From the Guidelines
Mandibular infections require prompt CT imaging for accurate diagnosis and management, as CT provides high image resolution and is superior to radiography for evaluating mandibular fractures and infections 1. When diagnosing mandibular infections, CT scans are essential for identifying the extent of infection, abscess formation, bone involvement, and potential spread to adjacent spaces.
- CT imaging offers superb delineation of osseous and soft-tissue structures, allowing for the detection of subtle nondisplaced fractures of the facial skeleton 1.
- CT is nearly 100% sensitive with an improved interobserver agreement, and is proficient in detecting fractures of the mandible, especially posterior mandibular fractures 1.
- CT is beneficial when evaluating ramus or condyle fractures, because the degree of displacement in these areas can be subtle 1. For management,
- empiric antibiotic therapy should begin with amoxicillin-clavulanate or clindamycin for 7-10 days 1.
- Severe infections necessitate hospitalization for IV antibiotics such as ampicillin-sulbactam or clindamycin 1.
- Surgical intervention is crucial for abscesses, with incision and drainage followed by placement of a drain for 24-48 hours 1.
- Odontogenic sources require dental treatment including extraction or root canal therapy 1.
- Pain management with ibuprofen and acetaminophen is recommended 1.
- Patients should maintain hydration, soft diet, and proper oral hygiene with warm saltwater rinses 1.
- Close follow-up within 24-48 hours is essential to assess treatment response 1. Mandibular infections can rapidly progress to life-threatening complications, making early aggressive management critical to prevent these serious sequelae 1.
From the Research
CT Diagnosis of Mandibular Infection
- Computed Tomography (CT) imaging is a crucial diagnostic tool for evaluating odontogenic infections, particularly in cases where the infection is severe or has spread to multiple fascial spaces 2.
- The decision to use CT imaging should be based on evidence-based clinical criteria, such as the location of the abscess, mandibular inferior border blunting, and restricted mouth opening 2.
- CT scans have high specificity and sensitivity in identifying acute mandibular fractures, making them the preferred imaging modality in trauma patients 3.
Management of Mandibular Infection
- Antibiotic therapy is an essential component of managing odontogenic infections, with amoxicillin/clavulanic acid being a commonly used and effective treatment option 4, 5.
- The duration of antibiotic therapy should be tailored to the individual patient's needs, with some studies suggesting that prolonged postoperative antibiotic therapy may not be necessary 6.
- Surgical drainage and debridement may also be necessary in cases where the infection is severe or has not responded to antibiotic therapy.
Imaging Modalities for Mandibular Injury
- CT scans are the preferred imaging modality for evaluating acute mandibular fractures, due to their high specificity and sensitivity 3.
- Cone-beam CT is a newer advanced imaging modality that offers high-resolution images with low radiation dose, but is less widely available and more expensive 3.
- Ultrasound and magnetic resonance imaging (MRI) may also be useful in certain situations, such as identifying soft-tissue injury or detecting nondisplaced fractures 3.