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Cervical facial necrotizing fasciitis with medistinic spread from odontogenic origin. Two case reports
Abstract:
Necrotizing fasciitis is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria especially in mediastinum. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus characterized by necrosis of skin, subcutaneous tissues, fasciae, and muscles. It usually occurs in adults and is most often localized to the abdominal wall, the extremities, the perineum, the pelvis, and the thoracic region. Localization to the head and neck area is rarely encountered. Descending necrotising mediastinitis is a form of mediastinitis caused by odontogenic infection or deep cervical infections, which spreads to the mediastinum from the cervical fascial planes. Early diagnosis, prompt surgical drainage, monitoring of disease process, appropriate medical management in an intensive care unit and a multi-disciplinary approach can significantly reduces the mortality in this otherwise fatal condition.
Insights
Necrotizing fasciitis, a severe soft tissue infection, often involves widespread fascial necrosis. Prompt diagnosis and multidisciplinary care are crucial for reducing mortality in this rare but fatal condition.
Area of Science:
- Infectious Diseases
- Surgical Pathology
Background:
- Necrotizing fasciitis is a rare, aggressive soft tissue infection.
- It is characterized by rapid necrosis of skin, subcutaneous tissue, fascia, and muscles.
- While often bacterial, it can occur in the mediastinum, originating from cervical infections.
Observation:
- Streptococcus hemolyticus is a common causative agent, producing potent toxins.
- The infection typically affects adults and commonly localizes to the trunk and extremities.
- Head and neck involvement is exceptionally rare.
Findings:
- Descending necrotizing mediastinitis arises from deep cervical or odontogenic infections spreading via fascial planes.
- This condition necessitates aggressive management strategies.
Implications:
- Early diagnosis and prompt surgical intervention are critical.
- Intensive care unit monitoring and a multidisciplinary approach significantly improve patient outcomes.
- Effective management can reduce the high mortality associated with this severe infection.