DEEP NECK INFECTIONS OF ODONTOGENIC ORIGIN: SURGICAL MANAGEMENT AND MULTIDISCIPLINARY CONSIDERATIONS

Kamel Earar, Sergiu Ciprian Focsaneanu, Dorin Ioan Cocoș, Mircea Beuran

DOI : 10.62610/RJOR.2026.3.18.11

Abstract

Background: Deep neck infections of odontogenic origin may progress rapidly and cause airway compromise, sepsis, or descending necrotizing mediastinitis. Early source control and multidisciplinary management are essential in severe cases.

Methods: This retrospective observational study included 74 adult patients treated for odontogenic deep neck infections at the Department of Surgery, Clinical Emergency Hospital of Bucharest. Demographic, clinical, laboratory, imaging, microbiological, therapeutic, and outcome-related variables were analyzed. Factors associated with a complicated clinical course were assessed using multivariable logistic regression.

Results: Twenty-eight patients (37.8%) developed a complicated course. Mandibular molars were the most frequent odontogenic source (73.0%), while the submandibular space was most commonly involved. Complicated cases showed higher leukocyte counts and C-reactive protein levels and more frequent multispace and bilateral involvement. ICU admission was required in 24.3%, repeat surgery in 10.8%, advanced airway intervention in 9.5%, and descending necrotizing mediastinitis occurred in 6.8%. In-hospital mortality was 2.7%. Multispace involvement (OR 8.73; 95% CI 1.87–40.64; p = 0.006) and increasing CRP (OR 3.99 per 50 mg/L; 95% CI 1.84–8.68; p < 0.001) independently predicted complicated evolution.

Conclusions: Multispace extension and elevated CRP identify patients at increased risk and may support early escalation of surgical and multidisciplinary management.