Craniocervical Necrotizing Fasciitis Resulting from Dentoalveolar Infection

Rare Insights: Temporoparietal Necrotizing Fasciitis Stemming From a Dental Source

Necrotizing fasciitis (NF) of the face is a rare yet serious condition requiring prompt and comprehensive management. This approach typically involves input from various medical specialties such as infectious disease specialists, critical care physicians, and surgeons. The primary goals are early recognition, aggressive surgical debridement, appropriate antibiotic therapy, and supportive care. Prompt diagnosis is crucial, based on symptoms like severe pain, rapidly spreading erythema, and systemic signs of infection. Broad-spectrum antibiotics are initiated empirically, and adjusted based on culture results. Urgent surgical debridement is crucial, removing all necrotic tissue. Careful consideration must be given to preserve vital structures. Close monitoring and intensive care may be necessary, especially for severe cases. Soft tissue reconstruction may follow once the infection is controlled, aiming to restore function and aesthetics. Long-term follow-up is essential to observe for complications and recurrence.

Vacuum-Assisted Closure Therapy: A Lifesaver in a Case of Neck Necrotizing Fasciitis

Necrotizing fasciitis (NF) is a severe and rare soft tissue infection with a high potential for mortality, particularly in cases related to odontogenic infections in immunocompromised patients. The conventional treatment for NF includes broad-spectrum antibiotics and aggressive surgical debridement. This report presents a unique case of a 34-year-old healthy male who developed NF following a lower left wisdom tooth extraction. The infection extended into the superior mediastinum, requiring emergency surgical intervention. The therapeutic management included vacuum-assisted closure (VAC), a treatment modality showing promise in managing complex soft tissue infections, in combination with other adjunct treatments. The patient showed a satisfactory healing process and no signs of recurrence during the six-month follow-up period. This case underlines the importance of early diagnosis and the potential benefit of VAC therapy in managing advanced NF, emphasizing the need for further research and clinical application.

Necrotizing fasciitis of the entire head and neck: Literature review and case report

Necrotizing fasciitis (NF) is uncommon but potentially lethal when it is associated with systemic disorders. We report a case of odontogenic NF in a patient with uncontrolled diabetes mellitus. The patient was referred on day 10 since the onset of odontogenic NF. Protective tracheostomy, local facial-cervical fasciotomy were conducted and broadspectrum antibiotics were given, subsequent serial surgical drainage and debridement were performed in theater. Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumonia were isolated. Five staged debridements were performed to the targeted anatomic regions thus reducing surgical time and blood loss. The patient survived the acute infection and received subsequent reconstruction. Cervical NF with descending mediastinitis and periorbital NF is associated with high mortality rates. This is the only known report of an adult who survived NF affecting entire scalp, periorbital, cervical, and thoracic region. Early diagnosis and staged surgical planning minimize morbidity and mortality from NF.

Necrotizing fasciitis of the masticator space with osteomyelitis of the mandible in an edentulous patient

Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the subcutaneous tissue and fascia, caused by bacterial infection. Usually presenting in the extremities, trunk, or perineum, it is uncommon in the craniofacial or cervical area. Cervicofacial NF is a potentially fatal infection, which should be managed with early detection and intervention. Most cases have a primary odontogenic source of infection, especially when the masticator space is involved. We report a case of masticator space NF that developed without odontogenic origin in a 78-year old female who was treated with prompt surgical drainage and intravenous antibiotics.

Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature

BACKGROUND

Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality.

METHODS

A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis."

RESULTS

There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%.

CONCLUSION

Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.

[Severe head and neck cellulitis, risk factors and severity criteria]

La cellulite cervico-faciale grave est une infection polymicrobienne extensive et redoutable du tissu cellulo-adipeux de la face et du cou. L'objectif de cette étude est d'analyser certains facteurs favorisants et d’évaluer les critères de gravité en fonction des formes anatomo-cliniques. Il s'agit d'une étude rétrospective réalisée, entre janvier 2007 et décembre 2012, au service de chirurgie maxillo faciale de l'hôpital militaire Avicenne de Marrakech. Sur 147 cas de cellulites cervico-faciales pris en charge au niveau du service, 13 dossiers de cellulites graves ont été retenus. Neuf hommes (69%) et quatre femmes (31%) ont fait l'objet de cette étude, avec un âge moyen de 35 ans. Tous les patients ont été adressés pour prise en charge secondaire après avoir pris des anti-inflammatoires (AI). Sept cas (54%) étaient immunocompétents. La cause dentaire était soulevée chez neufs cas (69%). Cinq cas (38%) ont présenté une forme pseudo phlegmoneuse avec des signes compressifs des voies aéro-digestives. L'extension médiastinale a été observée chez quatre patients (31%). La forme nécrosante extensive a été retrouvée dans trois cas (23%). L’étude bactériologique, réalisée chez tous les patients, avait mis en évidence une flore microbienne mixte et polymorphe. Les cellulites cervico-faciales graves posent un réel problème de prise en charge thérapeutique. L'analyse des facteurs favorisants et l’évaluation des critères de gravité dans cette série ont permis de limiter une évolution défavorable.

The predominant bacteria isolated from radicular cysts

Purpose

To detect predominant bacteria associated with radicular cysts and discuss in light of the literature.

Material and methods

Clinical materials were obtained from 35 radicular cysts by aspiration. Cultures were made from clinical materials by modern laboratory techniques, they underwent microbiologic analysis.

Results

The following are microorganisms isolated from cultures: Streptococcus milleri Group (SMG) (23.8%) [Streptococcus constellatus (19.1%) and Streptococcus anginosus (4.7%)], Streptococcus sanguis (14.3%), Streptococcus mitis (4.7%), Streptococcus cremoris (4.7%), Peptostreptococcus pevotii (4.7%), Prevotella buccae (4.7%), Prevotella intermedia (4.7%), Actinomyces meyeri (4.7%), Actinomyces viscosus (4.7%), Propionibacterium propionicum (4.7%), Bacteroides capillosus (4.7%), Staphylococcus hominis (4.7%), Rothia denticariosa (4.7%), Gemella haemolysans (4.7%), and Fusobacterium nucleatum (4.7%).

Conclusions

Results of this study demonstrated that radicular cysts show a great variety of anaerobic and facultative anaerobic bacterial flora. It was observed that all isolated microorganisms were the types commonly found in oral flora. Although no specific microorganism was found, Streptococcus spp. bacteria (47.5%) – especially SMG (23.8%) – were predominantly found in the microorganisms isolated. Furthermore, radicular cysts might be polymicrobial originated. Although radicular cyst is an inflammatory cyst, some radicular cyst fluids might be sterile.

Emergency imaging assessment of deep neck space infections

Deep neck space infection may lead to severe and potentially life-threatening complications, such as airway obstruction, mediastinitis, septic embolization, dural sinus thrombosis, and intracranial abscess. The clinical presentation is widely variable, and often early symptoms do not reflect the disease severity. The complication risk depends on the extent and anatomical site: diseases that transgress fascial boundaries and spread along vertically oriented spaces (parapharyngeal, retropharyngeal, and paravertebral space) have a higher risk of complications and require a more aggressive treatment compared with those confined within a nonvertically oriented space (peritonsillar, sublingual, submandibular, parotid, and masticator space). Imaging has 5 crucial roles: (1) confirm the suspected clinical diagnosis, (2) define the precise extent of the disease, (3) identify complications, (4) distinguish between drainable abscesses and cellulitis, and (5) monitor deep neck space infection progression. Ultrasonography is the gold standard to differentiate abscesses from cellulitis, for the diagnosis of lymphadenitis. and to identify internal jugular thrombophlebitis in the infrahyoid neck. However, field-of-view limitation and poor anatomical information confine the use of ultrasonography to the evaluation of superficial lesions and to image-guided aspiration or drainage. Computed tomography (CT) combines fast image acquisition and precise anatomical information without field-of-view limitations. For these reasons, it is the most reliable technique for the evaluation of deep and multicompartment lesions and for the identification of mediastinal and intracranial complications. Contrast agent administration enhances the capability to differentiate fluid collections from cellulitis and allows the detection of vascular complications. Magnetic resonance imaging is more time-consuming than CT, limiting its use to selected indications. It is the technique of choice for assessing the epidural space involvement in pre- and paravertebral space infections and complements CT in the evaluation of the infections reaching the skull base.