Necrotizing fasciitis of the neck due to an odontogenic infection: A case report |
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Authors: | Haruo Sakamoto Hiroyuki Naito Takayuki Aoki Kazunari Karakida Kazuo Shiiki |
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Institution: | (1) Department of Oral Surgery, Tokai University School of Medicine, Boserdai, 259-11 Isehara, Japan;(2) Department of Dentistry and Oral Surgery, Iwaki Kyoritsu Hospital, Iwaki, Japan |
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Abstract: | Deep fascial space infections of the neck are most frequently odontogenic in origin. We describe a case of odontogenic infection
of the mandible which extended to the lateral pharyngeal space and resulted in a severe life-threatening necrotizing fasciitis
of the neck. A 69-year-old nondiabetic male complained of dysphagia and a severe toothache of the lower left molar and was
transported to the emergency ward. A CT scan revealed swelling of the peritonsillar, lateral pharyngeal and masticator space
with narrowing of the airway of the middle pharynx. The patient underwent a tracheotomy with surgical drainage. The strap
muscles, including the fascia, of the neck were necrotic. He was treated with a combination of ampicillin and clindamycin-2-P.
On the second postoperative day, the patient's platelet count fell to 20,000/mm3. The patient was transfused with platelet concentrate, and given gamma globulin and gabexate mesilate, and his predisseminated
intravascular coagulation (DIC) status improved. However, on the eight post operative day, progressive tissue necrosis of
the face and neck was observed. Panipenem betamipron was started and continued for 20 days. A second extensive surgical debridement
of the neck and face was carried out, and the patient ultimately recovered.Prevotella buccae, Streptococcus intermedius, Lactobacillus fermentum, L. casei, L. catenaforme, L. acidophilus, andBifidobacterium sp. were isolated from either the peritonsillar, submandibular, lateral pharyngeal or carotid space abscesses. We emphasize
the importance of proper diagnosis, early surgical intervention and systemic antimicrobial chemotherapy to control this aggressive
infectious disease. |
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Keywords: | necrotizing fasciitis odontogenic infection DIC Prevotella buccae Streptococcus intermedius Lactobacilli |
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