A Case of Periocular Necrotizing Fasciitis of Odontogenic Origin

Abstract

Purpose: We report a case of periocular necrotizing fasciitis originating from dontogenic infection. Case summary: A 53-year-old man, who had suffered from severe periodontitis one week prior, visited our clinic due to a 2-day history of rapidly progressing left mandibular and periorbital swelling and pain. By the time of his visit, he had lost vision in the left eye and had moderate swelling, expression of pus, and skin explosion with necrotizing discoloration of the left lid and lower facial area. MRI of the orbits revealed soft tissue necrosis, gas accumulation, and subperiosteal abscess formation of the left orbit. We administered systemic antibiotics and surgically excised the left periorbital necrotic tissue. A constant expression of pus material was also achieved, decreasing painful swelling. We considered exenteration of the left eye to block the spread of necrosis to adjacent intact tissue; however, the left eye was fairly well-preserved with the exception of mild lagophthalmos developed by the excision of necrotic skin. Streptoccocal species was observed in microbiologic cultures of pus and necrotic tissue and ‘necrotizing inflammation’ was described on tissue biopsy, with the findings consistent with necrotizing fasciitis. Conclusions: Through the diagnosis of necrotizing fasciitis originating from an odontogenic infection, the proper administration of antibiotics and surgical management were achieved. As a result, we were able to preserve the eye. J Korean Ophthalmol Soc 49(6):993-999, 2008