ROLE OF ADVANCED CT/MRI IMAGING IN THE EARLY DETECTION AND MANAGEMENT OF CRANIOFACIAL INFECTIONS: INTEGRATION OF DENTISTRY, NEUROSURGERY, RADIOLOGY, AND ANTIBIOTIC STEWARDSHIP

Abstract

Background: Craniofacial infection of odontogenic and sinogenic origin may cause rapid progression to life-threatening intracranial or orbital complications and early and accurate imaging as well as coordinated multidisciplinary management are essential in timely diagnosis and treatment. Objective: To evaluate the impact of the use of advanced CT and MRI imaging for early diagnosis of craniofacial infections and to compare outcomes of patients treated after early multidisciplinary team (MDT) engagement (involving Dentistry, Neurosurgery, Radiology and Antibiotic Stewardship) to standard or delayed referral team. Methodology: The study involved a multi-centre observational study with usual data collection from the Dental, Neurosurgery and Radiology departments of different Tertiary Care Hospitals of Pakistan that commenced from August 2025 to January 2026. 96 patients with a clinical diagnosis of craniofacial infection had computed tomography (CT) and/or magnetic resonance imaging (MRI) imaging performed for assessment and were separated into two groups: early multidisciplinary team (MDT) referral (n = 54) and standard and/or delayed referral (n = 42). Using SPSS version 26.0, the groups were compared in terms of the time from the initial onset of the signs or symptoms to the definitive diagnosis, length of stay in the hospital, the rate of repeated imaging studies, the rate of complications, the rate of revision surgery, and the time until appropriate empiric antibiotic selection was made. The continuous variables were compared by independent samples t-test and the categorical variables were compared by Chi-square test, taking P-value of < 0.05 as statistically significant. Results: Compared to the standard/delayed referral group, the multidisciplinary team approach group had a significantly earlier definitive diagnosis time (6.2 ± 2.4 vs 14.6 ± 5.2 hours, P < 0.001) and reduced hospital stay (7.8 ± 2.6 vs 12.4 ± 3.8 days, P < 0.001). The MDT group had significantly lower rates of repeat imaging (11.1% vs. 35.7%, p = 0.003), incidence of intracranial or orbital complications (13.0% vs. 33.3%, p = 0.014) and the percentage undergoing revision surgical intervention (7.4% vs. 26.2%, p = 0.011), while being significantly superior in terms of selecting appropriate empirical antibiotic therapy within 24 hours (90.7% vs. 47.6%, p < 0.001). Conclusion: Using structured multidisciplinary pathways that incorporate advanced computed tomography/magnetic resonance imaging (CT/MRI) and ensure coordinated input from Dentistry, Neurosurgery, Radiology and Antibiotic Stewardship, was associated with significantly reduced time to diagnosis, decreased complication rates and improved antimicrobial stewardship for patients with craniofacial infection.