Odontogenic cervical necrotizing fasciitis in diabetic patients – A case series highlighting critical complications and surgical management

Cervical necrotizing fasciitis (CNF) is a rapidly progressive and potentially fatal soft-tissue infection that may arise from odontogenic sources, particularly in patients with uncontrolled diabetes mellitus. This series describes two patients with diabetes presenting with acute cervical swelling and marked leucocytosis. Computed tomography demonstrated extensive subcutaneous emphysema tracking along multiple cervical fascial planes, highly suggestive of CNF, with findings supporting an odontogenic origin. Both patients underwent urgent, repeated surgical debridement until healthy, viable tissue margins were obtained, followed by definitive reconstruction using a rotation flap in the first case and a split-thickness skin graft in the second. Broad-spectrum intravenous antibiotics, intensive wound care, and frequent laboratory monitoring were performed. Despite complications including transient pancytopenia and septic shock, both patients achieved successful healing and demonstrated stable outcomes at 3-month follow-up. These cases highlight the importance of early recognition, aggressive surgical intervention, and timely reconstruction to optimize survival and reduce morbidity in odontogenic CNF. • Both patients had uncontrolled type 2 diabetes, worsening the cervical necrotizing fasciitis. • CT imaging confirmed necrotizing fasciitis with clear fascial-plane involvement. • High inflammatory markers and leukocytosis indicated a severe systemic infection upon admission. • Management required repeated surgical debridement to achieve viable tissue and enable wound closure. • Both patients demonstrated satisfactory favorable recovery following prolonged inpatient care and targeted antibiotics.