Empyema thoracis of odontogenic origin: experience from a maxillofacial unit

Introduction
Cervicofacial infections of odontogenic origin continue to cause various complications despite improvements in clinical services, especially the use of potent antibiotics. Empyema thoracis is a life-threatening and extremely rare complication of odontogenic infections. The aim of this report is to discuss the pattern of presentation of empyema thoracis as complication of odontogenic cervicofacial infections observed in a maxillofacial unit.

Material and methods
A retrospective review of cases of descending cervicofacial infection with chest cavity involvement seen at the oral and maxillofacial clinic and co-managed with the cardiothoracic unit between January 2016 and January 2020.

Results
Five male patients presented with empyema thoracis from odontogenic infections, aged between 21 and 29 years (median, 27; mean age, 25.4 years). Coexisting systemic conditions were diabetes mellitus (1 patient), malnutrition (1 case), and mental illness (1 patient). In all cases, plain radiographs revealed pneumothorax, lung collapse, and pleural effusion. Treatment included systemic intravenous antibiotic therapy, control of diabetes, nutritional supplementation, and chest tube insertion. There was favorable outcome in four cases, while one patient died. Patients were discharged home after removal of chest tube.

Conclusions
Cervicofacial odontogenic infections are complicated by empyema thoracis, which could be fatal in various patients.