Cervicofacial necrotizing fasciitis after topical application of herbal medicine

Abstract

Cervical necrotizing fasciitis represents an aggressive form of deep neck space infection with a high mortality rate. The origin is generally odontogenic, in most cases, resulting from a dental abscess. A series of three cases developed after local application of herbal medicine in patients with no co-morbidities and with a history of a toothache in the lower quadrants for >2 weeks is presented. All patients were managed with antibiotics, extraction of offending tooth and serial wound debridement. Two patients recovered with a resultant skin defect on the neck and one died due to multiple organ failure. This case series demonstrated that early diagnosis, prompt surgical intervention and appropriate medical treatment are very important to increase patient survival. Late report to hospital because of financial constraints and over-reliance on herbal preparation could lead to the development of serious complication in patients with dental infections and could even lead to death of the patient.

Figure 1

Anterior aspect of the neck and chest.

Figure 2

Right lateral facial view.

Figure 3

Chest debridement under general anaesthesia.

Figure 4

Ulcerations of the neck to the upper third of the chest.

Figure 5

Deviation of the lower lip to the right.

Figure 6

Large ulceration of right submandibular region.

Figure 7

Skin defect after wound debridement.