title: Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature.
abstract: BACKGROUND
  Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin.
  
  
  METHODS
  In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need.
  
  
  CONCLUSIONS
  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.
authors: Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy. ancortese@unisa.it.
authors: Antonio
authors: http://orcid.org/0000-0002-0875-0725
authors: A
authors: Cortese
authors: Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.
authors: Giuseppe
authors: G
authors: Pantaleo
authors: Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.
authors: Antonio
authors: A
authors: Borri
authors: Department of Medicine and Surgery, University of Salerno, Baronissi, SA, Italy.
authors: Massimo
authors: M
authors: Amato
authors: Department of BioMolecular Sciences, School of Pharmacy, National Center for Natural Products Research, University of Mississippi, Oxford, MS, USA.
authors: Pier Paolo
authors: PP
authors: Claudio
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003646:Debridement / Q000379:methods*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging*; D009333:Neck / Q000000981:diagnostic imaging*; D011862:Radiography, Panoramic / Q000379:methods; D009057:Stomatognathic Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Head and neck; High mortality; Necrotizing fasciitis; Saline solution