Cervicofacial Necrotizing Fasciitis of Non-Odontogenic Origin

A 38-year-old male patient with no preexisting diseases presented as an emergency with swelling in the region of the left cervicofacial transition. He had been experiencing difficulty swallowing for 3 days. The patient history included occasional drug use (amphetamines). Clinical examination confirmed a pressure-sensitive swelling in this patient, who had tachycardia and a high fever. Laboratory tests showed elevated inflammatory parameters (leukocytes 27.51 × 109/L, CRP 337 mg/L). Computed tomography revealed a pronounced inflammatory event with gas inclusions in the left perimandibular area arising from the submandibular gland and consistent with cervicofacial necrotizing fasciitis (CNF) (Figure a, b). Multiple surgical debridements were performed, which in combination with perioperative antibiotic therapy (piperacillin/tazobactam), led to an abatement of the inflammatory event. CNF is a life-threatening soft tissue infection and frequently of odontogenic origin. Cervicofacial manifestations are rare (4%). Immunodeficiency and drug use are risk factors for CNF. Immediate surgical intervention together with antibiotic therapy form the treatment pillars of this clinical picture (40% mortality rate). This case report highlights the fact that CNF can also be of non-odontogenic origin.

Figure

Computed tomography

Dr. med. Florian Dudde, Dr. med. dent. Martin Kreibich, Prof. Dr. med. Dr. med. dent. Kai-Olaf Henkel
Abteilung für Mund-, Kiefer- und plastische Gesichtschirurgie, Bundeswehrkrankenhaus Hamburg-Wandsbek, [e-mail]

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Dudde F, Kreibich M, Henkel KO: Cervicofacial necrotizing fasciitis of non-odontogenic origin. Dtsch Arztebl Int 2024; 121: 147. DOI: 10.3238/arztebl.m2022.0407