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Necrotizing fasciitis: review of the literature and case report. J Oral Maxillofac Surg 2011; 69:2786-94. [PMID: 21367503 DOI: 10.1016/j.joms.2010.11.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/21/2010] [Accepted: 11/23/2010] [Indexed: 11/20/2022]
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Lee JW, Immerman SB, Morris LGT. Techniques for early diagnosis and management of cervicofacial necrotising fasciitis. J Laryngol Otol 2010; 124:759-64. [PMID: 20298644 PMCID: PMC3016424 DOI: 10.1017/s0022215110000514] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cervicofacial necrotising fasciitis carries high rates of morbidity and mortality, and is not often initially suspected due to its rarity and misleadingly innocuous presentation. We propose an algorithm for the timely diagnosis and management of cervicofacial necrotising fasciitis. METHODS Retrospective review of seven patients ultimately diagnosed with cervicofacial necrotising fasciitis. RESULTS In these seven patients, common presenting symptoms included sore throat, fever and neck pain. On initial examination and imaging, only three had obvious findings. One patient's diagnosis was facilitated via a bedside cut-down procedure. Six patients underwent surgical debridement. Four required tracheotomy, and five wounds closed via secondary intention. There were two deaths. CONCLUSION The severity of cervical necrotising fasciitis and its rapid spread necessitate early diagnosis and timely surgical management. The presentation often appears benign. A high index of clinical suspicion should be maintained in cases of neck cellulitis with nonspecific clinical findings, especially in diabetic or otherwise immunocompromised patients. A normal computed tomography scan does not rule out necrotising fasciitis. A cut-down procedure may be critical to early diagnosis in some cases.
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Affiliation(s)
- J W Lee
- Head and Neck Surgery Service, Bellevue Hospital Center and New York University School of Medicine, New York, New York, USA
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Flanagan CE, Daramola OO, Maisel RH, Adkinson C, Odland RM. Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing fasciitis. Otolaryngol Head Neck Surg 2009; 140:730-4. [PMID: 19393420 DOI: 10.1016/j.otohns.2009.01.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 12/22/2008] [Accepted: 01/13/2009] [Indexed: 11/26/2022]
Abstract
Objective: To review our management of cervical necrotizing fasciitis (CNF) with the use of adjunctive hyperbaric oxygen therapy (HBO). Study Design: Case series with chart review. Subjects and Methods: Evaluation of ten patients with CNF between 2001 to 2006. Results: There were five male and six female patients. Mean age was 43 ± 11 years. Eight cases resulted from an odontogenic source. Comorbidities included diabetes mellitus, hypertension, and substance abuse. All patients had computed tomography scans performed, received intravenous antibiotics, and underwent surgical debridement. Eight patients underwent surgery within 24 hours. The average number of debridements was 2.2 ± 0.8. Hospitalization was twice as long for diabetic patients (15.5 ± 8.16 days) compared with nondiabetic patients (7.5 ± 1.6 days, P = 0.029). Nine patients had HBO therapy. Combined data revealed a possible decrease in length of hospitalization with HBO therapy ( P < 0.001). No mortality was documented. Conclusion: In addition to early and aggressive medical management and surgical debridement, this study suggests that HBO therapy is a beneficial adjunct by potentially decreasing length of hospitalization. Randomized trials are still needed to demonstrate its efficacy.
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Affiliation(s)
- Carrie E. Flanagan
- University of Minnesota Medical School, Hennepin County Medical Center, Minneapolis, MN
- Department of Otolaryngology–Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, MN
| | - Opeyemi O. Daramola
- University of Minnesota Medical School, Hennepin County Medical Center, Minneapolis, MN
| | - Robert H. Maisel
- University of Minnesota Medical School, Hennepin County Medical Center, Minneapolis, MN
- Department of Otolaryngology–Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, MN
| | - Cher Adkinson
- Hyperbaric Oxygen Medicine, Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Rick M. Odland
- University of Minnesota Medical School, Hennepin County Medical Center, Minneapolis, MN
- Department of Otolaryngology–Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, MN
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Quereshy FA, Baskin J, Barbu AM, Zechel MA. Report of a case of cervicothoracic necrotizing fasciitis along with a current review of reported cases. J Oral Maxillofac Surg 2009; 67:419-23. [PMID: 19138621 DOI: 10.1016/j.joms.2008.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Faisal A Quereshy
- Department of Oral and Maxillofacial Surgery, Case School of Dental Medicine and University Hospitals Case Medical Center, Cleveland, OH 44106-4905, USA.
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Righini CA, Motto E, Ferretti G, Boubagra K, Soriano E, Reyt E. [Diffuse cervical cellulites and descending necrotizing mediastinitis]. ACTA ACUST UNITED AC 2008; 124:292-300. [PMID: 17689483 DOI: 10.1016/j.aorl.2007.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 02/01/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To give a report on the progress in physical examination, investigations and treatment of diffuse cervical cellulites (DCC) associated with descending necrotizing mediastinitis. MATERIALS AND METHODS A Retrospective study (1995-2005) of patients presenting DCC with mediastinitis was made. All had a cervical and thoracic Computed tomography (CT) scan. The references were collected by a Medline search. RESULTS Six men and 2 women, average ages 53 years were treated. Four had an immunodeficient status. Two had had an anti-inflammatory drug treatment without antibiotic treatment. The average for diagnosis and treatment was 4 days. In 2 cases we found a dental origin and in 6 cases a pharyngeal origin. The most frequently identified germs were streptococcus beta haemolytic group A and Prevotella. In 4 cases, no physical sign of mediastinitis was noted. The diagnosis of mediastinitis was made thanks to the thoracic CT scan. All the patients were treated by broad-spectrum antibiotic therapy. All had cervical and thoracic surgical drainage. Mediastinal drainage was made by cervical way in 3 cases and by thoracotomy in 5 cases. One patient died. CONCLUSIONS The DCC with mediastinum extension are serious infectious emergencies with a high mortality rate. Clinical diagnosis of mediastinitis is difficult. A thoracic CT scan should be performed systematically. Performing thoracotomy best controls mediastinal drainage.
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Affiliation(s)
- C-A Righini
- Service d'ORL et de chirurgie cervicofaciale, CHU A.-Michallon, 38043 Grenoble cedex 09, France.
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Craniofacial necrotizing fasciitis: reconstruction after radical surgery. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-007-0197-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Choi YK. Poster 024: Cervical Necrotizing Fascitis & Mediastinitis Caused Odontogenic Infection: Cases Report. J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.joms.2007.06.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Riggio MP, Aga H, Murray CA, Jackson MS, Lennon A, Hammersley N, Bagg J. Identification of bacteria associated with spreading odontogenic infections by 16S rRNA gene sequencing. ACTA ACUST UNITED AC 2006; 103:610-7. [PMID: 17141534 DOI: 10.1016/j.tripleo.2006.08.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 07/06/2006] [Accepted: 08/11/2006] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the bacterial species associated with spreading odontogenic infections (SOIs). STUDY DESIGN Pus samples from 4 cases of SOI were analyzed by microbiological culture methods for the presence of bacteria, and by polymerase chain reaction (PCR) amplification, cloning, and sequencing of bacterial 16S rRNA genes. RESULTS Culture methods identified species from the genera Prevotella, Streptococcus, and Fusobacterium, as well as anaerobic streptococci. Molecular detection methods identified a far more diverse microflora. The predominant genus detected was Prevotella, representing 102 (50.2%) of 203 clones analyzed. Prevotella oris was the most abundant species identified, representing 45 (22.2%) of 203 clones analyzed. Twelve clones (5.9%) represented uncultivable species, namely Prevotella PUS9.180, an uncultured Peptostreptococcus species, and an uncultured bacterium belonging to the Bacteroidetes phylum. CONCLUSIONS Prevotella species may play an important role in SOIs, and further work to examine in more detail the pathogenicity determinants of these organisms and associated host responses is warranted.
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Affiliation(s)
- Marcello P Riggio
- Infection and Immunity Section, University of Glasgow Dental School, Glasgow, UK.
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Gaggl AJ, Rainer H, Grund E, Chiari FM. Local Oxygen Therapy for Treating Acute Necrotizing Periodontal Disease in Smokers. J Periodontol 2006; 77:31-8. [PMID: 16579700 DOI: 10.1902/jop.2006.77.1.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The main aim of treatment for acute necrotizing periodontal disease is fast and effective reduction of anaerobic destructive microorganisms to avoid periodontal damage. The effect of adjunctive local oxygen therapy in the treatment of necrotizing periodontal disease was examined in this study. METHODS Thirty patients with acute necrotizing periodontal disease were treated with the systemic antibiotics amoxicillin, clavulanic acid, and metronidazole. In 15 out of 30 patients, adjunctive local oxygen therapy was administered. The patients were followed from the first to 10th day of treatment with clinical and bacteriological examinations. The clinical examination registered gingival bleeding, periodontal probing depth, and attachment loss; to follow up microbiological colonization of the periodontal sulcus, five representative bacteria were registered by a semiquantitative DNA polymerase chain reaction test. RESULTS In both groups of patients, colonization with Prevotella intermedia, Tannerella forsythensis, and Treponema denticola was initially positive. None of these three microorganisms were completely eradicated in any of the patients in the group without oxygen therapy within the first 10 days of treatment. In the group with adjunctive oxygen therapy, all patients either showed a reduction in or complete eradication of the microorganisms, resulting in more rapid clinical restitution with less periodontal destruction. CONCLUSIONS Adjunctive oxygen therapy results in early eradication of pathogenic anaerobic microorganisms in cases of acute necrotizing periodontal disease. The damage to periodontal tissue is reduced.
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Affiliation(s)
- Alexander J Gaggl
- Department of Oral and Maxillofacial Surgery, General Hospital/LKH Klagenfurt, Klagenfurt, Austria.
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Zilberstein B, de Cleva R, Testa RS, Sene U, Eshkenazy R, Gama-Rodrigues JJ. Cervical necrotizing fasciitis due to bacterial tonsillitis. Clinics (Sao Paulo) 2005; 60:177-82. [PMID: 15880255 DOI: 10.1590/s1807-59322005000200015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Necrotizing fasciitis is a severe and potentially fatal soft tissue infection, but involvement of the head and neck is rare. We report on 4 cases of cervical necrotizing fasciitis arising from tonsillitis. One patient was diabetic and one had received steroids before disease development. One patient developed acute respiratory failure and died of septic shock. Three patients recovered, helped by early recognition, aggressive surgical intervention, appropriate broad-spectrum antibiotics, and supportive therapy. The common bacteria found in all abscess samples were Streptococcus sp., but mixed flora with anaerobic organisms was seen in all but 1 case. Tonsillitis and peritonsillar abscess must be suspected as a cause of cervical necrotizing fasciitis and a successful result can be achieved with immediate aggressive treatment.
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Nakamori Y, Fujimi S, Ogura H, Kuwagata Y, Tanaka H, Shimazu T, Ueda T, Sugimoto H. Conventional Open Surgery Versus Percutaneous Catheter Drainage in the Treatment of Cervical Necrotizing Fasciitis and Descending Necrotizing Mediastinitis. AJR Am J Roentgenol 2004; 182:1443-9. [PMID: 15149988 DOI: 10.2214/ajr.182.6.1821443] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to determine the clinical usefulness of percutaneous catheter drainage compared with conventional surgical drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis. SUBJECTS AND METHODS. Thirty-one patients with cervical necrotizing fasciitis and descending necrotizing mediastinitis were included. Twenty consecutive patients were treated by percutaneous catheter drainage. Catheters were introduced into the infected space from the neck, under the guidance of sonography and X-ray fluoroscopy. The results of the treatment were compared with those of 11 patients treated previously by surgical drainage. RESULTS In the catheter group, no patient required supplementary surgical drainage. Mortality was 0% in both groups. Comparison of length of stay in the ICU, serial changes in C-reactive protein levels, duration of antibiotic therapy, and duration of mechanical ventilation all showed no statistically significant difference between groups. Secondary infection of the wound and positive culture of antibiotic-resistant bacteria were observed less frequently in the catheter group than in the open surgical group. The total use of plasma infusion and analgesics was significantly less in the catheter group than in the surgery group. Oral feeding was started significantly earlier in the catheter group than in the surgery group. CONCLUSION Percutaneous catheter drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis was less invasive than conventional surgical drainage but produced a similar outcome.
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Affiliation(s)
- Yasushi Nakamori
- Department of Traumatology, Osaka University Medical School, 2-15 Yamadaoka, Suita-shi, Osaka 565-0871, Japan.
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Hamza NS, Farrel J, Strauss M, Bonomo RA. Deep Fascial Space Infection of the Neck: A Continuing Challenge. South Med J 2003; 96:928-32. [PMID: 14513995 DOI: 10.1097/01.smj.0000051203.76005.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present our clinical experience with two complex cases of deep fascial space infections of the neck. The first was a case of cervical necrotizing fasciitis involving the submental space. The second was an infection beginning at the soft palate and extending to the anterior mediastinum. Both infections emanated from an oral source in patients with diabetes mellitus, and both patients required multiple surgical debridements and endotracheal intubation for airway protection. Despite the declining incidence of deep space neck infections, our cases illustrate the challenging diagnostic and treatment dilemmas for the clinician managing patients with diabetes.
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Affiliation(s)
- Nashaat S Hamza
- Division of Infectious Disease, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH 44106, USA
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Umeda M, Minamikawa T, Komatsubara H, Shibuya Y, Yokoo S, Komori T. Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:283-90. [PMID: 12627098 DOI: 10.1067/moe.2003.85] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Necrotizing fasciitis of the head and neck is an uncommon, potentially fatal soft tissue infection characterized by extensive necrosis and gas formation in the subcutaneous tissue and fascia. The aims of this study were to describe the condition of this rare disease and to find factors affecting the mortality. STUDY DESIGN Nine of our new cases and 125 reported cases in the English-language literature with necrotizing fasciitis of dental origin were reviewed. RESULTS Two of our 9 patients had some form of systemic disease such as diabetes, cardiac insufficiency, renal failure, or cerebral infarction, whereas the other 7 had no particular general complications. A computed tomography examination was useful for detecting gas formation in the deep neck. All 9 patients underwent extensive debridement within 24 hours, and good results were obtained. In contrast, 24 of the 125 reviewed patients died despite therapy. Factors affecting the mortality were associated diseases such as diabetes or alcohol abuse, delay of surgery, and the complication mediastinitis. CONCLUSION Necrotizing fasciitis is still a potentially fatal disease. Early and aggressive debridement may reduce mortality.
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Affiliation(s)
- Masahiro Umeda
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kobe University.
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Ndukwe KC, Fatusi OA, Ugboko VI. Craniocervical necrotizing fasciitis in Ile-Ife, Nigeria. Br J Oral Maxillofac Surg 2002; 40:64-7. [PMID: 11883974 DOI: 10.1054/bjom.2001.0715] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sixteen cases of necrotizing fasciitis were seen at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from 1990 to 2000. Primary craniocervical involvement was recorded in seven patients (five men and two women). The clinical records of five patients were sufficiently detailed to allow us to report their age, aetiology, predisposing illness, clinical features, complications, management regimen and outcome. The patients were aged 30-75 years and in four of them odontogenic infections were the cause of the condition. Hypertension, diabetes mellitus and obesity were the underlying systemic diseases in three cases and the body/angle region of the mandible was the predominant site of the infection on the face. All five cases had involvement of the neck. Mediastinal extension was recorded in three cases. Two patients had complications: one had septicaemia and renal failure and the other developed bone necrosis. Pre-existing ill health, old age, late surgical intervention, and mediastinal and thoracic extension of infection were responsible for the only death. Treatment involved frequent and multiple surgical debridement, aggressive antimicrobial treatment and control of systemic disease. Early recognition, prompt surgical intervention, and aggressive antimicrobial treatment are essential to minimize morbidity and mortality. Rapid progression of infection, financial constraints, delayed referrals from rural clinics and distance to the tertiary hospital caused problems.
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Affiliation(s)
- K C Ndukwe
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
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Hyperbaric Oxygen Therapy: Ten Common Questions Related to the Management of Severe Necrotizing Skin and Soft-Tissue Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2001. [DOI: 10.1097/00019048-200111000-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shand JM, Breidahl A, Hing NR, Johnstone BR, Wiesenfeld D. Ascending necrotising fasciitis as a result of odontogenic infection: a report of two cases. Aust Dent J 2001; 46:134-8. [PMID: 11491229 DOI: 10.1111/j.1834-7819.2001.tb00568.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Necrotising fasciitis is a severe soft tissue infection which spreads rapidly through fascial planes, is characterised by soft tissue necrosis and is potentially life-threatening. It is a rare entity in the head and neck region. The management of this condition is difficult and early diagnosis and aggressive surgical and medical management are essential. This paper reports two cases of necrotising fasciitis as a result of ascending odontogenic infection involving the temporalis muscle.
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Affiliation(s)
- J M Shand
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne
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Obiechina AE, Arotiba JT, Fasola AO. Necrotizing fasciitis of odontogenic origin in Ibadan, Nigeria. Br J Oral Maxillofac Surg 2001; 39:122-6. [PMID: 11286446 DOI: 10.1054/bjom.2000.0585] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We reviewed eight patients with necrotizing fasciitis of odontogenic origin. There were three women and five men, mean age 58 (range 46-72), and none had any associated medical condition such as diabetes. All cases had symptoms of toothache for a mean duration of 34 days (range 26-42) before they sought treatment. Infection originated in the molar teeth region, and initially presented as an odontogenic or periodontal abscess. The clinical features of necrotizing fasciitis became apparent only after the superficial fascia had been invaded. The transient unusually reddish hue for a dark skin might be explained by the fact the deep fascia and muscles were affected before the superficial fascia and skin. Necrosis of the skin began in the submandibular region and progressed downwards. The necrotic area was less than the extent of infection. Antimicrobial treatment, debridement, and fasciotomy improved healing. Delay before appropriate treatment had an adverse affect on outcome, and one patient died.
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Affiliation(s)
- A E Obiechina
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
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