Odontogenic cervical necrotizing fasciitis, etiological aspects

Area of Science:

• Oral and Maxillofacial Surgery
• Infectious Diseases
• Head and Neck Surgery

Background:

• Cervical necrotizing fasciitis is a rare, severe soft-tissue infection of the head and neck.
• It frequently arises from odontogenic (dental) disorders and has a high mortality rate.
• This condition represents a critical infection of the maxillofacial spaces.

Purpose of the Study:

• To analyze the characteristics of cervical necrotizing fasciitis of odontogenic origin.
• To identify common origins, affected spaces, and microbiological findings.
• To evaluate treatment outcomes and contributing factors to disease development.

Main Methods:

• Retrospective study of 55 patients with confirmed cervical necrotizing fasciitis of odontogenic origin.
• Data collected from January 1996 to December 2012.
• Analysis included patient demographics, systemic disorders, time to treatment, initial treatment, origin of infection, affected spaces, and bacteriology.

Main Results:

• Most patients (60%) had no systemic disorders; type 2 diabetes mellitus was most common among those who did.
• The time from symptom onset to treatment ranged from 2 to 30 days.
• Antibiotic treatment was administered to 78.18% of patients without success.
• Mandibular molars were the most frequent origin (47.27%), with the submandibular space being the first affected.
• Facultatively aerobic/anaerobic Gram-positive bacteria were most frequently identified (72.22%).

Conclusions:

• Odontogenic infections of lower molars leading to submandibular space infections are the primary cause of odontogenic cervicofacial necrotizing fasciitis.
• Delayed surgical intervention and solely antibiotic therapy are associated with disease progression.
• Prompt diagnosis and appropriate surgical management are crucial for treating this severe infection.