{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:40:59Z","timestamp":1792093259384,"version":"4.4.0"},"reference-count":44,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Odontogenic infections range from localized abscesses to life-threatening deep neck infections and are a frequent cause of emergency admission. We aimed to identify prognostic factors for postoperative complications after their surgical treatment. Methods: We retrospectively analyzed 194 adults (59.3% male) treated at the Department of Cranio-Maxillofacial Surgery in Cracow between 2020 and 2025. The primary outcome was any postoperative complication, graded by the Clavien\u2013Dindo classification and dichotomized into minor (grade I\u2013II) and major (grade \u2265 III). Prolonged hospitalization and prolonged irrigation (&gt;7 days) were secondary outcomes. Pre-specified main factors (advanced age, diffuse phlegmonous spread, diabetes mellitus) and covariates (sex, maxillary location, systemic disease) were tested by uni- and multivariable logistic regression. Results: Comorbidities were present in 69.1%. Complications occurred in 49 patients (25.3%): 19 (9.8%) minor and 30 (15.5%) major, including 12 grade IV intensive-care events and two deaths (grade V). In multivariable analysis, diffuse phlegmonous spread independently predicted any complication (adjusted OR 11.7), major complication (OR 23.4), prolonged hospitalization (OR 5.02) and prolonged irrigation (OR 4.39; all p \u2264 0.004). Advancing age independently predicted major complications (OR 1.03 per year, p = 0.037). Both fatal cases shared phlegmon, maxillary location and diabetes. Conclusions: Diffuse phlegmonous spread was the principal prognostic factor across all adverse outcomes, with advancing age additionally predicting major complications. Because intensive-care admission occurred almost exclusively in phlegmon patients, this association is partly definitional. Early identification of diffuse spread and advanced age may support effective triage.<\/jats:p>","DOI":"10.3390\/jcm15135120","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:41:01Z","timestamp":1782902461000},"page":"5120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic Factors for Adverse Outcomes in Odontogenic Infections Requiring Hospitalization: A Single-Center Retrospective Study in Krak\u00f3w, Poland"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8180-948X","authenticated-orcid":false,"given":"Micha\u0142","family":"Gontarz","sequence":"first","affiliation":[{"name":"Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5056-1980","authenticated-orcid":false,"given":"Agata","family":"Wieczorkiewicz","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Group of the Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5640-1925","authenticated-orcid":false,"given":"Andrei","family":"Hramyka","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Group of the Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1032-3084","authenticated-orcid":false,"given":"Jakub","family":"Bargiel","sequence":"additional","affiliation":[{"name":"Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3819-3499","authenticated-orcid":false,"given":"Krzysztof","family":"G\u0105siorowski","sequence":"additional","affiliation":[{"name":"Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"Szczurowski","sequence":"additional","affiliation":[{"name":"Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4215-0798","authenticated-orcid":false,"given":"Kamil","family":"Nelke","sequence":"additional","affiliation":[{"name":"Maxillo-Facial Surgery Ward, EMC Hospital, Pilczycka 144 Street, 54-144 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8602-3462","authenticated-orcid":false,"given":"Barbara","family":"Czopik","sequence":"additional","affiliation":[{"name":"Private Endodontic Practice PS24, 30-654 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0628-2419","authenticated-orcid":false,"given":"\u00d6mer","family":"Uranbey","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ayd\u0131n Adnan Menderes University, 09010 Ayd\u0131n, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Rusek","sequence":"additional","affiliation":[{"name":"Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7185-0633","authenticated-orcid":false,"given":"Gra\u017cyna","family":"Wyszy\u0144ska-Pawelec","sequence":"additional","affiliation":[{"name":"Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7086763","DOI":"10.1155\/2021\/7086763","article-title":"Odontogenic Head and Neck Region Infections Requiring Hospitalization: An 18-Month Retrospective Analysis","volume":"2021","author":"Nowak","year":"2021","journal-title":"BioMed Res. Int."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Weise, H., Naros, A., Weise, C., Reinert, S., and Hoefert, S. (2019). Severe odontogenic infections with septic progress\u2014A constant and increasing challenge: A retrospective analysis. BMC Oral Health, 19.","DOI":"10.1186\/s12903-019-0866-6"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.anorl.2015.08.007","article-title":"Criteria for admission of odontogenic infections at high risk of deep neck space infection","volume":"132","author":"Alotaibi","year":"2015","journal-title":"Eur. Ann. Otorhinolaryngol. Head Neck Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.cden.2016.11.004","article-title":"Odontogenic Infections","volume":"61","author":"Ogle","year":"2017","journal-title":"Dent. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s15010-023-02117-5","article-title":"Odontogenic infections in the antibiotic era: Approach to diagnosis, management, and prevention","volume":"52","author":"Lou","year":"2024","journal-title":"Infection"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Iwata, E., Obata, K., Kikuta, S., Kaneko, N., Sato, K., Kitagawa, N., Takeshita, Y., Matsuo, K., Sameshima, J., and Tachibana, A. (2025). The Role of the Mylohyoid Line in the Spread of Mandibular Odontogenic Deep Neck Infection. Oral Dis., Epub ahead of print.","DOI":"10.1111\/odi.70149"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1053\/j.sult.2012.06.008","article-title":"Emergency imaging assessment of deep neck space infections","volume":"33","author":"Maroldi","year":"2012","journal-title":"Semin. Ultrasound CT MRI"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajem.2020.12.030","article-title":"Diagnosis and management of Ludwig\u2019s angina: An evidence-based review","volume":"41","author":"Bridwell","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s10096-021-04347-7","article-title":"Descending necrotizing mediastinitis from Ludwig\u2019s angina: A life-threatening condition","volume":"41","author":"Carrascosa","year":"2022","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pham Dang, N., Delbet-Dupas, C., Mulliez, A., Devoize, L., Dallel, R., and Barth\u00e9l\u00e9my, I. (2020). Five Predictors Affecting the Prognosis of Patients with Severe Odontogenic Infections. Int. J. Environ. Res. Public Health, 17.","DOI":"10.21203\/rs.3.rs-28101\/v1"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hagelberg, J., Pape, B., Heikkinen, J., Nurminen, J., Mattila, K., and Hirvonen, J. (2022). Diagnostic accuracy of contrast-enhanced CT for neck abscesses: A systematic review and meta-analysis of positive predictive value. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0276544"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Neal, T.W., and Schlieve, T. (2022). Complications of Severe Odontogenic Infections: A Review. Biology, 11.","DOI":"10.3390\/biology11121784"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e834","DOI":"10.4317\/jced.59830","article-title":"Antimicrobial resistance in patients with odontogenic infections: A systematic scoping review of prospective and experimental studies","volume":"14","author":"Ardila","year":"2022","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.coms.2021.08.005","article-title":"Update on Antimicrobial Therapy in Management of Acute Odontogenic Infection in Oral and Maxillofacial Surgery","volume":"34","author":"Caruso","year":"2022","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Tapalaga, G., Nica, L.M., Cirligeriu, L.E., Bumbu, B.A., and Pricop, M. (2024). Assessment of Inflammatory Scores in Severity Prediction for Elderly Patients with Odontogenic Infections. Dent. J., 12.","DOI":"10.3390\/dj12110371"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hramyka, A., Wieczorkiewicz, A., Bargiel, J., \u015aliwi\u0144ski, K., G\u0105siorowski, K., Marecik, T., Szczurowski, P., Wyszy\u0144ska-Pawelec, G., Zapa\u0142a, J., and Gontarz, M. (2025). Management of Odontogenic Infections in Pregnant Patients: Case-Based Approach and Literature Review. Pathogens, 14.","DOI":"10.3390\/pathogens14101024"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jinf.2008.06.002","article-title":"Analysis of systemic and local odontogenic infection complications requiring hospital care","volume":"57","author":"Lauhio","year":"2008","journal-title":"J. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/BF03327427","article-title":"Deep neck infection in elderly patients. A single institution experience (2000\u20132004)","volume":"18","author":"Marioni","year":"2006","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1053\/ajot.2003.31","article-title":"Characterizations of life-threatening deep cervical space infections: A review of one hundred ninety-six cases","volume":"24","author":"Wang","year":"2003","journal-title":"Am. J. Otolaryngol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1002\/hed.20014","article-title":"Deep neck infection: Analysis of 185 cases","volume":"26","author":"Huang","year":"2004","journal-title":"Head Neck"},{"key":"ref_21","first-page":"703","article-title":"Immune disorders in sepsis and their treatment as a significant problem of modern intensive care","volume":"71","author":"Nelke","year":"2017","journal-title":"Post\u0119py Hig. I Med. Do\u015bw."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s40463-014-0035-5","article-title":"Factors associated with severe deep neck space infections: Targeting multiple fronts","volume":"43","author":"Barber","year":"2014","journal-title":"J. Otolaryngol.-Head Neck Surg."},{"key":"ref_23","first-page":"e670","article-title":"Severe odontogenic infections: Epidemiological, microbiological and therapeutic factors","volume":"16","author":"Mirada","year":"2011","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.otohns.2005.01.035","article-title":"Deep neck infection in diabetic patients: Comparison of clinical picture and outcomes with nondiabetic patients","volume":"132","author":"Huang","year":"2005","journal-title":"Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/j.jocn.2014.11.015","article-title":"Intracranial bacterial infections of oral origin","volume":"22","author":"Moazzam","year":"2015","journal-title":"J. Clin. Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.survophthal.2021.03.009","article-title":"Septic cavernous sinus thrombosis: A review","volume":"66","author":"Caranfa","year":"2021","journal-title":"Surv. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"354","DOI":"10.3390\/oral4030029","article-title":"Residual Cyst Mimicking an Aggressive Neoplasm\u2014A Life-Threatening Condition","volume":"4","author":"Lis","year":"2024","journal-title":"Oral"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1177\/0003489419843143","article-title":"The pH Value as a Factor Modifying Bacterial Colonization of Sinonasal Mucosa in Healthy Persons","volume":"128","author":"Jermakow","year":"2019","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Morawska-Kochman, M., Marycz, K., Jermakow, K., Nelke, K., Pawlak, W., and Bochnia, M. (2017). The presence of bacterial microcolonies on the maxillary sinus ciliary epithelium in healthy young individuals. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0176776"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.joms.2006.03.031","article-title":"Severe odontogenic infections, part 2: Prospective outcomes study","volume":"64","author":"Flynn","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1016\/j.joms.2006.05.023","article-title":"Microbiology and antibiotic sensitivities of head and neck space infections of odontogenic origin","volume":"64","author":"Rega","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1086\/431587","article-title":"Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus","volume":"41","author":"Muller","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.amjoto.2011.01.003","article-title":"Deep neck space infections: A retrospective review of 173 cases","volume":"33","author":"Bakir","year":"2012","journal-title":"Am. J. Otolaryngol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1177\/000348940111001111","article-title":"Deep neck abscess: A retrospective review of 210 cases","volume":"110","author":"Parhiscar","year":"2001","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_35","first-page":"293","article-title":"Deep Neck Space Infections: A Study of 76 Cases","volume":"27","author":"Kataria","year":"2015","journal-title":"Iran. J. Otorhinolaryngol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Marecik, T., G\u0105siorowski, K., Bargiel, J., Wyszy\u0144ska-Pawelec, G., and Gontarz, M. (2026). Serratia marcescens Maxillary Sinusitis and Ethmoiditis in an HIV-Positive Patient Caused by Dental Implant Migrating into the Maxillary Sinus. Oral, 6.","DOI":"10.3390\/oral6010017"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.jcms.2014.12.002","article-title":"Incidence and management of severe odontogenic infections-a retrospective analysis from 2004 to 2011","volume":"43","author":"Opitz","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1111\/adj.12070_1","article-title":"Management of severe odontogenic infections in pregnancy","volume":"58","author":"Klein","year":"2013","journal-title":"Aust. Dent. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s12070-017-1196-0","article-title":"Deep Neck Space Infections-A Study in Diabetic Population in a Tertiary Care Centre","volume":"70","author":"Sharma","year":"2018","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e10161","DOI":"10.1590\/1414-431x202010161","article-title":"Socio-environmental determinants of the delay in the first dental visit: Results of two population-based cohort studies in Brazil","volume":"54","author":"Soares","year":"2020","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"702","DOI":"10.2340\/aos.v83.42371","article-title":"Patients with severe odontogenic infections receive insufficient dental treatment before hospitalization\u2014A retrospective cross-sectional study","volume":"83","author":"Markvart","year":"2024","journal-title":"Acta Odontol. Scand."},{"key":"ref_42","first-page":"e86662","article-title":"Addressing Barriers to Care in Odontogenic Infections: The Impact of Timely Surgical Intervention on Reducing Hospital Readmissions in Vulnerable Populations","volume":"17","author":"Hussain","year":"2025","journal-title":"Cureus"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.bjoms.2020.08.075","article-title":"Neutrophil to lymphocyte ratio as a prognostic marker of deep neck space infections secondary to odontogenic infection","volume":"59","author":"Gallagher","year":"2021","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"216","DOI":"10.5125\/jkaoms.2024.50.4.216","article-title":"Prediction of intensive care unit admission using machine learning in patients with odontogenic infection","volume":"50","author":"Yoon","year":"2024","journal-title":"J. Korean Assoc. Oral Maxillofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:05:54Z","timestamp":1782907554000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":44,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135120"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135120","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]}}}