title: Patterns of cervicofacial infections: analysis of the use of computed tomography.
abstract: OBJECTIVE
  The aim of this study was to determine which clinical, microbiological and radiological factors contribute to the need for repeated computed tomography (CT) imaging and surgical drainage.
  
  
  METHODS
  In this retrospective study, medical records of all patients who underwent surgical drainage of cervicofacial infections between January 2006 and August 2010 at a London tertiary referral centre were analysed. Patients who underwent CT due to a clinical suspicion of deep cervicofacial infection were divided into two groups: (1) single CT only and (2) repeated CT imaging. These groups were then compared using Fisher's exact test. Patients requiring return to theatre for additional exploration and drainage of collection were also analysed.
  
  
  RESULTS
  Four hundred and forty-five patients were admitted with cervicofacial infections, of whom 78 patients had a CT scan. The most frequent site of infection was the submandibular space, involving 54 % of patients. Among the patients who underwent repeated imaging compared to those who underwent a single CT scan, the parapharyngeal space was involved significantly more frequently (5/24 vs 2/54, p = 0.03), as was the presence of multiple-space infections (13/24 vs 15/54, p = 0.04) and osteomyelitis (4/24 vs 0/54, p = 0.007). Multiple-space infection was also more frequent in the group who required repeat visits to theatre as compared to those who had a single drainage (7/9 vs 23/69, p = 0.02).
  
  
  CONCLUSIONS
  The majority of cervicofacial infections are managed without the need for CT scanning. Presence of infection in multiple cervicofacial spaces and in the parapharyngeal space and presence of osteomyelitis result in persistent sepsis necessitating repeat imaging and drainage.
authors.affiliation: Department of Oral and Maxillofacial Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK, sunilsharma@doctors.org.uk.
authors.forename: Sunil Dutt
authors.initials: SD
authors.lastname: Sharma
authors.forename: Sri
authors.initials: S
authors.lastname: Mahalingam
authors.forename: Leandros
authors.initials: L
authors.lastname: Vassiliou
authors.forename: Stephen
authors.initials: S
authors.lastname: Connor
authors.forename: Kathleen
authors.initials: K
authors.lastname: Fan
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000601:surgery; D001424:Bacterial Infections / Q000000981:diagnostic imaging* / Q000601:surgery; D004322:Drainage; D004739:England; D006801:Humans; D010038:Otorhinolaryngologic Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome