CECT Outperforms Physical Exam in Mapping Deep-Neck Infections, Suggests Study

Although odontogenic space infections represent common maxillofacial emergencies that rapidly propagate along fascial planes and cause severe airway or vascular compromise, prior radiological research has focused on isolated findings rather than standardized evaluation, leaving a distinct gap in systematic reporting. Addressing this clinical unmet need, Dr. Bhavana K. Murjani from All India Institute of Medical Sciences (AIIMS) Kalyani, along with co-investigators from Government Dental College and Hospital (GDCH) Mumbai, conducted the study to systematically evaluate CECT manifestations and establish a structured reporting framework for comprehensive image interpretation.

Therefore, the cross-sectional study at GDCH Mumbai evaluated 40 patients with suspected deep or recurrent odontogenic infections using 128-slice CECT within 24 hours of clinical assessment. Using paired t-tests, the study compared fascial space involvement detected clinically versus via CECT, while establishing a systematic interpretation framework.

Key Clinical Findings of the Study Includes:

• Widespread Multi-Space Propagation – The study shows that multi-space spread occurred in 97.5% of patients (n=39) compared to isolated single-space involvement in only 2.5% (n=1), with buccal (n=29) and submandibular (n=27) regions being most frequently affected.
• Superior Deep Compartment Detection— CECT identified significantly more total fascial spaces than bedside examination (mean 4.20 vs. 3.08 spaces; P = 0.022), successfully detecting clinically occult deep spaces including submasseteric (n=16), infratemporal (n=12), and pterygomandibular (n=21) compartments.
• High Inflammatory and Suppurative Yield – Imaging demonstrated reactive lymphadenopathy and subcutaneous fat stranding in 90% of cases (n=36), drainable abscess formation in 80% (n=32), loss of fat planes in 62.5% (n=25), and anaerobic gas pockets in 22.5% (n=9).
• Critical Adjacent Structure Impact – The data show that CECT confirmed adjacent soft tissue involvement, including muscle enlargement or displacement in 45% (n=18), salivary gland pathology in 42.5% (n=17), and airway displacement or narrowing in 30% (n=12) of evaluated cases.

The results suggest that contrast-enhanced computed tomography provides essential diagnostic accuracy by capturing multi-space involvement in 97.5% of patients and identifying an average of 4.20 involved fascial compartments per individual compared to 3.08 detected clinically. Furthermore, CECT effectively distinguishes medical cellulitis from drainable abscesses present in 80% of cohort subjects while systematically evaluating potential life-threatening airway and vascular complications.

To optimize patient management, clinicians evaluating recurrent, refractory, or suspected deep-space head and neck infections should integrate CECT alongside routine physical examinations and adopt a standardized assessment framework to ensure thorough image interpretation.

While constrained by a single-institution sample of 40 patients and an unvalidated retrospective framework without formal interobserver agreement testing, these initial findings pave the way for future multicenter prospective trials to confirm interobserver reproducibility, integrate microbiological profiles, and refine clinical severity scoring systems.

Reference

Murjani BK, Kadam SG, Ramaswami E, Nimma V, Ramchandani AD, Umarji H. Contrast‑enhanced computed tomography in odontogenic space infections: A cross‑sectional study with the development of a structured reporting framework. J Indian Acad Oral Med Radiol 2026;38:298-303.