This study aimed to evaluate deep odontogenic infection (DOI) spread and features utilizing head and neck computed tomography (CT) imaging.

Patients with acute DOI and preoperative contrast-enhanced CT-imaging were included in the study. Infection spaces, radiological features of these infections, CT imaging-based compromised airway and patients’ background factors were evaluated and associations between these and need for postoperative mechanical ventilation (MV) were reported.

Altogether 262 hospitalized patients were included in the final analysis. Typically affected spaces were submandibular (74%), mandibular buccal/vestibular (37%), and sublingual (26%). Retropharyngeal (1%), mediastinal (1%) and danger space (1%) involvements were unusual. The infections were quite evenly distributed between multispace abscesses (53%) and other infections (47%). In multivariate analysis, CT-based compromised airway (OR 5.6, CI 95%, 2.9–10.9, P <0.001), midline crossing (OR 3.3, CI 95%, 1.2–8.8, P = 0.018) and extension at the level or below hyoid body (OR 2.4, CI 95% 1.2–5.1, P = 0.016) predicted the need for MV. Other radiological findings and patients’ background variables remained statistically non-significant for MV.

Anterolateral and superior spread to the neck is typical in DOIs, whereas caudal progression is rare. Postoperative need for MV can be well recognized from CT.