E788 Med Oral Patol Oral Cir Bucal. 2008 Dec 1;13(12):E788-91. Cervical necrotizing fasciitis Cervical necrotizing fasciitis: An unusual sequel of odontogenic infection Krishnaraj Subhashraj 1 , Naveen Jayakumar 1 , Chinnasamy Ravindran 2 (1) Former Postgraduate Residents (2) Professor and Head of the Department Department of Oral and Maxillofacial Surgery, Sri Ramachandra Dental College and Hospital, Porur, Chennai, India Correspondence: Dr. K. Subhashraj 10, 8th Cross, Brindavan, Pondicherry 605013 India. rajsubhash@rediffmail.com Received: 31/03/2008 Accepted: 01/10/2008 Subhashraj K, Jayakumar N, Ravindran C. Cervical necrotizing fasciitis: An unusual sequel of odontogenic infection. Med Oral Patol Oral Cir Bucal. 2008 Dec 1;13(12):E788-91. © Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946 http://www.medicinaoral.com/medoralfree01/v13i12/medoralv13i12p788.pdf Abstract Cervical necrotizing fasciitis is a rare infection of the fascial planes, which is less common in head and neck, be- cause of the rarity and higher vascularity in the region. We reviewed five patients with cervical necrotizing fasciitis of odontogenic infection managed at a teaching hospital at Chennai, India. There were four men and one woman, of whom four patients were diabetic and hypertensive, with a mean age of 53 years. Mandibular molars (periapical or pericoronal abscess) were found to be the source of infection in all of the cases. The treatment involved incision and drainage and debridement. Anti-microbial drugs were given for all the patients, which included cephalosporins, metronidazole and gentamycin. In four patients the wound healed by contracture and one patient required split skin grafting. Due to the smaller extent of the necrosis, better control of the systemic disease and small size of the sam- ple, there was neither a major complication nor death. This paper reminds us that cervicofacial necrotizing fasciitis (CNF) remains one of the potential complications of long standing odontogenic infections in patients with immune- compromised status, particularly in lower dentition. Key words: Cervical, necrotizing fasciitis, odontogenic, mandibular. Article Number: 1111111751 © Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946 eMail: medicina@medicinaoral.com Indexed in: - Science Citation Index Expanded - Journal Citation Reports - Index Medicus, MEDLINE, PubMed - Excerpta Medica, Embase, SCOPUS, - Indice Médico Español Introduction Necrotizing fasciitis was first described in 1848. In 1920, Meleney identified 20 patients in China in whom hemolytic streptococcus was the sole organism. Wilson coined the term necrotizing fasciitis in 1952 and found no specific pathologic bacteria related to the disease (1). Necrotizing fasciitis is characterized by fulminating, de- vastating and rapidly progressing condition, with a high morbidity and mortality rate. The disease is caused by a polymicrobial or mixed aerobic-anaerobic infection (2). Patients with immunocompromised status like diabetes mellitus, cancer, alcoholism, vascular insufficiencies, organ transplants, HIV, or neutropenia are prone to this type of infection (3,4). Organisms spread from the subcutaneous tissue along the superficial and deep fascial planes, presumably facilitated by bacterial enzymes and toxins. This deep infection causes vascular occlusion, ischemia, and tissue necrosis. Superficial nerves are damaged, producing the characte- ristic localized anesthesia (5,6). Septicemia ensues with systemic toxicity. Necrotizing fasciitis seen commonly seen in the extremities, trunk and perineum. They require aggressive treatment to combat the associated high morbidity and mortality. However, cervicofacial necrotizing fasciitis (CNF) of odontogenic origin were being reported from few countries (1-8). These infections can be difficult to recognize in their early stages, but they rapidly progress. Publication Types: Case Reports