Extensive head and neck necrotizing fasciitis induced by mandibular canine tooth infection in an uncontrolled diabetic patient: a case report

Abstract Background Head and neck necrotizing fasciitis is a rare, progressive soft tissue infection that usually originates from odontogenic sources. Systemic diseases, including immunosuppression and diabetes mellitus, can complicate patient management. Case presentation We report a case of necrotizing fasciitis in a 46-year-old Iranian woman with uncontrolled diabetes. The patient was referred to the hospital with tenderness and erythematous swelling in the right buccal, submandibular, submental, and upper neck regions. Computed tomography (CT) revealed necrotic areas and gas accumulation extending to the superficial temporal, deep temporal, and periorbital spaces. The patient was admitted under the care of the infectious disease service. A multidisciplinary management was implemented. Empiric antibiotics were prescribed by the infectious disease service. Surgical debridement of the necrotic areas and extraction of decayed teeth were performed under general anesthesia. Wet-to-dry dressings were applied and changed every three hours. Tracheostomy and jejunostomy were performed by the general surgery service to provide long-term secured airway and nutritional support. Culture results revealed Klebsiella pneumoniae infection, and the antibiotic regimen was adjusted to colistin, imipenem and vancomycin. Conclusion Early diagnosis and prompt multidisciplinary approach can survive complicated patients with extensive necrotizing fasciitis.