Cervical necrotizing fasciitis of odontogenic origin: Case report

Abstract

Introduction. Necrotizing fasciitis is a rapidly spreading soft tissue polymicrobial infection characterized by necrosis of the subcutaneous tissue and superficial fascia. When its origin is an odontogenic infection, most cases resulted from an abscessed mandibular molar. The most common significant medical conditions in the patient's history are diabetes, immunodeficiency and substance abuse, between others. Left unchecked this infection invariably leads to systemic toxicity, multi-system organ failure and eventual death. Aggressive and frequent debridement with proper antibiotic and supportive care are essential for limiting morbidity and mortality. Case Report. A case of cervical necrotizing fasciitis involving Streptococcus pyogenes (group A) and Staphylococcus aureus in a 23-year-old woman with history of systemic lupus erythematosus is described. She was taking 20 mg/day prednisolone for 8 months and had a deeply carious tooth. Conclusion. This case shows what tooth decay may cause in immunologically compromised person. The professional should be aware of the early endodontic treatment importance, because when left unchecked, it might lead to an infection of the deep spaces of face and neck, or to cervical necrotizing fasciitis in patients with certain risk factors

A neglected lower impacted premolar leading to cervical necrotizing faciitis

“…The basic principles for the treatment of odontogenic abscesses are incision and drainage and source control. 21,23,26 In our case, x-ray examination showed an impacted tooth (mandibular right first premolar), but the patient had severe trismus and dysphagia, which prevented extraction of the tooth that had caused the infection. Moreover, the atrophic alveolar ridge might have fractured during extraction, causing additional morbidity.…”

“…9 NF is typically polymicrobial, often with anaerobic Enterobacteriaceae and occasionally with facultative anaerobes. 1,2,26 Administration of inappropriate treatment may lead to selective growth of resistant population and severe complications for the patient. It is our position that, in sepsis, not only aerobes but also anaerobes are important.…”

“…We agree with other reports that clindamycin plus gentamicin appears to be efficient for initial combination therapy in such patients. 1,16,26 Reconstruction is typically initiated once the patient has been stable for a number of days. 19,25 In the case reported herein, complete healing of the affected regions was achieved, with less esthetic and no functional restrictions at the end of treatment.…”

“…25 Fatal outcomes can be prevented by professionals who are at the first point of patient contact, 25 although the window of opportunity for surgical treatment extends to the advanced stages of the disease. 21,25,26 Adjunctive therapies as hyperbaric oxygen (HBO) therapy and frozen sections biopsies facilitate the eradication of diseased tissue, and might decrease the mortality and limit the extent of debridement in patients with CNF. 11,16 CNF is a rare, rapidly progressive, life-threatening polymicrobial infection that may be encountered by dentists, as odontogenic infection is one of its main causes.…”