Clinical Articles
Cervical necrotizing fasciitis of odontogenic origin: A case report and review of 12 cases,☆☆,,☆☆

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Abstract

Purpose: This article reviews the demographics, presentation, cause, clinical findings, and treatment of 12 cases of cervical necrotizing fasciitis of odontogenic origin. Patients and Methods: A retrospective chart review of 12 cases treated between 1987 and 1997 was done. Results: Most cases resulted from an abscessed mandibular molar. The most common significant medical conditions in the patient's history were diabetes, hypertension, obesity, and substance abuse. All patients were treated surgically within 24 hours of admission. Hyperbaric oxygen (HBO) was used as adjunctive treatment in all cases. The average length of hospital stay was 31 days. All patients recovered. Conclusion: Early surgical intervention and the use of HBO decreases morbidity and improves the clinical outcome.

Section snippets

Report of case

A 46-year-old HIV-positive woman, with a history of hypertension, presented to the emergency department of University of Maryland Medical System in April 1997 with the complaint of increasing pain and swelling for the previous 3 days. She had seen a dentist in the community earlier in the week for a painful lower molar and was treated with penicillin.

Physical examination showed an obese woman with moderate to severe edema of the sublingual, submandibular, and submental spaces, causing

Review of cases

A retrospective review was conducted for the charts of adult patients with NF of the head and neck admitted to the R. Adams Cowley Shock Trauma Center or the University of Maryland Medical System between 1987 and 1997. Twenty-five charts meeting this criterion were collected. Eleven patients had documented cervical NF of odontogenic origin; the other 14 had cervical NF from a nonodontogenic source. Children were not considered for this study because cervical NF in the pediatric population

Discussion

Patients with cervical NF typically are febrile, with elevated WBC counts (as were 80% of the patients in this series). They also tend to be dehydrated and malnourished secondary to poor oral intake during the course of their disease.2, 4, 6, 12 Hypocalcemia is frequently present secondary to necrosis of fat and may be demonstrated clinically with neuromuscular excitability and positive Chvostek's and Trousseau's signs.2, 4

Risk factors for the development of NF include diabetes mellitus,

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      Infection of second and third molars of the mandible are the most frequent aetiologies of odontogenic cervical NF [5]. Wong's study also indicated the lower molars are the most common regions [6], and Whitesides et al. revealed up to 81% of patients with cervical NF were originated from second and third molar infections [7]. These teeth deepen into the mylohyoid insertion over the lingual side of the mandible.

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    *Formerly, Resident; Currently, Private Practice, Marietta, GA.

    ☆☆

    †Co-director.

    ‡Director.

    ☆☆

    Address correspondence and reprint requests to Dr Myers: Hyperbaric Medicine, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S Greene St, Baltimore, MD 21201.

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