Early Diagnosis of Necrotizing Fasciitis of Unknown Origin: A Challenge to Prevent the Delay of Surgical Treatment

Abstract

Cervical Necrotizing Fasciitis is an uncommon infection. It is characterised by a rapidly progressive polymicrobial infection that spreads along the deep fascial planes of the neck. Its fulminant course and high morality makes this disease a diagnostic challenge for the maxillofacial surgeon. Therefore, when clear clinical signs and suspicious images are available, the patient must be taken to the operating room for surgical treatment. Although it is considered a rare entity, misdiagnosis is not acceptable due to its fatal outcome. Close physical examination with a thorough medical history may set the alarm. Further medical test will help to achieve the diagnosis, but never should delay the start of the appropriate treatment. We present a case of cervical necrotizing fasciitis of unknown origin successfully managed in our department. Odontogenic infection and less frequently tonsilar infections are the origin of this infection. Nevertheless, just an auricular wound could be identified as a possible source of this cervical necrotizing fasciitis. We believe that the aggressive surgical treatment combined with broad-spectrum antibiotic and intensive medical care was the key of the early recovery and few after-effects. The aim of this article is to insist in the weigh of the maxillofacial surgeon on the early surgical treatment of the cervical necrotizing fasciitis.