Odontogenic necrotizing fasciitis of the neck and upper chest wall

Abstract

Necrotizing fasciitis (NF) is rapidly progressing bacterial infection spreading along the deep fascial planes. One of NF's characteristic features is the presence of subcutaneous gas. NF is associated with systemic toxicity and high mortality rate. The prognosis of NF depends on early recognition and aggressive treatment. A 23-year-old female was admitted with painful neck and upper chest swelling following inadequately treated odontogenic cellulitis. CT scan with contrast revealed enhancing swelling of the soft tissues of the neck and upper chest with a loss of all muscle planes and presence of gas. The patient underwent urgent surgical exploration of involved fascial spaces and intensive antibiotic and supportive therapy. She recovered and was discharged after 25 days of hospital stay. Odontogenic infections are often improperly managed by primary care physicians and general dental practitioners. Delays in removal of offending teeth and proper surgical drainage while relying on antibiotic treatment only can result in serious complications.