Orofacial space infections, etiology, microbiological susceptibility and surgical management.

  • Noor Abdullah Sulaiman Ghazi al-Hariri Surgical Specialities Hos-pital, Baghdad, Iraq.
  • Sabah Abdulaziz Issa Ghazi al-Hariri Surgical Specialities Hospital, Baghdad, Iraq.
  • Najwa Abdul Razzak Ghazi al-Hariri Surgical Specialities Hospital, Baghdad, Iraq.


Orofacial infections are considered as one of most common infections and need rapid and adequate treatment as they affect a very delicate region and are associated with serious life-threatening complications. Orofacial infections can be either odontogenic that is with an origin in teeth and associated structures or non-odontogenic, not associated with teeth, can affect facial spaces and spread from one space to another, so a good knowledge about diagnosis and treating these infections is of utmost importance, and can include both non-surgical and surgical treatment. The aim of our study was to determine the most common cause of orofacial infections, the most common bacterial microorganisms and their antibiotic susceptibility. Materials and Methods: A descriptive study was undertaken in the Department of Oral and Maxillofacial Surgery, Al-Shaheed Ghazi Al-Hariry Hospital, Baghdad, Iraq from 1st January to 30th September 2015. This study included 45 patients with different forms of orofacial infections; data regarding age, gender, underlying cause, facial space involvement, presenting signs were collected through history, clinical examination and radiographs, incision and drainage with swab sample for culture and sensitivity test was performed. Results: Patients with orofacial infections showed a female to male ratio of 1.25:1. The mean age was 32.8 years. Most of the patients were in their 4th decade of life (27%). Most infections were odontogenic in origin (62%), the most common facial space involved was submandibular (65%), the most common isolated microorganism was Streptococcus pyogenes (59%), and most patients were treated using an extra-oral surgical approach (78%). Antibiotics to which bacterial isolated showed the most sensitivity were netilmicin, cefoperazone and rifampicin (91%). Pain and limitation of mouth opening gradually decreased in most of patients during the two weeks follow up period. Conclusion: Orofacial infections were more common in females, in the third and fourth decade of life, were odontogenic in origin, were mostly caused by Streptococcus pyogenes, and most isolates were susceptible to netilmicin, cefoperazone and rifampicin. Pain and trismus decreased over two weeks post-treatment.


1. Huang TT, Tseng FY, Yeh TH, Hsu CJ, Chen YS, Factors affecting the bacteriology of deep neck infection: A retrospective study of 128 patients. Acta Otolaryngol.2006; 126:396-401.
2. Parhiscar A, Har-El G. Deep neck abscess: A retros-pective review of 210 cases. Ann Otol Rhinol Laryngol. 2001;110(11):1051-4.
3. Sandor GK, Low DE, Judd PL, Davidson RJ. Antimicrobial treatment options in the management of odontogenic infections. J Can Dent Assoc. 1998;64:508-14.
4. Kuriyama T, Nakagawa K, Karasawa T, Saiki Y, Yamamoto E, Nakamura S. Past administration of â-lactam antibiotics and increase in the emergence of â-lactamase-producing bacteria in patients with orofacial odontogenic infections. J Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:186-92.
5. Fragiskos, Fragiskos D, Oral surgery. Berlin: Springer. 2007.
6. The Medical Dictionary of Mosby. 8th Ed. San Luis, United States. ELSEVIER. 2009.
7. Levinson W, Chin-Hong P, Joyce EA, Nussbaum J, Schwartz B. Review of Medical Microbiology & Immunology: A Guide to Clinical Infectious Diseases. 11th Ed. New York: McGraw-Hill. 2010.
8. Fating NS, Saikrishna D, Vijay Kumar GS, Shetty SK, Raghavendra Rao M. Detection of bacterial flora in orofacial space infections and their antibiotic sensitivity profile, J Maxillofac Oral Surg. 2014;13(4):525-32.
9. Kityamuwesi R, Muwaz L, Kasangaki A, Kajumbula H, Rwenyonyi CM. Characteristics of pyogenic odontogenic infec-tion in patients attending Mulago Hospital, Uganda: a cross-sectional study. BMC Microbiol. 2015;15:46.
10. Ishfaq M, Khan M, ud Din Q. Primary facial space infections. JKCD. 2012;2(2): 78-82.
11. Singh M, Deepashri H. Kambalimath, Gupta KC. Mana-gement of Odontogenic Space Infection with Microbiology Study. J Maxillofac Oral Surg. 2014; 13(2): 133–9.
12. Chow A. Orofacial Infections, Infectious disease and antimicrobial agents. 2014. Avalaible at: http://www.antimicrobe.org/e57.asp
13. Read-Fuller A, Mueller A, Finn R. Maxillofacial infections. SROMS. 2015;23(3).
14. Veronez B, Pando de Matos F, Monnazzi MS, Sverzut AT, Sverzut CE, Trivellato AE. Maxillofacial infection. A retrospective evaluation of eight years. Braz J Oral Sci. 2013;13(2):98-103.
15. Bahl R, Sandhu S, Singh K, Sahai N, Gupta M. Odontogenic infections: Microbiology and management. Contemp Clin Dent. 2014;5(3):307-11.
16. İsmi O, Yeşilova M, Özcan C, Vayisoğlu Y, Görür K. Difficult Cases of Odontogenic Deep Neck Infections: A Report of Three Patients. Balkan Med J. 2017;34(2):172-9.
17. Walia IS, Borle RM, Mehendiratta D, Yadav AO. Sensitivity Microbiology and antibiotic sensitivity of head and neck space infections of odontogenic origin. J Maxillofac Oral Surg. 2014;13(1):16-21.
18. Celakovsky P, Kalfert D, Smatanova K, Tucek L, Cermakova E, Mejzlik J, Bacteriology of deep neck infections: analysis of 634 patients. Aust Dent J. 2015;60:212–5.
19. Kim MK, Chuang SK, August M. Antibiotic Resistance in Severe Orofacial Infections. J Oral Maxillofac Surg. 2017;75(5):962-8.
20. Sobottka I, Wegscheider K, Balzer L, Böger RH, Hallier O, Giersdorf I, Streichert T, Haddad M, Platzer U, Cachovan G. Microbiological analysis of a prospective, randomized, double-blind trial comparing moxifloxacin and clindamycin in the treatment of odontogenic infiltrates and abscesses. Antimicrob Agents Chemother. 2012;56(5):2565-9.
21. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009;10(5):447-85.
22. Chunduri NS, Madasu K, Goteki VR, Karpe T, Reddy H. Evaluation of bacterial spectrum of orofacial infections and their antibiotic susceptibility. Ann Maxillofac Surg. 2012; 2(1): 46–50,
23. O'Toole M. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, 7th Edition. Saunders. 2003.
24. Santosh AN, Viresh AN, Sharmada BK, Microbiology and antibiotic sensitivity of odontogenic space infection, IJMDS. 2014; 3(1).
How to Cite
SULAIMAN, Noor Abdullah; ISSA, Sabah Abdulaziz; RAZZAK, Najwa Abdul. Orofacial space infections, etiology, microbiological susceptibility and surgical management.. Journal of Oral Research, [S.l.], v. 9, n. 1, p. 44-50, feb. 2020. ISSN 0719-2479. Available at: <http://joralres.com/index.php/JOR/article/view/1002>. Date accessed: 08 apr. 2020. doi: https://doi.org/10.17126/10.17126/joralres..