Necrotizing fasciitis of the head and neck is a rare polymicrobial infection, rapidly progressing with a potentially fatal outcome, without early recognition and treatment. Odontogenic infection spreading to the lower neck or anterior chest is an important clinical feature. CT-scan and MRI can be useful in case of doubt. As the relative mild external clinical signs can mask the severe underlying necrosis, the difference in outcome is due to the rapidity of diagnosis and surgical intervention. Surgery consists of complete debridement of all necrotic tissues, repeated as needed and associated with an early tracheotomy. Antibiotherapy is based on the organisms most frequently involved. Hyperbaric oxygen therapy and vacuum-assisted closure could have a role after initiation of intravenous antibiotics and surgical debridement. We report a case of a 23-year old man with a necrotizing fasciitis from a dental origin, necessitating an extensive and repeated surgery, a tracheotomy and antibiotherapy; he developed severe complications such as multisystem organ failure, pericardial effusion and cardiorespiratory arrest.
Ouazzani, Dequanter, Buttafuoco, Raynal, Lothaire, , , , (). [Cervical necrotizing fasciitis arising from dental abscess: a rare clinical observation]. Revue medicale de Bruxelles, ;30(2):99-105. https://www.ncbi.nlm.nih.gov/pubmed/19517906