Airway management in odontogenic infections

A national trend is developing in dramatic increases in admissions due to spreading odontogenic infections requiring incision and drainage under general anaesthetic (Carter and Starr, 2006; Morris and Ong, 2006). Odontogenic infections originate from teeth or tissues close to teeth. The literature demonstrates that admissions due to such infections have almost doubled between 1998 and 2006 (Thomas et al, 2008). However, it must be stressed that many serious dental infections can be prevented with regular routine dental care (Thomas et al, 2008).

Spreading odontogenic infections have the potential to be life threatening due to the proximity of the airway and associated factors that cause airway obstruction (Saifeldeen and Evans, 2004; Lee et al, 2014). The diameter of the upper airway is often reduced as pus enters the lateral pharyngeal and retropharyngeal spaces. The development of pus as well as generalised oedema (tissue swelling) causes elevation and displacement of the tongue, trismus (difficulty and restriction in opening the mouth) and upper airway deviation. Overall, these factors contribute to the upper airway becoming distorted. Airway compromise is often the ultimate result of rapidly spreading infection through the soft tissue spaces in the submandibular and sublingual regions.