Odontogenic infection progressing to necrotizing fasciitis: An unusual clinical emergence

Rajanikanth, B. R.; Madhuri, B.; Prasad, Kavitha; Vineeth, K; Munoyath, Sejal K.

doi:10.1016/j.omsc.2018.10.006

Cited by 1 publication

(3 citation statements)

References 14 publications

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“…Presenting in different forms and progressing rapidly, cervical NF caused by oral cavity infection is a disease with limited prevalence but considerable complexity. The case described herein was treated following clinical consensus, which implies the adequate management of the patient's comorbidities, the application of broad-spectrum empirical antibiotic treatment plus an antibiogram, early surgical intervention involving extensive surgical debridement, and the elimination of oral infection (Voros et al, 1993;Mohammedi et al, 1999;Ord & Coletti, 2009;Al-Ali et al, 2018;Gore, 2018;Rajanikanth et al, 2018). We also calculated the LRINEC score (Table I), which can allow the early detection of cases of NF (Wong et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

“…Necrotizing fasciitis (NF), also known as streptococcal gangrene, necrotizing erysipelas, and Fournier's gangrene (Sahoo & Tomar, 2014;Ord & Coletti, 2009;Rajanikanth et al, 2018), is a rare, aggressive infection that compromises the subcutaneous cellular tissue, fascia, and, in advanced stages, muscles and deep vessels, thereby generating significant systemic toxicity (Ord & Coletti, 2009). The literature describes a variable prevalence of NF depending on the population studied, along with a mortality rate ranging from 17 % to 64 % (Whitesides et al, 2000;Hohlweg-Majert et al, 2006;Ord & Coletti, 2009;Al-Ali et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Concerning the head and neck, the literature reports that cervical NF constitutes between 2.6 % and 5.0 % of all NF (Martínez et al, 2016), with dental and pharyngeal infections being the most frequent causes (Elander et al, 2016;Barria et al, 2018;Rajanikanth et al, 2018). The late diagnosis and treatment of cervical NF can lead to several complications, the most frequent being sepsis and mediastinitis (Lanisnik & Cizmarevic, 2010;Cortese et al, 2017;Alegbeleye, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Cervical Necrotizing Fasciitis Caused by Oral Cavity Infection: A Case Report Considering Therapeutic Approach and its Morphofunctional Implications

Calderón,

Loo,

Bozán

et al. 2023

Int. J. Morphol.

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Cervical necrotizing fasciitis (NF) is a rare complication of oral cavity infection with high morbi-mortality. Given its low prevalence, adequately reporting cases of NF, its therapeutic management, and associated morphofunctional modifications to the clinical and scientific community is pivotal. To that end, we herein describe a case of cervical NF in a 60-year-old patient with comorbidities and patient presented large, painful cervical swelling associated with a necrotic ulcer lesion in the anterior neck region. Intraoral examination indicated a periodontal abscess in the right mandibular area, while computed tomography indicated the lesion's extension from the right mandibular to the submandibular region. Following empirical intravenous antibiotic treatment, a broad surgical debridement was performed, and the foci of oral infection were removed. Debridement revealed communication between deep and superficial anatomical regions in the submandibular area, where we subsequently placed a Penrose drain. Biopsies showing acute inflammatory infiltrate associated with necrotic and hemorrhagic regions confirmed the diagnosis of NF. When an antibiogram revealed resistance to the empirical treatment, the antibiotic scheme was replaced with an adequate alternative. After a second debridement, we closed the defect with fascio-mucocutaneous advancement flaps with a lateral base while maintaining suction drainage. Having reacted positively, the patient was discharged 10 days after the operation. Despite an extensive morphofunctional change generated in the treated area, the patient showed no difficulties with breathing, phonation, swallowing, or mobilizing the area during control sessions. Altogether, this report contributes to the highly limited literature describing morphological aspects that can facilitate or delay the spread of infection or the morphofunctional disorders associated with the size and depth of surgical interventions for cervical NF, information that is relevant for the comprehensive, long-term prognosis of the treatment of NF.

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