Cervical necrotizing fasciitis originating with a periapical infection.
BACKGROUND
Necrotizing fasciitis is a rapidly spreading, soft-tissue infection involving the subcutaneous tissues. Necrotizing fasciitis originating from a dental-related source is rare. Practitioners should be aware that this infection could occur in patients who are immunocompromised and in patients who are healthy. Practitioners must treat this disease aggressively with surgical debridement and intensive medical support.


METHODS
The authors present a case report of a man with poorly controlled diabetes mellitus in whom a periapical infection progressed into a maxillofacial space abscess and finally cervical necrotizing fasciitis (CNF). A delay in his initial visit to a dentist was evident. The authors observed a successful outcome in the patient after he underwent several wide surgical debridement procedures, hyperbaric oxygen therapy and a protracted, intensive hospital stay lasting 34 days.


CONCLUSIONS
Dentists should suspect that a patient has CNF when maxillofacial cellulitis or an abscess does not respond to conventional therapy. Findings of spreading skin erythema, induration, purple discoloration and anesthesia suggest necrotizing fasciitis. Early computed tomography scans may reveal gas within the deep tissues of the neck, fascial plane involvement or both.


CONCLUSIONS
CNF has high morbidity and mortality rates if rapid aggressive therapy is not pursued. Spread of this polymicrobial infection can lead to mediastinitis or cranial base involvement. Mortality is directly proportional to the time to intervention.
Treasure
Trevor
T
Department of Oral Surgery and Hospital Dentistry,School of Dentistry, Indiana University, 1050 Wishard Blvd., Indianapolis, IN 46202, USA. ttreasur@iupui.edu
Hughes
William
W
Bennett
Jeffrey
J
D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D016970:Eikenella; D004754:Enterobacter; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000382:microbiology / Q000601:surgery / Q000628:therapy; D005440:Fluid Therapy; D006190:Haemophilus; D006801:Humans; D006931:Hyperbaric Oxygenation; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009333:Neck; D009343:Neisseria; D010482:Periapical Abscess / Q000150:complications* / Q000382:microbiology; D013297:Streptococcus pyogenes; D013997:Time Factors
D000900:Anti-Bacterial Agents