CERVICOFACIAL NECROTIZING FASCIITIS SECONDARY TO ODONTOGENIC INFECTION IN A NIGERIAN POPULATION

Cervicofacial necrotizing fasciitis secondary to odontogenic infection

Abstract

OBJECTIVE: This study aimed to present the clinical features, 
microbiological patterns of odontogenic infection and treatment 
outcome associated with cases of Cervicofacial necrotizing fasciitis 
(CNF) seen in a South-South Nigerian population. 
METHODS: A 6-year retrospective review of patients diagnosed of 
CNF. The data analyzed were patients’ age, gender, site of infection, 
implicated tooth, co-morbid conditions, microbiology profile, 
treatment modalities, length of stay in the hospital, treatment 
outcome and possible cause of death. 

RESULTS: There were 6 patients diagnosed of CNF during the 
period of study, consisting of 2 (33.3%) males and 4 (66.7%) 
females, giving a ratio of 1:2. The patients’ mean age was 59.5 + 7.9 
years (SEM) and 5 (83.3%) patients presented with associated 
medical conditions, among which 2 (33.3%) patients each had 
diabetes mellitus, hypertension and jaundice. Acute apical 
periodontitis was the most common odontogenic infection and the 
second mandibular tooth was the most frequently affected tooth type 
(n=4, 66.7%). All the patients presented with infected facial space 
swelling especially the submandibular space. Most of the patients 
had mixed bacterial infection, with peptostreptococcus sp and 
klesiella sp occurring in 2(33.3%) patients each. Most patients’ (n=4, 
66.7%) treatment included exodontia of infected tooth, fasciotomy, 
debridement, twice daily dressings and antimicrobial therapy. The 
mortality rate was 50%, with 3 patients, death resulting from septic 
shock (n=2, 33.3%) and thromboembolism (n=1, 16.7).  

CONCLUSION: CNF in the head and neck region mimics facial 
space infections. A high index of suspicion is needed for prompt 
management of CNF. Mortality can thus be reduced by early 
diagnosis and treatment of the patients.