Septic Cervicofacial Phlegmon Following Basal Cell Carcinoma Excision: Life-threatening Complication of Routine Operation in Maxillofacial Surgery?

Abstract

Basal cell carcinoma (BCC) is a frequent tumor entity, especially in the facial region. The standard therapy for BCC is surgical tumor excision which is generally a low-risk procedure. One of the life-threatening surgical risks and complications when removing BCC in the facial area is infection with the possibility to spread across the deep neck spaces as well as systemic inflammation (sepsis). A 73-year-old patient presented to the emergency department with a swelling of the right cheek, extended towards the neck. Based on his medical history, an outpatient BCC excision of the cheek had been performed the day before. Laboratory tests showed a fulminant inflammatory process of sepsis. Computed tomography (CT) revealed a buccal phlegmon on the right extended towards the deep neck. A diagnosis of septic cervicofacial phlegmon following BCC excision was made. The therapy consisted of intensive care sepsis treatment, surgical relief, and drainage of the phlegmon and a calculated antibiotic treatment (piperacillin/tazobactam, clindamycin). Removal of BCC in the facial region is generally a low-risk procedure. A possible complication is postoperative wound infection. In rare cases the clinical picture of a septic cervicofacial phlegmon can develop. Surgical focus sanitation, broad-based antibiotic therapy and intensive care sepsis management are the key therapeutic pillars of this postoperative complication.