<p class="abstract">Mr KE is a 46 years old gentleman with a background of type 2 diabetes mellitus who was referred to our department for severe polymicrobial cervical necrotising fasciitis with descending mediastinitis after mandibular dental extraction. He was managed with endotracheal intubation, cervicotomy and video assisted thorascopic surgery (VATS), antibiotic and antifungal therapy and myocutaneous flap coverage. This case describes a classical presentation of an uncommon pathology and discusses options for airway management, surgical debridement, antimicrobial therapy and definitive defect coverage.   </p>