Cervical Necrotizing Fasciitis Caused by Oral Cavity Infection: A Case Report Considering Therapeutic Approach and its Morphofunctional Implications
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2023
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Cervical necrotizing fasciitis (NF) is a rare complication of oral cavity infection with high morbi-mortality. Given its low
prevalence, adequately reporting cases of NF, its therapeutic management, and associated morphofunctional modifications to the clinical and
scientific community is pivotal. To that end, we herein describe a case of cervical NF in a 60-year-old patient with comorbidities and patient
presented large, painful cervical swelling associated with a necrotic ulcer lesion in the anterior neck region. Intraoral examination indicated a
periodontal abscess in the right mandibular area, while computed tomography indicated the lesion’s extension from the right mandibular to the
submandibular region. Following empirical intravenous antibiotic treatment, a broad surgical debridement was performed, and the foci of oral
infection were removed. Debridement revealed communication between deep and superficial anatomical regions in the submandibular area,
where we subsequently placed a Penrose drain. Biopsies showing acute inflammatory infiltrate associated with necrotic and hemorrhagic regions
confirmed the diagnosis of NF. When an antibiogram revealed resistance to the empirical treatment, the antibiotic scheme was replaced with an
adequate alternative. After a second debridement, we closed the defect with fascio-mucocutaneous advancement flaps with a lateral base while
maintaining suction drainage. Having reacted positively, the patient was discharged 10 days after the operation. Despite an extensive
morphofunctional change generated in the treated area, the patient showed no difficulties with breathing, phonation, swallowing, or mobilizing
the area during control sessions. Altogether, this report contributes to the highly limited literature describing morphological aspects that can
facilitate or delay the spread of infection or the morphofunctional disorders associated with the size and depth of surgical interventions for cervical
NF, information that is relevant for the comprehensive, long-term prognosis of the treatment of NF.