Cervical necrotizing fasciitis of odontogenic origin in a healthy young patient without pre-systemic disorders

Abstract

Necrotizing fasciitis (NF) is a rapidly spreading soft-tissue infection characterized by diffuse necrosis of fasciae and subcutaneous tissues. Cervical NF (CNF) can develop from odontogenic infections that spread to the deep fascial planes of the neck. This polymicrobial infection is rapidly progressive, destructive, and often fatal. The majority of CNF patients are known to present an immunosuppressed status or to have systemic disease. CNF is uncommon in healthy individuals. Here we describe the case of a patient with CNF due to an odontogenic polymicrobial infection including Streptococcus milleri group (S. milleri) after extraction of the mandibular third molar in a healthy 32-year-old Thai man. The CNF progressed to descending mediastinitis, which often leads to a poor prognosis and decreased survival. Prompt diagnosis, intensive antibiotic therapy and repeated surgical treatment successfully contributed to the survival of this patient. His case suggests the importance of perioperative care for invasive dental treatments in not only patients with pre-systemic disorders but also healthy young individuals.