Fact-sheet: Dental cellulitis - abcess


Updated on 10/03/2018 at 2:31 PM

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Definition

Cervicofacial cellulitis secondary to a dental abscess: infection of the cervicofacial fascial and fat spaces spreading contiguously from a septic inoculation of the tissues (apical dental granuloma).

Predisposing factors: poor oral hygiene, diabetes, alcoholism, NSAIDs…

Complications:

  • necrotizing fasciitis
  • mediastinitis (low risk given lateral rather than midline cellulitis)
  • sepsis

Clinical features

Forms: localized vs extensive form (more severe clinical presentation)

Clinical signs:

  • dull pain
  • fever
  • lymphadenopathy / cervical-facial swelling
  • local inflammation
  • +/- subcutaneous emphysema (crepitus)
  • -/+ dysphagia, trismus

Laboratory findings

Biological inflammatory syndrome

CT

Cellulitis: infiltration of a fat space with increased density and reticular pattern of the fat.

--> lateral cellulitis most often centered on the masticator space

Superficial fasciitis: thickening of the superficial cervical fascia and/or the superficial layer of the deep cervical fascia

Myositis: increased volume +/- heterogeneous enhancement of adjacent muscles (often associated with cellulitis and fasciitis)

Dental abscess: markedly hypodense (fluid) collection, well defined by a rim enhancing after IV contrast, adjacent to a tooth with periradicular lucency

Management

Antibiotic therapy +/- drainage

Treatment of the causative tooth

Differential diagnosis

Other etiologies of cervicofacial cellulitis (non-dental):

  • Pharyngo-tonsillar (sore throat)
  • Salivary gland involvement (e.g., sialadenitis)
  • Traumatic (foreign body), iatrogenic (postoperative)
  • Epiglottitis
  • Superinfected tumor
  • Tuberculosis or other infection with suppurative adenitis
  • Cutaneous
  • Congenital (thyroglossal duct cysts / branchial cleft cysts...): sources of recurrent infection