A Novel Anatomic Classification System and Management Protocol for Odontogenic Cervicofacial Necrotizing Fasciitis

Cervicofacial necrotizing fasciitis (CNF) is a rare but life-threatening condition, most often secondary to odontogenic infections. The aim of this study was to propose a new, anatomically based classification system for CNF of odontogenic origin and to outline a management protocol.

This retrospective single-center study included all patients diagnosed with CNF of odontogenic origin between June 2017 and May 2024. Sociodemographic data, anatomic extent of disease, treatment modalities, intensive care unit (ICU) requirements, grafting, and physiotherapy were recorded and analyzed.

Of 68 patients, 52 (76.5%) presented with class I disease (limited to the head and neck), 11 (16.2%) with class IIA (extension to the anterior chest wall, limited inferiorly by the lower costal ribs), 3 (4.4%) with class IIB (extension to the lateral chest wall, limited by the floating ribs), and 2 (2.9%) with class III (extension to the anterior chest and abdominal wall, limited inferiorly by the inguinal ligament). Management involved serial debridement ± ICU care, antiseptic dressings, removal of affected teeth, physiotherapy, and occasional skin grafting. Three deaths (4.4%) occurred, all in patients with advanced disease (class IIA/IIB).

This new classification system provides a simple, clinically applicable framework for describing the anatomic spread of odontogenic CNF. By enabling earlier risk stratification and guiding tailored interventions, it may improve survival and optimize outcomes, especially in low-resource settings.