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      Minor trauma triggering cervicofacial necrotizing fasciitis from odontogenic abscess

      case-report

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          Abstract

          Necrotizing fasciitis (NF) of the face and neck is a very rare complication of dental infection. Otolaryngologists and dentists should be familiar with this condition because of its similarity to odontogenic deep neck space infection in the initial stages, its rapid spread, and its life-threatening potential. Trauma has been reported to be an important predisposing factor for NF of the face. In this paper, we describe the presentation and treatment of a 62-year-old man who developed NF of the face and neck following bilateral odontogenic deep neck space abscesses. The disease progressed rapidly, with necrosis of the skin, after the patient inflicted minor trauma in the form of application of heated medicinal leaves. The organism isolated in culture from pus was Acinetobacter sp. The comorbid conditions in our patient were anemia and chronic alcoholism. The patient was managed by immediate and repeated extensive debridements and split-skin grafting.

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          Necrotizing fasciitis of the head and neck: role of CT in diagnosis and management.

          R Hermans, P Zbären, F. MARCHAL … (1997)
          To determine the characteristic diagnostic features of necrotizing fasciitis and to evaluate the role of computed tomography (CT) in its management. Fourteen patients with surgically proved necrotizing fasciitis of the extracranial head and neck were examined with contrast material-enhanced CT. Clinical, radiologic, surgical, pathologic, and anatomic findings at admission and after initial treatment were analyzed retrospectively. Constant CT features of necrotizing fasciitis were diffuse thickening and infiltration of the cutis and subcutis (cellulitis); diffuse enhancement and/or thickening of the superficial and deep cervical fasciae (fasciitis); enhancement and thickening of the platysma, sternocleidomastoid muscle, or strap muscles (myositis); and fluid collections in multiple neck compartments. Inconstant CT features included gas collections, mediastinitis, and pleural or pericardial effusions. All patients underwent extensive surgical debridement. Follow-up CT scans in 11 patients revealed clinically unsuspected progression of the inflammatory process in previously unaffected areas, a finding that warranted additional surgery in nine patients. Twelve patients survived, and two patients died of septic shock and aspiration pneumonia despite intensive surgical and medical treatment. Early recognition of necrotizing fasciitis with CT enables appropriate surgical treatment. CT may also be a useful guide in further patient treatment after initial surgical debridement.
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            Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature.

            Satoshi Yokoo, Tsutomu Minamikawa, Takahide Komori … (2003)
            Necrotizing fasciitis of the head and neck is an uncommon, potentially fatal soft tissue infection characterized by extensive necrosis and gas formation in the subcutaneous tissue and fascia. The aims of this study were to describe the condition of this rare disease and to find factors affecting the mortality. Nine of our new cases and 125 reported cases in the English-language literature with necrotizing fasciitis of dental origin were reviewed. Two of our 9 patients had some form of systemic disease such as diabetes, cardiac insufficiency, renal failure, or cerebral infarction, whereas the other 7 had no particular general complications. A computed tomography examination was useful for detecting gas formation in the deep neck. All 9 patients underwent extensive debridement within 24 hours, and good results were obtained. In contrast, 24 of the 125 reviewed patients died despite therapy. Factors affecting the mortality were associated diseases such as diabetes or alcohol abuse, delay of surgery, and the complication mediastinitis. Necrotizing fasciitis is still a potentially fatal disease. Early and aggressive debridement may reduce mortality.
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              Cervical necrotizing fasciitis of odontogenic origin: a report of 11 cases.

              H Jehn-Shyun, Michael W C Yiu, John C Ching (2000)
              Although most cases of cervical necrotizing fasciitis (CNF) are odontogenic in origin, reports of this disease in the dental literature are sparse. The purpose of this study was to review the cases treated on our service, and to analyze the features of this disease and the responses to management, to supplement the understanding of this relatively rare and life-threatening disease. All cases of infection admitted to the OMS service in a period of 10.5 years were studied retrospectively. The diagnosis of CNF was established by the findings on surgical exploration and histologic examination. The patients' age, sex, medical status, causes of the infection, bacteriology, computed tomography scan findings, surgical interventions, complications, survival, and other clinical parameters were reviewed. A total of 422 cases of infection were admitted, and 11 cases of cervical necrotizing fasciitis were found. The incidence of CNF was 2.6% among the infections hospitalized on the OMS service. There were 7 male and 4 female patients. Eight patients were older than 60 years of age. Seven patients had immunocompromising conditions, including diabetes mellitus in 4, concurrent administration of steroid in 2, uremia in 1, and a thymus carcinoma in 1. All patients showed parapharyngeal space involvement; four also showed retropharyngeal space involvement. Gas was found in the computed tomography scan in 6 patients, extending to cranial base in 3 of them. Anaerobes were isolated in 73% of the infections, whereas Streptococcus species were uniformly present. All patients received 1 or more debridements. Major complications occurred in 4 patients, including mediastinitis in 4, septic shock in 2, lung empyema in 1, pleural effusion in 2, and pericardial effusion in 1. All major complications developed in the immunocompromised patients, leading to 2 deaths. The mortality rate in this study was 18%. Early surgical debridement, intensive medical care, and a multidisciplinary approach are advocated in the management of CNF.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Emerg Trauma Shock
                Journal ID (publisher-id): JETS
                Title: Journal of Emergencies, Trauma and Shock
                Publisher: Medknow Publications (India )
                ISSN (Print): 0974-2700
                ISSN (Electronic): 0974-519X
                Publication date (Print): Jul-Dec 2008
                Volume: 1
                Issue: 2
                Pages: 114-118
                Affiliations
                Department of Otorhinolaryngology and HNS, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
                Author notes
                Correspondence: Dr. Shraddha Jain, E-mail: sjain_med@ 123456yahoo.co.in
                Article
                Publisher ID: JETS-01-114
                DOI: 10.4103/0974-2700.43197
                PMC ID: 2700617
                PubMed ID: 19561990
                SO-VID: 588f1dae-6368-4e64-a2cc-4e829daea2d5
                Copyright © © Journal of Emergencies, Trauma and Shock
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 April 2008
                Date accepted : 21 June 2008
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: necrotizing,fasciitis,tooth diseases/complications,face,trauma
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: necrotizing, fasciitis, tooth diseases/complications, face, trauma

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