Computed tomography (CT) images showing the presence of gas appeared to indicate a more serious infection, according to a study published recently in the Journal of Oral and Maxillofacial Surgery.
Imaging that showed gas resulted in patients not only having more severe infections but longer stays at hospitals and needing more incision and drainage procedures, the authors wrote.
“The presence of gas bubbles was strongly correlated with more serious head and neck infections, which led to worse patient outcomes,” wrote the authors, led by Dr. S. Loren Moles, an assistant professor with the University of Texas Health Science Center at Houston (J Oral Maxillofac Surg, February 16, 2026).
Figure 1. Demonstration of an odontogenic abscess without (left) and with (right) gas contained within the abscess.Images and captions courtesy of Moles et al. Licensed under CC BY 4.0.
In the U.S., there are about 2 million visits to hospital emergency rooms annually for dental pain. When patients have a dental abscess with facial swelling, they undergo a CT scan to help identify the size, location, and origin of the infection. Though the incidence of odontogenic infections and dental-origin deep neck infections dropped over the last few decades because of the use and availability of antibiotics, these infections are the leading cause of deep neck infections in U.S. adults.
To investigate whether gas found on a CT scan in a patient with an odontogenic infection influenced patient outcomes, a single-site retrospective cohort study was conducted at the University of Illinois Health Emergency Department. Patients with confirmed odontogenic abscesses who underwent required incision and drainage in the operating room were included in the study, according to the study.
Of the 321 patients, 86 (26.8%) presented with gas on their CT scans. Those who presented with gas on their scans had a mean hospital stay that was higher (5.9 +/- 7.8 days) compared to 3.3 +/- 3.1 days (p = 0.003) than those without gas present on their scan, the authors wrote.
Also, admission to the intensive care unit was higher, with 16.3% of the gas cohort admitted compared to 10.2% (p = 0.135) of the others. Furthermore, the need for multiple incision and drainage procedures was higher in the gas cohort, 16.3% compared to 8.1% (p=0.033), they wrote.
However, the study had limitations, including that the sizes and locations of the gas on the CT images were not evaluated, the authors wrote.
“In conclusion, patients with odontogenic head and neck abscesses, that had gas present on CT imaging within the abscess, were more severe regarding length of hospital stay and the need for additional incision and drainage procedures,” Moles and colleagues wrote.
