Therapeutic Approach to Odontogenic Cervicofacial Necrotising Fasciitis: An Unusual Case Report

ABSTRACT Background The necrotising fasciitis is a severe and progressive infection of the superficial fascia and the adjacent subcutaneous tissues. The involvement of the head and neck regions is rare and associated with high rates of mortality. The aim of this study was to report the treatment used for cervicofacial necrotising fasciitis originating from an odontogenic abscess. Methods A 54‐year‐old male, diabetic, complained of asymmetry and pain in the left face area. During the clinic exam, we noticed an odontogenic abscess in the left cervical, submandibular, sublingual and buccal spaces, besides the submental space. We performed extraction of the left lower first, second and third molars alongside extraoral drainage of the odontogenic abscess in the left submandibular and submental regions. Two days after the procedure, the area became blackened, evolving to local necrosis, fascial detachment and erythematous margins. Results We performed surgical debridement of the wound and biopsy with a positive culture for Streptococcus pyogenes . We established the diagnosis of cervicofacial necrotising fasciitis, followed by intravenous Gentamicin 240 mg and Clindamycin 600 mg administration, 18 sessions of hyperbaric oxygen therapy and vacuum curative maintenance. We reached total remission of the lesion and satisfactory cicatrisation within 18 days. Conclusion Surgical debridement, antibiotic therapy, hyperbaric oxygen therapy and vacuum‐assisted closure displayed satisfactory results in odontogenic cervicofacial necrotising fasciitis treatment.