title: [Dentogene Focus as a Rare Cause of Necrotizing Fasciitis].
abstract: History and clinical findingsWe elaborate the case of a 72-year-old patient who presented with a painful swelling of the lower jaw in the emergency unit.Investigations and diagnosisIn the clinical examination and the CT scan, a widespread cervical emphysema was found which raised suspicion for the presence of a necrotizing fasciitis of the head and neck due to aerogenic infection. Close spatial vicinity to the teeth of the left upper and lower jaw was present, so that the necrotizing fasciitis was assumed to be odontogenic.Treatment and courseBased on the clinical presentation and the imaging findings the diagnosis of necrotizing fasciitis in the sense of a possible infection with gas building bacteria accompanying with an infection of the mediastinum was made. Immediately performed therapy included sternotomy and extended surgical debridement of necrosis.ConclusionThe presented case emphasizes that necrotizing fasciitis due to gas-producing infections should be considered as a differential diagnosis for cervical soft tissue emphysema for which an odontogenic focus is the most common cause. Rapid diagnosis is essential for successful treatment consisting of immediate surgical debridement and intravenous antibiotics.
authors.affiliation: Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kloth
authors.affiliation: Klinik für Mund-, Kiefer- und Gesichtschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hoefert
authors.affiliation: Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen.
authors.forename: Till
authors.initials: T
authors.lastname: Fischborn
authors.affiliation: Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen.
authors.forename: Christina
authors.initials: C
authors.lastname: Schraml
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000150:complications* / Q000175:diagnosis*; D016896:Treatment Outcome