Ascending necrotizing fasciitis of the face following odontogenic infection

Eugene Park, Elliot M. Hirsch, Jordan Steinberg, Alexis B. Olsson

Research output: Contribution to journalArticle

Abstract

Necrotizing fasciitis (NF) of the face is a rare but extremely dangerous complication of dental infection associated with a nearly 30% mortality rate. This infection spreads rapidly along the superficial fascial planes of the head and neck and can lead to severe disfigurement. Reports in the literature of cases of NF of the face caused by dental infection are few. We report such a case in a 36-year-old woman and review the current standards of diagnosis and management. The patient initially presented with pain and severe swelling in the left side of her face subsequent to a dental infection. The symptoms had progressed quickly and had not improved with administration of oral antibiotics in the outpatient setting. The patient had no palpable crepitus despite its classic association with NF. The infection also took a rare, ascending route of spread with involvement of the temporalis muscle. Cultures taken during debridement grew Streptococcus anginosus and Bacteroides. Biopsies of involved muscle showed histologic evidence of necrosis. Through early surgical intervention including aggressive debridement, and the adjunctive use of appropriate antibiotics, the patient recovered with minimal loss of facial mass and no skin loss. Although NF of the face is rare, the surgeon must maintain a high index of suspicion with any patient presenting after a dental infection with rapid progression of swelling and a disproportionate amount of pain that is unresponsive to antibiotics.

Original languageEnglish (US)
Pages (from-to)e211-e214
JournalJournal of Craniofacial Surgery
Volume23
Issue number3
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

Fingerprint

Necrotizing Fasciitis
Tooth
Infection
Debridement
Anti-Bacterial Agents
Streptococcus anginosus
Pain
Muscles
Bacteroides
Oral Administration
Necrosis
Outpatients
Neck
Head
Biopsy
Skin
Mortality

Keywords

  • Dental infection
  • Necrotizing fasciitis
  • Superficial musculoaponeurotic system

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Ascending necrotizing fasciitis of the face following odontogenic infection. / Park, Eugene; Hirsch, Elliot M.; Steinberg, Jordan; Olsson, Alexis B.

In: Journal of Craniofacial Surgery, Vol. 23, No. 3, 01.01.2012, p. e211-e214.

Research output: Contribution to journalArticle

Park, Eugene ; Hirsch, Elliot M. ; Steinberg, Jordan ; Olsson, Alexis B. / Ascending necrotizing fasciitis of the face following odontogenic infection. In: Journal of Craniofacial Surgery. 2012 ; Vol. 23, No. 3. pp. e211-e214.
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