Odontogenic inflammatory processes of head and neck in computed tomography examinations

Aleksandra Wabik; Barbara K Hendrich; Jan Nienartowicz; Maciej Guziński; Marek J Sąsiadek

doi:10.12659/PJR.890808

Odontogenic inflammatory processes of head and neck in computed tomography examinations

Pol J Radiol. 2014 Nov 24:79:431-8. doi: 10.12659/PJR.890808. eCollection 2014.

Authors

Aleksandra Wabik¹, Barbara K Hendrich¹, Jan Nienartowicz², Maciej Guziński³, Marek J Sąsiadek³

Affiliations

¹ Department of General Radiology, Interventional Radiology and Neuroradiology, University Hospital, Wrocław, Poland.
² Department of Maxillofacial Surgery, Wrocław Medical University, Wrocław, Poland ; Department of Maxillofacial Surgery, University Hospital, Wrocław, Poland.
³ Department of General Radiology, Interventional Radiology and Neuroradiology, University Hospital, Wrocław, Poland ; Department of General Radiology, Interventional Radiology and Neuroradiology, Wrocław Medical University, Wrocław, Poland.

Abstract

Background: Infections of odontogenic origin are the most common cause of inflammatory disease of head and neck region. Computed tomography allows for defining localization and extent of inflammatory lesions, visualizes soft tissue involvement, presence of an abscess or an osteolytic lesion around causative tooth. THE AIM OF THIS STUDY WAS TO ASSESS PATHWAYS, BY WHICH ODONTOGENIC INFECTIONS SPREAD INTO RESPECTIVE DEEP HEAD AND NECK STRUCTURES IN COMPUTED TOMOGRAPHY EXAMINATION, TAKING INTO ACCOUNT THE FOLLOWING CRITERIA: frequency of involvement of respective deep cervical spaces, possibility to determine a probable causative tooth and concordance with the results of clinical examination.

Material/methods: Thirty-eight patients cervicofacial inflammatory disease had undergone CT examination of head and neck region with a 64-slice CT scanner after intravenous contrast administration.

Results: Abscess was reported in 30 (79%) cases, while inflammatory infiltration was diagnosed in remaining 8 (21%) patients. There was full concordance between radiological report and intraoperative report In 33 cases (87%). The most commonly involved cervical space was masticator space - 31 patients (82%), followed by submandibular space - 27 patients (71%). Dental examination was impossible in 29 patient because of trismus. During analysis of CT studies we evaluated maxillary and mandibular alveolar processes for presence of osteolytic bone lesions around causative teeth roots and we found them in 30 cases (79%). In 32 cases (84%) cervicofacial infection were of mandibular odontogenic origin.

Conclusions: In most cases CT study in patients suspected of odontogenic craniofacial infection revealed presence of an abscess, needing urgent surgery. Inflammatory infiltration of dental origin most frequently involves masticator space, followed by submandibular space. In most cases CT scanning allows for identification of causative teeth, especially when trismus makes detailed clinical examination impossible.

Keywords: Inflammation; Multidetector Computed Tomography; Tooth.