Acta Scientific Otolaryngology (ASOL) (ISSN: 2582-5550)

Research Article Volume 4 Issue 4

Odontogenic Cervical Necrotizing Fasciitis - A Case series with Review of literature

Sonika Kotwal, Vipan Gupta, Manpreet Singh Nanda, Shenny Bhatia, Deepika Sharma, Sushumna Yadav, Pheiroijam Romibala and Pooja Thakur*

Department of Otorhinolaryngology and Head and Neck Surgery, Maharishi Markandeshwar Medical College and Hospital, India

*Corresponding Author: Pooja Thakur, Department of Otorhinolaryngology and Head and Neck Surgery, Maharishi Markandeshwar Medical College and Hospital, India.

Received: February 22, 2022; Published: March 24, 2022

Abstract

Cervical necrotizing fasciitis (CNF) is an uncommon and aggressive deep neck infection, is potentially life threatening causing rapid destruction of muscles, fascia and subcutaneous fat. It clinically mimics some more benign infections (cellulitis) in its early stages. Owing to its significant mortality, it is imperative to have an early and definitive diagnosis, aided by high index of clinical suspicion, laboratory indices and radiology.

Aim: Owing to its rarity, main aim of this series is to present our clinical experience of CNF aiming to set a standard protocol for prompt diagnosis and management.

Materials and Methods: A total of 5 patients presented to ENT Department with Cervical necrotizing fasciitis from December 2011 to December 2019 were reviewed retrospectively. In this series (n = 5) of odontogenic CNF, all cases were diagnosed on the basis of clinical features, Laboratory risk indicator for necrotising fasciitis (LRINEC) score and Computed Tomography (CT) scan.

Results: Majority of cases were males (4) with co-morbidities (diabetes, hepatitis, anaemia). Although mixed flora was identified on culture and sensitivity, one had Methicillin Resistant Staphylococcus aureus (MRSA) infection. LRINEC score was correlating with the severity of infection and coordinated with Laboratory risk indicator for necrotising fasciitis - Orocervical region (LRINEC-OC) score.

Conclusion: Odontogenic infections are commonly seen but their progression to cervical necrotizing fasciitis is rare with subtle clinical findings, leading to delay in the diagnosis and management. So, ancillary diagnostic indices including LRINEC and LRINEC-OC scores should be included in the protocol.

Keywords: Cervical Necrotizing Fasciitis; Necrotizing Fasciitis; Odontogenic Necrotizing Fasciitis; LRINEC; LRINEC-OC

References

  1. Camino Junior Rubens., et al. “Cervical necrotizing fasciitis of odontogenic origin in a diabetic patient complicated by substance abuse”. Brazilian Dental Journal 25,1 (2014): 69-72.
  2. Irani Soussan. “Orofacial Bacterial Infectious Diseases: An Update”. Journal of International Society of Preventive and Community Dentistry2 (2017): S61-S67.
  3. Stevens Dennis L and Amy E Bryant. “Necrotizing Soft-Tissue Infections”. The New England journal of medicine23 (2017): 2253-2265.
  4. Bahu S J., et al. “Craniocervical necrotizing fasciitis: an 11-year experience”. Otolaryngology--head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery3 (2001): 245-252.
  5. Karkas A., et al. “Optimal treatment of cervical necrotizing fasciitis associated with descending necrotizing mediastinitis”. The British Journal of Surgery4 (2010): 609-615.
  6. Kessenich Cathy R and Ashima Bahl. “Necrotizing fasciitis: understanding the deadly results of the uncommon 'flesh-eating bacteria'”. The American Journal of Nursing 104,9 (2004): 51-55.
  7. Wong Chin-Ho., et al. “The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections”. Critical Care Medicine7 (2004): 1535-1541.
  8. Ogawa Masaru., et al. “Laboratory Risk Indicator for Necrotizing Fasciitis of the Oro-Cervical Region (LRINEC-OC): A Possible Diagnostic Tool for Emergencies of the Oro-Cervical Region”. Emergency Medicine International (2019): 1573453.
  9. Cruz Toro P., et al. “Cervical necrotizing fasciitis: report of 6 cases and review of literature”. European Annals of Otorhinolaryngology, Head and Neck Diseases 131,6 (2014): 357-359.
  10. Ferzli George., et al. “Aggressive Necrotizing Fasciitis of the Head and Neck Resulting in Massive Defects”. Ear, Nose, and Throat Journal4 (2019): 197-200.
  11. Amponsah Emmanuel Kofi., et al. “Clinical classification of cervical necrotizing fasciitis”. European Archives of Oto-Rhino-Laryngology: Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery12 (2018): 3067-3073.
  12. Obimakinde O S., et al. “Retrospective evaluation of necrotizing fasciitis in University College Hospital, Ibadan”. Nigerian Journal of Clinical Practice3 (2012): 344-348.
  13. Flanagan Carrie E., et al. “Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing fasciitis”. Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery5 (2009): 730-734.
  14. Bakshi Jaimanti., et al. “Cervical necrotizing fasciitis: Our experience with 11 cases and our technique for surgical debridement”. Ear, Nose, and Throat Journal2 (2010): 84-86.
  15. Mao Johnny C., et al. “Craniocervical necrotizing fasciitis with and without thoracic extension: management strategies and outcome”. American Journal of Otolaryngology1 (2009): 17-23.
  16. Lanisnik Bostjan and Bogdan Cizmarevic. “Necrotizing fasciitis of the head and neck: 34 cases of a single institution experience”. European Archives of Oto-Rhino-Laryngology: Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery3 (2010): 415-421.
  17. Whitesides L., et al. “Cervical necrotizing fasciitis of odontogenic origin: a case report and review of 12 cases”. Journal of Oral and Maxillofacial Surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons2 (2000): 144-151; discussion 152.
  18. Suárez Aldo., et al. “Cervical necrotizing fasciitis of nonodontogenic origin: case report and review of literature”. The American Journal of Emergency Medicine11 (2014): 1441.e5-6.
  19. Ord R and D Coletti. “Cervico-facial necrotizing fasciitis”. Oral Diseases2 (2009): 133-141.
  20. Zhang W-J., et al. “Cervical necrotizing fasciitis due to methicillin-resistant Staphylococcus aureus: a case report”. International Journal of Oral and Maxillofacial Surgery8 (2010): 830-834.
  21. Fernando Shannon M., et al. “Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis”. Annals of surgery1 (2019): 58-65.
  22. McGurk Mark. “Diagnosis and treatment of necrotizing fasciitis in the head and neck region”. Oral and Maxillofacial Surgery Clinics of North America1 (2003): 59-67.
  23. WILSON B. “Necrotizing fasciitis”. The American Surgeon4 (1952): 416-431.
  24. Juncar M., et al. “Odontogenic cervical necrotizing fasciitis, etiological aspects”. Nigerian Journal of Clinical Practice 3 (2016): 391-396.
  25. Lin C., et al. “Necrotizing fasciitis of the head and neck: an analysis of 47 cases”. Plastic and Reconstructive Surgery7 (2001): 1684-1693.
  26. Mtenga Arnold A., et al. “Cervicofacial necrotizing fasciitis among patients attending the Muhimbili National Hospital, Dar es Salaam, Tanzania”. BMC Infectious Diseases1 (2019): 642.

Citation

Citation: Pooja Thakur., et al. “Odontogenic Cervical Necrotizing Fasciitis - A Case series with Review of literature".Acta Scientific Otolaryngology 4.4 (2022): 52-57.

Copyright

Copyright: © 2022 Pooja Thakur., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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