Necrotizing Fasciitis after Wisdom Tooth Removal

Background: Necrotizing fasciitis (NF) is a rare life-threatening infection characterized by a rapid and progressive necrosis of subcutaneous tissues and fascia with resultant skin gangrene and further systemic toxicity. NF is mostly reported in extremities, trunk and perineum, while head and neck structures account for only 3-4% of all reported cases. Cervical NF is an even more severe condition, with a high mortality rate, usually caused by dental infection, infection secondary to trauma, throat abscess, osteoradionecrosis or, more rarely, to salivary gland infection. A higher mortality is reported to occur in patients with evolution to mediastinitis, condition called descending necrotizing fasciitis or descending necrotizing mediastinitis. When this complication is accompanied by immunosuppressive conditions, such as diabetes, the infection is often reported as fatal. Case report: We present the case of a 18-years-old female Afro-descendant patient who developed a NF after ambulant extraction of a single third molar (48). Although she got antibiotics (Amoxicillin) beginning right after extraction she developed a descending necrotizing fasciitis. For nearly two weeks symptoms were rare (i.e. due to her dark skin) and undefined which may have protracted the diagnosis finding process. On the other hand the Diabetes type I of the patient may have abet the severity of the symptoms. When diagnosis was found two weeks after extraction CT showed signs of large air retentions in subcutaneous cervical and thoracic tissue as well as a distinctive mediastinitis Although extensive incisions and multiantibiotic therapy was performed condition progressed rapidly leading to a severe sepsis and lead into death of the patient. Conclusion: The presented case highlights the important role of dental infections as initial focus of cervical necrotizing fasciitis, as well as the value of early recognition of the disease and prompt clinical and surgical intervention for a successful outcome, especially in patients with systemic disabling immune conditions. Keywords: cervical necrotizing fasciitis, wisdom tooth removal, mediastinitis