The pattern of presentation and management of fascial space infections at Charlotte Maxeke Academic Hospital

Abstract

Purpose: The purpose of this study was to determine the major causes of fascial space infections as well as the pattern of distribution. This study describes the social, demographic and clinical characteristics of the affected patients as well as the incidence of fascial space infections and the extent of treatment received. Study design: This is a retrospective study evaluating all patients admitted to the Maxillofa-cial and Oral surgery department at Charlotte Maxeke Johannesburg Academic Hospital from 1 September 2015 - 31 August 2017.Results: A total of 202 patients were included in the study with a male dominance of 68.32% and a mean age of 34.13 years ranging from 16 – 84 years. All patients were treated ac-cording to the guidelines proposed by Peterson which included incision and drainage with the administration of antibiotics. An odontogenic cause for the fascial space infection was determined in 157 cases (77,72%) whilst non-odontogenic causes accounted for 45 cases (22.28%). The fascial spaces involved presented either in isolation or in combination with other spaces and the submandibular space was most commonly involved (64 cases), fol-lowed by the subperiosteal space (55), buccal space (40), submasseteric space (35), sub-lingual and submental spaces (31 each). 59 patients had involvement of 2 or more fascial spaces. Ludwig’s angina was recorded in 14 cases. Mandibular third molars were directly or indirectly involved in 146 cases (72.27 %) when odontogenic and non-odontogenic causes were considered. Six antibiotics were effective in the treatment of the patients either in isolation or in combination with another antibiotic. Of the 202 patients that were admitted with fascial space infections, 201 were discharged home following a mean hospital stay 4.93 days ranging from 1 day to 29 days and 1 patient demised. Conclusion: Fascial space infections are a serious risk to patient’s health and life and needs extensive surgical as well as medical treatment in order to reverse the condition. The major cause of fascial space infections at CMJAH was sepsis associated with third molars occur-ring at a mean age of 34.13. We concluded that fascial space infections are of great concern and the incidence of 19.39% is significant. HIV prevalence in the population may also be a contributing factor. It is suggested that the prophylactic removal of suspicious mandibular third molars at a younger age may significantly improve outcomes by decreasing the inci-dence and severity of fascial space infections. This will in turn reduce the usage of scarce resources to treat these conditions and prevent significant morbidity to patients whilst im-proving the overall economic impact of the hospitalization.