Cervical necrotizing fasciitis originating with a periapical infection

Trevor Treasure, William Hughes, Jeffrey Bennett

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background. Necrotizing fasciitis is a rapidly spreading, softtissue 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. Case Description. 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. Clinical Implications. 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.

Original languageEnglish (US)
Pages (from-to)861-866
Number of pages6
JournalJournal of the American Dental Association
Volume141
Issue number7
StatePublished - Jul 2010
Externally publishedYes

Fingerprint

Necrotizing Fasciitis
Infection
Debridement
Dentists
Abscess
Mediastinitis
Hyperbaric Oxygenation
Cellulitis
Mortality
Subcutaneous Tissue
Skull Base
Immunocompromised Host
Erythema
Coinfection
Length of Stay
Diabetes Mellitus
Tooth
Neck
Anesthesia
Gases

Keywords

  • Cervical necrotizing fasciitis
  • Diabetes
  • Flesh-eating bacteria
  • Hyperbaric oxygen therapy
  • Immunocompromised patient

ASJC Scopus subject areas

  • Dentistry(all)
  • Medicine(all)

Cite this

Cervical necrotizing fasciitis originating with a periapical infection. / Treasure, Trevor; Hughes, William; Bennett, Jeffrey.

In: Journal of the American Dental Association, Vol. 141, No. 7, 07.2010, p. 861-866.

Research output: Contribution to journalArticle

Treasure, T, Hughes, W & Bennett, J 2010, 'Cervical necrotizing fasciitis originating with a periapical infection', Journal of the American Dental Association, vol. 141, no. 7, pp. 861-866.
Treasure, Trevor ; Hughes, William ; Bennett, Jeffrey. / Cervical necrotizing fasciitis originating with a periapical infection. In: Journal of the American Dental Association. 2010 ; Vol. 141, No. 7. pp. 861-866.
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