Necrotizing fasciitis of the masticator space with osteomyelitis of the mandible in an edentulous patient

Abstract

Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the subcutaneous tissue and fascia, caused by bacterial infection. Usually presenting in the extremities, trunk, or perineum, it is uncommon in the craniofacial or cervical area. Cervicofacial NF is a potentially fatal infection, which should be managed with early detection and intervention. Most cases have a primary odontogenic source of infection, especially when the masticator space is involved. We report a case of masticator space NF that developed without odontogenic origin in a 78-year old female who was treated with prompt surgical drainage and intravenous antibiotics.

Keywords: Mouth, edentulous; Necrotizing, fasciitis; Osteomyelitis.

Fig. 1.

Preoperative and postoperative clinical photographs. (A) The patient at presentation. Swelling and redness of the right mandibular angle and temporal areas are seen. (B) The patient during subsequent irrigation. Incisions at the upper and lower aspects of the necrotizing fasciitis cavity are seen. Resolution of swelling is seen.

Fig. 2.

Initial contrast-enhanced computed tomography scans. (A) Abscess formation in the right masticator and parapharyngeal spaces with extensive gas formation involving the temporalis, masseter and buccinators muscles. (B) Air densities were found in the right mandible suggesting osteomyelitis.

Fig. 3.

Contrast-enhanced computed tomography scans. (A) Masticator and parapharyngeal spaces (yellow dotted line) in axial view and (B) coronal view.