Cervical Necrotizing Fasciitis After Surgery of a Mandibular Fracture

Abstract

Introduction: Cervical necrotizing fasciitis (CNF) is a rapid progressing and potentially fatal infection of connective tissues that spreads along the fascial planes. It commonly develops from odontogenic sources. In this article, the authors present a case of CNF which was developed after open reduction and internal fixation (ORIF) of a mandibular fracture. Clinical case: A 19-year-old male patient with no past medical history was admitted due to a mandibular fracture. Following ORIF surgery, on third post-operative day, Physical examination revealed extensive cervical swelling extending from submandibular to suprasternal area, with tender and erythematous skin. Soon after confirmation of CNF diagnosis, surgical debridement and wide spectrum antibiotic therapy was performed. The residual soft tissue defect was reconstructed following infection subsidence. Conclusion: Our study aims to highlight the risk of CNF development during postoperative period of a simple mandibular fracture ORIF surgery which is considered a routine maxillofacial procedure. Early detection and adequate emergency treatment including immediate surgical intervention are critical in the management of these patients.

Cervical Necrotizing Fasciitis: A Severe Sequela of Open Mandibular Fracture and Delay in Treatment

“…In this case, aggressive surgical source control and coordinated intensive care management were essential to improving patient survival in CNF and septic shock, which is associated with a high mortality rate 2–4 . Although external fixation has largely fallen out of favor for the repair of mandible fractures, it remains a valuable option in select cases where extensive comminution, bone or soft tissue loss, or infection are present 9 .…”

“…Factors that contributed to this severe presentation include delay in treatment and poor oral hygiene, which led to an increased risk for odontogenic infections. Therefore, early treatment of open mandibular fractures in patients with poor oral hygiene and/or immunocompromised state is indicated to prevent the development of severe infectious complications 4,7,8 …”

“…Cervical necrotizing fasciitis (CNF) is an exceedingly rare disease with an incidence of 0.40 cases per 100,000 people, most often arising from odontogenic sources in the setting of underlying diabetes mellitus 1 . CNF following mandibular fracture is even less common, with only 5 documented cases in the literature and 2 out of 5 cases resulting in patient demise 2–6 . In this report, we describe the clinical management of a patient with no known history of diabetes or immunocompromised state who developed CNF and Lemierre syndrome secondary to delayed treatment of a mandibular fracture.…”

Fatal necrotizing fasciitis following a non-treated mandibular fracture: case report

“…CNF can be caused by odontogenic infection (47%), pharyngolaryngeal (28%), tonsillar (6%), traumatic, iatrogenic, or post-operative (4%) salivary gland (2%), skin (1%) between others [2]. There are few cases reported in the literature whose cause is a mandibular fracture [3,4]. Of these, Chin et al (1995) [4] had a fatal outcome, and however, unlike our case, the patient was severely immunocompromised elderly.…”

“…There are few reported cases of CNF developing after mandibular fracture [3,4], causing this report crucial for professionals who treat maxillofacial trauma.…”