Odontogenic Cervicofacial Necrotizing Fasciitis: Microbiological Characterization and Management of Four Clinical Cases

Abstract

Necrotizing fasciitis of the head and neck is a rare, very severe disease, which, in most cases, originates from odontogenic infections and frequently ends with the death of the patient. Rapid surgical intervention in combination with a preferably pathogen-specific antibiotic therapy can ensure patients’ survival. The question arises concerning which pathogens are causative for the necrotizing course of odontogenic inflammations. Experimental 16S-rRNA gene analysis with next-generation sequencing and bioinformatics was used to identify the microbiome of patients treated with an odontogenic necrotizing infection and compared to the result of the routine culture. Three of four patients survived the severe infection, and one patient died due to septic multiorgan failure. Microbiome determination revealed findings comparable to typical odontogenic abscesses. A specific pathogen which could be causative for the necrotizing course could not be identified. Early diagnosis and rapid surgical intervention and a preferably pathogen-specific antibiotic therapy, also covering the anaerobic spectrum of odontogenic infections, are the treatments of choice. The 16S-rRNA gene analysis detected significantly more bacteria than conventional methods; therefore, molecular methods should become a part of routine diagnostics in medical microbiology.

Síndrome Da Abstinência Neonatal E Suas Consequencias Ao Recém-Nascido

“…Quando a doença é diagnosticada, faz-se necessário realizar a terapia cirúrgica com urgência. Entretanto, deve ser instalada como terapia de emergência na presença de manchas arroxeadas, bolhas hemorrágicas escuras ou necrose cutânea definitiva (MELLO et al, 2017;GUNARATNE et al, 2018;BÖTT-GER et al, 2021;BÖTTGER et al, 2022). Em comparação com o abscesso Volume 5 odontogênico, a FN não tem uma adequada resistência tecidual, permitindo que o dedo contuso seja avançado sob a pele enfraquecida.…”

“…Em comparação com o abscesso Volume 5 odontogênico, a FN não tem uma adequada resistência tecidual, permitindo que o dedo contuso seja avançado sob a pele enfraquecida. Aqui, é imperativo expor a fáscia afetada e remover completamente o tecido necrosado (BÖTTGER et al, 2021;BÖTTGER et al, 2022). Após o diagnóstico e o avanço da doença, com sinais de isquemia e aparecimento de tecido necrótico como resultado, a biodisponibilidade dos medicamentos no tecido desvitalizado é reduzida, com isso, a cirurgia deverá ser realizada precocemente através do desbridamento e lavagem dos espaços.…”

“…Após o diagnóstico e o avanço da doença, com sinais de isquemia e aparecimento de tecido necrótico como resultado, a biodisponibilidade dos medicamentos no tecido desvitalizado é reduzida, com isso, a cirurgia deverá ser realizada precocemente através do desbridamento e lavagem dos espaços. Esta técnica tem sido associada a um melhor prognóstico e menor incidência de mortalidade, sendo atualmente considerada o tratamento de primeira escolha (BÖTTGER et al, 2021;BÖTTGER et al, 2022).…”

Complications of Severe Odontogenic Infections: A Review

“…The incidence of necrotizing fasciitis in the United States is estimated to be 0.4 cases per 100,000 individuals [ 74 ]. While odontogenic infections are the most common cause of cervical necrotizing fasciitis, an estimated 3–10% of all necrotizing fasciitis cases involve the head and neck [ 75 , 76 ]. It is estimated that 1% of severe odontogenic infections progress to cervical necrotizing fasciitis [ 77 ].…”

Delayed diagnosis and management of necrotizing fasciitis of the left lower leg: A case report

“…NF patients are at a risk of developing sepsis, septic shock, and multiple organ failure, with a high mortality rate (6-76%) and potentially fatal outcomes. [1][2][3] NF may be misdiagnosed as a common skin and soft tissue infection, thereby leading to erroneous treatment. Here we report a case of NF with delayed diagnosis and treatment due to the inexperience of the attending physician, and subsequent correct diagnosis and good recovery after multidisciplinary consultations.…”