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Case Reports
. 2023 Jul 22;10(7):1262.
doi: 10.3390/children10071262.

Pediatric Cervicofacial Necrotizing Fasciitis-A Challenge for a Medical Team

Adina Simona Coșarcă  1 , Dániel Száva  1 , Bálint Bögözi  1 , Alina Iacob  1 , Anca Frățilă  2 , Guzun Sergiu  2
Affiliations
Case Reports

Pediatric Cervicofacial Necrotizing Fasciitis-A Challenge for a Medical Team

Adina Simona Coșarcă et al. Children (Basel). .

Abstract

Cervical necrotizing fasciitis is a very rare complication of a bacterial infection that can have a dental cause. This type of infection typically affects fascial plane, which has a poor blood supply and can affect soft tissue and cervical fascia and can spread quickly causing infection of mediastinum. Initially, in the first stage, the overlying tissues are unaffected, and this can delay diagnosis and surgical intervention. Incidence in children is extremely rare and can be frequently associated with various other general pathologies that decrease the immune system response. We present a case of a young 12-year-old boy diagnosed with this type of infection in the head and neck as a complication of a second inferior molar pericoronitis. The treatment and the management of the case was difficult not only due to the presence of the infection but also because of the prolonged intubation.

Keywords: multidisciplinary approach; necrotizing fasciitis; odontogenic infection; pericoronitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CT scan. The red arrows point to the necrotic and gaseous collections in the affected areas—infratemporal, sublingual, submandibular, submental, parapharyngeal, retropharyngeal and peripharyngeal spaces, and extend to the anterior upper mediastinum.
Figure 2
Figure 2
CT scan: Postoperative reevaluation of the involved anatomical spaces. Red arrows point to the drainage tubes inserted into the infratemporal region bilaterally, submandibular space bilateral, floor of the mouth, parapharyngeal and retropharyngeal space and anterior mediastinum.
Figure 3
Figure 3
(a) Absence of the local fascial necrosis and pathological secretions and (b) wound secondary sutures and the last drain tube located in the anterior mediastinum that was removed.
Figure 4
Figure 4
Blood clot: (a) endoscopic view and (b) removal of the blood clot.
Figure 5
Figure 5
Final CT scan showing healing of the head, neck and mediastinum, with no further pathologies.
Figure 6
Figure 6
Pressure ulcers: (a) occipital, (b) legs and (c) calcaneus (heel).
Figure 7
Figure 7
Postoperative wound during healing.
Figure 8
Figure 8
(a) OPG showing periapical lesion on distal root of tooth 3.6, (b) the mucous cap on 3.7 (coronal distal part), and (c) extraction of tooth 3.6 and the periapical lesion.
Figure 9
Figure 9
Postoperative scars of the neck.
See this image and copyright information in PMC

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