Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature

Abstract

Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.

Anterior Chest Wall Abscess Secondary to Odontogenic Infection: A Case Report

“…Propagation of infection in these spaces can lead to other life threatening complications such as necrotizing fasciitis and descending mediastinitis. Necrotizing fasciitis of odontogenic origin affecting the head and neck region is a rare but life threatening clinical condition that is associated with a poor prognosis if not treated early [6]. Management of necrotizing fasciitis entails surgical treatment of the necrotic tissue by debridement fasciotomy and antimicrobial therapy against the offending organism [14].…”

“…Inappropriate surgical management of space infections of the head and neck can result in progression to life threatening complications. Such complications include sepsis, mediastinitis, Lemierre's syndrome, necrotizing fasciitis, empyema aspiration pneumonia and brain abscesses [4][5][6]. Much of the literature has spoken about these complications but only one case thus far has been reported on spread of odontogenic infection to the anterior chest wall [7].…”

The Efficacy of Pyogenic Cavity Aerobic Therapy with Negative Pressure Drainage in the Treatment of Deep Neck Space Infections

“…2,3 In severe cases, these infections are life-threatening. 4,5 The standard treatment of deep fascial space infections includes medical support for patients, surgical drainage of the infection and correct use of antibiotics. 4 With early administration of antibiotics, there has been a decline in the incidence of this type of disease in recent years.…”

“…Reports have shown that vacuum sealing drainage (VSD) or a method similar to VSD can markedly improve the therapeutic effect of deep neck multiple space infections. 9, 14 Cortese et al 5 reported that the use of a suctioning resection technique associated with hyperbaric oxygen therapy achieved good results in the treatment of odontogenic necrotizing fasciitis. They considered that sucking and removing dead tissue controlled the spread of inflammation into deeper areas.…”

“…They considered that sucking and removing dead tissue controlled the spread of inflammation into deeper areas. 5 Crew et al 17 reported that negative pressure wound therapy combined with irrigation of a pure hypochlorous acid solution 0.01% achieved good results in the treatment of acute necrotizing fasciitis, as this combination therapy killed bacteria quickly and simultaneously inactivated toxins and superantigens. 17 We consider that when an abscess in the deep neck spaces has formed in a large area, incision and drainage should be carried out as early as possible, especially for a multiple lacunar abscess.…”