World J Oral Maxillofac Surg | Volume 1, Issue 1 | Case Report | Open Access
Henrik Holtmann1*, Julian Lommen1, Karoline Sander1, Norbert R Kübler1 and Renan Langie2
1Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Germany
2Centro de Odontologia/Santa Casa de Misericórdia de Porto Alegre (SCMPA), Brazil
*Correspondance to: Henrik Holtmann
Fulltext PDFCervical Necrotizing Fasciitis (CNF) is a rare yet critical wound infection with a tendency for rapid
progression. Diabetic patients are particularly vulnerable due to their deprived wound-healing
capabilities. We report the case of a black 18-year-old female patient of African descent with a type
I diabetes mellitus and CNF. The patient presented in state after surgical removal of the lower right
third molar. Despite a prescribed antibiotic therapy by the attending doctor the patient complained
about persisting pain and a reduced overall well-being. Presenting at our clinic the patient showed
no clinical signs of swelling, reddening, indurations or restricted mouth opening that would have
indicated an abscess. Hence, we extended the antibiotic therapy and dismissed the patient. Two
weeks later the patient returned in a considerably reduced general state of health including syncope
and drowsiness. An immediately implemented CT-scan of the head and neck as well as the clinical
appearance leads to the diagnosis CNF with profound mediastinitis. Despite surgical intervention,
microbiological testing of wound swaps and an extended antibiotic therapy septic shock with acute
hepatic failure caused the patient’s death two weeks after her admission to our hospital. This case
demonstrates the important role of odontogenic infections to the development of CNF and the
difficulty of diagnosing early stage CNF especially in patients with dark complexion and diabetes
mellitus. An early intervention is the deciding prognostic factor for the overall survival rate.
Necrotizing fasciitis; Cervical necrotizing fasciitis; Mediastinitis; Descending necrotizing mediastinitis; Descending necrotizing fasciitis; Odontogenic infection; Dental infection; Diabetes mellitus
Holtmann H, Lommen J, Sander K, Kübler NR, Langie R. Odontogenic Cervical Necrotizing Fasciitis and Descending Necrotizing Mediastinitis in a Diabetic Patient: Literature Review and Report of a Rare and Fatal Case.
World J Oral Maxillofac Surg. 2018;1(1): 1001.