Necrotizing Fasciitis of Odontogenic Origin in a Patient with Unknown Diabetes Mellitus: A Case Report and Literature Overview

Abstract

Necrotizing fasciitis (NF) is a life-threatening emergency that requires prompt and aggressive surgery with broad-spectrum antibiotherapy and resuscitation. This report aims to raise the index of suspicion for NF allowing early diagnosis mainly in patients with diabetes mellitus and who received non-steroid-anti-inflammatory. A 52-year-old man, without noticeable illness, was admitted for progressive submandibular swallowing, following wisdom tooth extraction, with extensive cervical redness centred by skin depression. The patient’s chief complaint was a sore throat, trismus and intensive pain leading to self-administration of non-steroid-anti-inflammatory drugs. Laboratory tests revealed an unknown diabetes mellitus. Enhanced Computed Tomography revealed the disappearance of fascial planes and tissular swelling containing multi-space emphysema with an airway compromise. The patient underwent surgical debridement of the involved fascial spaces and necrotic tissues until normal bleeding was obtained combined with intensive resuscitation and 37 inpatient days allowed patient rescue without soft tissue sequelae. Thus, Odontogenic NF should be suspected in patients with diabetes mellitus who have taken non-steroid-anti-inflammatory medication especially when there are discrepancies between signs of toxicity and deceptive clinical symptoms of an odontogenic infection. Computed tomography is crucial for prompt diagnosis, therapeutic management and postoperative assessment. Removal of the odontogenic focus simultaneously combined with thorough surgical debridement with broad-spectrum antibiotherapy and resuscitation improves survival rates and reduces visceral morbidity and soft tissue sequelae. Otherwise, Oral health education and care mainly in high-risk patients remain a key to prevent this serious health problem.