Deep Fascial Space Infection and Localized Acute Apical Abscess: A Cone Beam Computed Tomography Assessment

Abstract

Abstract Objectives Variability in the clinical and radiographic presentation of acute apical abscess (AAA) exists. The objective of this study was to evaluate anatomical differences and patterns of bone loss in patients with AAA clinically presenting as a localized swelling or with concomitant fascial space involvement using cone-beam computed tomographic (CBCT) imaging. Materials and Methods Thirty CBCT images of AAA cases presenting with fascial space involvement (FSI) and 31 cases of AAA presenting with a localized swelling (LAAA) were evaluated. Factors that were recorded and compared included the presence/absence of cortical disruption, the distance of the involved tooth apex to the buccal and lingual/palatal cortex, the length of the anatomic root/s of the involved tooth, and the volume of the endodontic lesions. Results The median for the volume of the lesions were 138 mm3 for the FSI group and 154 mm3 for the LAAA group (p > 0.05). Radiographic evidence of cortical disruption was seen in 26.7% of the cases with FSI and 41.9% of the cases with LAAA (p > 0.05). The mean root length was 12.3 mm for the FSI group and 12.4 mm for LAAA group (p > 0.05). The mean for distance of the apex to the buccal cortex was the only statistically significant difference between the two groups and was 4.2 mm for the FSI group and 3 mm for the LAAA group (p < 0.05). Conclusions CBCT assessment showed root apices associated with fascial space involvement tended to be more confined in cancellous bone. Though a significant difference between the 2 conditions was found, the inflammatory process is complex, and CBCT assessment alone cannot predict AAA remaining as a localized swelling versus spreading to fascial spaces. Clinical Significance: Emergency room visits for odontogenic infections are a burden on the healthcare system. Anatomical differences and radiographic patterns of bony lesions could be used in determining the tendency of cases with acute apical abscess toward forming a localized swelling or progressing into fascial space infection.