winter分类	垂直阻生	16/29.09	39/70.91	55/53.40
	水平阻生	2/25.00	6/75.00	8/7.77
	近中阻生	12/30.00	28/70.00	40/38.83
	远中阻生	0	0	0
	倒置阻生	0	0	0
	颊侧阻生	0	0	0
	舌向阻生	0	0	0

编号	性别	年龄	累及间隙	全身状况	并发症	治疗	预后
1	男	18	多间隙	—	边缘性骨髓炎	切开引流、手术刮除死骨	良好
2	女	24	多间隙	妊娠（7个月）	菌血症	切开引流	良好
3	女	25	单间隙	妊娠（6个月）	边缘性骨髓炎	切开引流	良好
4	男	26	多间隙	—	边缘性骨髓炎	切开引流	良好
5	女	27	单间隙	—	边缘性骨髓炎	切开引流、	良好
6	女	27	多间隙	早产后6天	早产、边缘性骨髓炎	切开引流、手术刮除死骨	良好
7	女	29	单间隙	妊娠（8个月）	先兆早产	切开引流	良好
8	男	30	多间隙	—	肺炎	切开引流	良好
9	男	31	多间隙	—	左下颌骨骨髓炎	切开引流、手术刮除死骨	良好
10	女	33	多间隙	“小三阳”	呼吸困难、肺炎	切开引流、气管切开	良好
11	女	33	多间隙	—	肺炎	切开引流	良好
12	男	38	多间隙	糖尿病、肝硬化	胸腔积液	切开引流	良好
13	男	41	多间隙	—	呼吸困难、肺炎	切开引流、气管切开	良好
14	女	48	多间隙	—	呼吸困难、肺炎、纵膈感染	切开引流、气管切开	良好
15	男	51	多间隙	糖尿病	呼吸困难、纵膈感染	切开引流、气管切开	良好
16	男	52	多间隙	高血压、冠状动脉支架植入术后、肾功能不全	呼吸困难、肺炎、胸腔积液	切开引流、气管切开	良好
17	男	62	多间隙	类风湿、梅毒	呼吸困难、败血症	切开引流、气管切开	自动出院

编号	性别	年龄	累及间隙	全身状况	并发症	治疗	预后
1	男	18	多间隙	—	边缘性骨髓炎	切开引流、手术刮除死骨	良好
2	女	24	多间隙	妊娠（7个月）	菌血症	切开引流	良好
3	女	25	单间隙	妊娠（6个月）	边缘性骨髓炎	切开引流	良好
4	男	26	多间隙	—	边缘性骨髓炎	切开引流	良好
5	女	27	单间隙	—	边缘性骨髓炎	切开引流、	良好
6	女	27	多间隙	早产后6天	早产、边缘性骨髓炎	切开引流、手术刮除死骨	良好
7	女	29	单间隙	妊娠（8个月）	先兆早产	切开引流	良好
8	男	30	多间隙	—	肺炎	切开引流	良好
9	男	31	多间隙	—	左下颌骨骨髓炎	切开引流、手术刮除死骨	良好
10	女	33	多间隙	“小三阳”	呼吸困难、肺炎	切开引流、气管切开	良好
11	女	33	多间隙	—	肺炎	切开引流	良好
12	男	38	多间隙	糖尿病、肝硬化	胸腔积液	切开引流	良好
13	男	41	多间隙	—	呼吸困难、肺炎	切开引流、气管切开	良好
14	女	48	多间隙	—	呼吸困难、肺炎、纵膈感染	切开引流、气管切开	良好
15	男	51	多间隙	糖尿病	呼吸困难、纵膈感染	切开引流、气管切开	良好
16	男	52	多间隙	高血压、冠状动脉支架植入术后、肾功能不全	呼吸困难、肺炎、胸腔积液	切开引流、气管切开	良好
17	男	62	多间隙	类风湿、梅毒	呼吸困难、败血症	切开引流、气管切开	自动出院

危险因素	单/多间隙		牙位		倾斜向		埋伏深度
危险因素	P	r	P	r	P	r	P	r
性别	0.468	-0.072	0.169	-0.136	0.513	0.065	0.775	0.029
年龄	0.3	0.103	0.553	0.059	0.047^*	-0.196	0.018^*	-0.232
牙位	0.184	0.132			0.156	0.141	0.2	-0.127
倾斜向	0.955	0.006	0.156	0.141			0.003^**	0.292
埋伏深度	0.136	0.148	0.2	-0.127	0.003^**	0.292
季节	0.717	-0.036	0.558	-0.058	0.097	-0.164	0.114	-0.157
职业妊娠	0.067 0.540	-0.181 -0.114	0.156 0.926	-0.141 0.017	0.235 0.316	0.118 0.186	0.574 1	0.056 0

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