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ORO-FACIAL FASCIAL SPACE INFECTION IN A PAEDIATRIC GAMBIAN POPULATION: A REVIEW OF 93 CASES.

Background
Oro-facial fascial space infection is known to be a clinical presentation of neglected dental care. The proportion of children with dental sepsis has also been known to increase markedly with caries experience. Such fascial space infection in the paediatric age group is known to progress rapidly within a short period and is thus potentially more fatal than in the adult population.


Aim
This study aimed to document and evaluate the pattern of oro-facial fascial space infection amongst paediatric Gambian population.


Patients and Methods
The study was a 4-year descriptive retrospective survey of all patients with oro-facial fascial space infection seen and managed at the dental unit of the polyclinic attached to the Edward Francis Small Teaching Hospital in Banjul, The Gambia from May 2015 to April 2019. The information collated were patients' sociodemographic data as well as clinical features related to their medical and dental condition. The extracted data were analyzed using Statistical Package for Social Sciences (SPSS) version 15.0 (SPSS Inc, Chicago, IL). Absolute numbers and simple percentages were used to describe categorical variables. Quantitative variables were described using mean (with standard deviation), median and range. Categorical variables were compared using chi square test and numeric variables compared using student t-test. Differences were considered significant if p<0.05.


Results
A total of 322 patients with oro-facial fascial space infection were managed within the period of the study out of whom 93 patients that met the inclusion criteria were studied. Their ages ranged from 3 months to 16 years, with a mean age of 8.5(SD2.1) years. There were 54 males and 39 females with a gender (M: F) ratio of 1.4: 1. All the patients presented with painful facial swelling and fever. Eighty-one (87.1%) had a history of toothache. The median number of fascial space involvement was 1 space; the submandibular space was involved unilaterally in 43 (46.2%) and bilaterally in 8 patients (8.6%). Eighty-one (87.1%) were odontogenic in origin and 12 (12.9%) were non-odontogenic. Seventy-two (88.89%) of odontogenic cases involved posterior teeth and 45 (62.5%) of these were the first permanent molars. Incision and decompression and teeth extraction were done for all the odontogenic cases. Staphylococci and/or streptococci were cultured from six patients. All the patients had inpatient treatment with a combination of intravenous amoxicillin, metronidazole and gentamicin treatment. Mortality rate was 5.4% (5 out of 93) and the mean age of patients who died, 3.0 (SD0.3) years, was significantly lower than that of those who survived, 8.3 (SD1.4) years, (p<0.0001).


Conclusion
The commonest symptoms of oro-facial fascial space infection in the Gambian paediatric population were fever, facial swelling and toothache. Most of the infections were odontogenic and affected most commonly the submandibular space. Posterior teeth were more commonly involved than the anterior, with the first permanent molar being the most commonly affected tooth. Incision and decompression were performed in all odontogenic cases, with extraction of all culprit teeth. All patients had in-patient treatment with intravenous amoxicillin, metronidazole and gentamicin. The mortality rate was 5.4%. The burden of dental caries with its complications is huge in the paediatric population of the Gambia. Training of dental surgeons and specialists and their auxiliaries with advocacy on the need for regular dental checkup for children, as well as prompt attention to dental diseases will help to reduce this scourge.