Cervicofacial necrotizing fasciitis of odontogenic origin

Abstract

Necrotizing fasciitis is a rare, rapidly progressing infection of the skin and soft tissues with high mortality. Its presentation in the cervicofacial region is unusual, and the most common cause is odontogenic infections. Systemic diseases that cause immune compromise are considered general risk factors in the occurrence of this condition. A case is presented showing the natural course of the disease in a 44-year-old male patient with a history of chronic kidney failure, who arrived at the emergency consultation due to respiratory difficulty associated with edema and skin breakdown in the cervicofacial region with a purplish-black appearance. In the anamnesis, the patient and family reported a history of pain in the lower right molar in the previous days. The laboratory tests performed as a complement to the physical examination, along with the deterioration of the patient's systemic condition, supported the presumptive diagnosis of necrotizing cervicofacial fasciitis. The surgical management was based on maintaining the patient's airway with tracheostomy and the excision of necrotic tissue. The pharmacological treatment, which was initially empirical, was maintained upon confirming through microbiological studies the sensitivity of the microorganisms present in the process. The multidisciplinary approach and the therapeutic conduct adopted for the patient allowed for his recovery from a disease that has an unfavorable prognosis in people with chronic kidney disease.