Life-threatening cervical necrotizing fasciitis after a common dental extraction

Abstract

We report a case of cervical necrotizing fasciitis (NF) with severe sepsis occurring 8 hours after a banal dental extraction in a healthy adult. A 44-year-old man was admitted for cervical NF and severe sepsis in the emergency department. An early diagnosis was based on clinical examination (violent pain, swelling of face, and crepitation), confirmed by computed tomography scan, which showed subcutaneous gas and a fracture of the maxillary sinus in regard of the extracted tooth. Broad spectrum antibiotherapy was started quickly followed by surgical debridement. Operative and sinus pus cultures were positive for polymicrobial strains (aerobes and anaerobe). Ventilatory and hemodynamic supports (large fluid infusion and catecholamine) were mandatory during a week. Successful outcome occurred within 2 weeks. Cervical NF is a rare but life-threatening disease with fulminant course. The mortality rate is high if the diagnosis and treatment are not begun promptly and vigorously. Therefore, the emergency medicine community must be aware of its initial symptoms.