Extensive Cervical Necrotizing Fasciitis of Odontogenic Origin

Abstract

Necrotizing fasciitis (NF) is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of necrotizing fasciitis from odontogenic origin in a patient with uncontrolled diabetes mellitus. The initial diagnosis was based on clinical information, in which multiple necrosis areas in cervical and thoracic regions were observed. Wide antibiotic therapy was applied, followed by surgical drain age and debridement. Culture was positive for methicillin-resistant Staphylococcus aureus. Although the treatment is established, the patient dies after sepsis and failure of vital organs. Clearly, the morbidity associated to this infection, even in diabetic patients, can be minimized if an early diagnosis and effective debridement are done.

Cervical necrotizing fasciitis and acute mediastinitis of odontogenic origin: A case series

“…In contrast, NF is less common in the head and neck area due to the high vascularization of cervical region ( 4 ). Despite this, the development of a cervical necrotizing fasciitis might be life-threatening ( 5 ). In fact, it is associated with mortality rates of 7% to 20% according to the extension of the infection at the time of diagnosis ( 3 ).…”

A neglected lower impacted premolar leading to cervical necrotizing faciitis

“…Once the disease has progressed sufficiently, small soft-tissue opacities representing gas formation can be observed on CT, as can compromise airway. 1,2,5,7,21,22 The availability of CT imaging has greatly enhanced early diagnosis. Treatment is often beset by complications, secondary not only to the patient's underlying medical condition but also to the delay in, or insufficiency of, surgical treatment.…”

“…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.…”

Determinants of Length of Hospitalization due to Acute Odontogenic Maxillofacial Infections: A 2009-2013 Retrospective Analysis

“…The longer hospitalization time associated with coexisting systemic diseases confirmed those of previous studies regarding the involvement of, for example, diabetes [ 6 ], patients' older age [ 20 ], self-medication and delayed presentation at the hospital [ 1 ]. Therefore, timely management of acute odontogenic infections is necessary not only to avoid local complications but also to minimize systemic complications or death [ 21 , 22 ].…”