Characteristics And Treatment Of Maxillofacial Space Infection In Diabetic Patients

Background:Oral and maxillofacial space infection is one of the common diseases in stomatology,and its insufficient cognition from patients is an important reason for its increasing incidence year by year.Most patients complain of unexpected dental or tonsil discomfort,which can lead to space infection or even hospitalization.As a basic disease,diabetes has evolved into one of the most common chronic noninfectious diseases in recent years,which can aggravate the symptoms of maxillofacial space infection,induce a variety of complications and even lead to death of patients.Objective:Through investigating the infection characteristics of patients with oral and maxillofacial space infection and hyperglycemia as well as comparing the blood routine count,bacterial culture,and drainage methods between diabetes patients and non-diabetes patients,a flushing and drainage method for the special position of the sub-temporal space was raised with the shorten course of diabetes infected patients and the improved cure rate of severe patients.Method:The clinical data of 70 patients diagnosed as maxillofacial space infection who were hospitalized in Affiliated hospital of Yangzhou university from December 2015 to December 2022 were retrospectively studied,then their blood glucose,maxillofacial CT examination,infection site incision and drainage,pus taken for bacterial culture and drug sensitivity test,and negative pressure drainage in the pus cavity were monitored.Patients with necrotizing fasciitis,local infection and even descending mediastinitis were treated with necessary surgery,systemic support,and lavatory drainage if necessary.SPSS 26.0 software was used to conduct independent sample T-test for two columns of normal grouping rows,and Mann-Whitney U test was used for comparison between groups with non-normal distribution,and P<0.05 showed a statistical difference.Result:1.The age of diabetes group was 43~80 years old with the average age of 60.92 years old;the age of the non-diabetes group was 9~84 years old with the average age of 45.24 years old,both of which showed significantly different(P = 0.007 < 0.05);2.The average fasting blood glucose concentration in diabetes group was 10.53 mmol/L,which was significantly higher than that in non-diabetes group(4.86 mmol/L,P<0.05).The average fasting white blood cell count of the diabetes group on the next day after admission was 15.78×10~9/L,showing no significant difference with that in nondiabetes group(14.43×10~9/L,P=0.852).The average percentage of neutrophils on the second day of admission in the diabetes group was 83.89%,significantly higher than that in the non-diabetes group(72.67%,P=0.001).The average fasting neutrophil count on the next day of admission in the diabetes group was 12.25×10~9/L,significantly higher than that in non-diabetes group(8.24×10~9 /L,P=0.005);3.Odontogenic infection occupied the first place in both groups,wherein the normal group and the diabetes group were most likely to affect the submandibular space,and the most commonly detected pathogens in both groups were streptococcus,accounting for 56.00% and 55.56% respectively.Besides,the detection rate of Klebsiella pneumoniae in the diabetes group was 22.22%,significantly higher than that in the non-diabetes group(4.00%).4.Vancomycin is sensitive to 98% of the common bacteria in both groups,and imipenem could also target most of the bacteria.Polymyxin + Ceftazidime Avibactam could effectively inactivate Klebsiella pneumoniae which often occurs in diabetes patients.5.The days in hospital for the diabetes group was 14.12,significantly higher than that for the non-diabetes group(7.87,P=0.009).Conclusion:1.The treatment of patients with severe oral and maxillofacial space infection should follow the below principles: establishing effective drainage under the premise of controlling the basic diseases of the whole body,and hedging the toilet to keep the pipeline unobstructed if necessary;selecting highly targeted antibiotics;effective treatment of basic diseases is often more important than simple control of maxillofacial space infection;2.The infection of patients with diabetes progresses rapidly,which is easy to form necrotizing fasciitis,deep neck infection and even descending mediastinitis in the early stage,showing longer hospitalization time and higher occurrence probability of electrolyte disorders,ketosis,endocrine disorders,and other complications,thus it is more important to actively control blood sugar and pay attention to the changes of electrolyte and routine blood test of patients;3.The scope of surgical indications for diabetes patients should be appropriately expanded,and the lavatory method of “upper washing and lower drainage” should be selected as compared to the traditional single root negative pressure drainage,which is conducive to improving the cure rate of patients;4.For the infection of the temporal and infratemporal space,mastering the anatomical structure skillfully could be used for placing the negative pressure drainage tube at the early stage to reduce or avoid important vascular and nerve tissue infection around the infratemporal space,so as to reduce the surgical trauma and hospitalization costs in the later treatment.