Necrotizing cervical fasciitis, a review of the literature in association to a clinical case

Introduction: Necrotizing cervical fasciitis is an aggressive and potentially fatal infection of the deep spaces of the neck that causes necrosis of various tissues throughout its layers. It is characterized by fast progression, systemic toxicity and high mortality rate of 40 to 75%. The latter due to the disease’s fast progression and inopportune recognition of initial signs. Cases have been documented as the result of infectious complications of odontogenic origin. Standard treatment includes endovenous antibiotics, hospitalization in intensive care units and aggressive surgical debridement.

Case report: 17-Year-old patient due for extraction of unerupted third molars per orthodontic indication. Undergoing treatment for hyperthyroidism, no other important medical history, no previous dental complications. Patient underwent surgical extraction of 4.8. Post op antibiotics and NSAIDs were indicated. 4 days after extraction the patient was admitted in the emergency room. Facial cervical CAT scan showed evident compromise of the floor of the mouth and left lateral pharyngeal space. Following hospitalization, endovenous antibiotics were administered upon evidence of left cervical color change and the diagnosis of necrotizing fasciitis. The patient was sent to the intensive care unit. Cervical surgical debridement and bacterial cultures were performed. A mixed flora of bacteria with high resistance to the initial antibiotic treatment was found. The patient presented DIC, multisystem organ failure, required sedation and assisted respiration through a ventilator. After 13 days in the intensive care unit, diverse surgical interventions of the area and the use of combined antibiotics, the case was resolved.

Conflict of interest: None declared.

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Feb 5, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Necrotizing cervical fasciitis, a review of the literature in association to a clinical case
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