Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Ear, Nose and Throat Disorders
Published in: BMC Ear, Nose and Throat Disorders 1/2018

Open Access 01-12-2018 | Research article

Odontogenic necrotizing fasciitis: a systematic review of the literature

Published in: BMC Ear, Nose and Throat Disorders | Issue 1/2018

Login to get access

Abstract

Background

While odontogenic soft tissue infections of the head and neck are common, progression to necrotizing fasciitis is relatively rare. Necrotizing fasciitis is a potentially life-threatening and rapidly progressive soft tissue infection that can lead to significant skin and soft tissue loss, mediastinitis, vascular thrombosis or rupture, limb loss, organ failure, and death.

Methods

A PubMed literature search was conducted for case reports and case series on odontogenic necrotizing fasciitis. Individual patient data was analyzed and compiled and demographic, treatment, microbiology, and mortality data were extracted. Fisher’s exact test was used to examine the relationship between death from odontogenic necrotizing fasciitis and diabetes mellitus (DM) and human immunodeficiency virus (HIV) positivity.

Results

A total of 58 studies totaling 164 patients were identified. Thirty-three patients had DM and 3 were HIV +. All patients underwent aggressive surgical debridement and treatment with IV antibiotics. Twenty patients were also treated with hyperbaric oxygen. There were 16 deaths reported, for a mortality rate of 9.8%. The mortality rate among patients with DM was 30.3 and 0% among HIV positive patients. There was a statistically significant increase in the mortality rate in DM patients with odontogenic necrotizing fasciitis (p = 0.0001, odds ratio for death 9.1).

Conclusions

Necrotizing fasciitis arising from odontogenic infection is a rapidly progressive and life-threatening illness. Prompt recognition of the infection, aggressive and often serial surgical debridement, and aggressive broad-spectrum antibiotics are necessary to prevent serious morbidity and mortality. Patients with diabetes mellitus are at a significantly increased risk of death from odontogenic necrotizing fasciitis.

Literature
  1. Camino Junior R, Naclerio-Homem MG, Cabral LM, Luz JG. Cervical necrotizing fasciitis of odontogenic origin in a diabetic patient complicated by substance abuse. Braz Dent J. 2014;25(1):69–72.View ArticlePubMed
  2. Irani S. Orofacial bacterial infectious diseases: an update. J Int Soc Prev Community Dent. 2017;7(Suppl 2):61–7.View Article
  3. Ha KY, Tyring SK. Vibrio vulnificus necrotizing fasciitis preceding herpes zoster. Proc (Bayl Univ Med Cent). 2013;26(1):55–7.View Article
  4. Vinikoor MJ, Wong YT, Margolis DM. Herpes simplex virus type 2 mimicking necrotizing fasciitis. Ann Intern Med. 2011;155(8):567–8.View ArticlePubMed
  5. Fung V, Rajapakse Y, Longhi P. Periorbital necrotising fasciitis following cutaneous herpes zoster. J Plast Reconstr Aesthet Surg. 2012;65(1):106–9.View ArticlePubMed
  6. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.View ArticlePubMed
  7. Al-Ali MA, Hefny AF, Idris KM, Abu-Zidan FM. Cervical necrotizing fasciitis: an overlooked diagnosis of a fatal disease. Acta Otolaryngol. 2018;138(4):411–4.View ArticlePubMed
  8. Inan CH, Yener HM, Yilmaz M, Gözen ED, Erdur ZB, Oroğlu B, Olcay E, Memmedova N. Cervical necrotizing fasciitis of odontogenic origin and hyperbaric oxygen therapy. J Craniofac Surg. 2017;28(7):691–2.View Article
  9. Cavalcante MB, Lima ALO, Moreira RT, de Oliveira E, Silva ED, Branco BLC. Cervical-thoracic necrotizing fasciitis of odontogenic origin in a diabetic patient: a case report. Gen Dent. 2017;65(4):25–9.PubMed
  10. Lareyre F, Cohen C, Declemy S, Raffort J, Quintard H. A fatal aortic arch rupture due to descending necrotizing Mediastinitis in a 24-year-old woman. Vasc Endovasc Surg. 2017;51(6):408–12.View Article
  11. Abdurrazaq TO, Ibikunle AA, Braimah RO. Cervical necrotizing fasciitis: a potentially fatal disease with varied etiology. Ann Med Health Sci Res. 2016;6(4):251–6.View ArticlePubMed
  12. Bayetto K, Cheng A, Sambrook P. Necrotizing fasciitis as a complication of odontogenic infection: a review of management and case series. Aust Dent J. 2017;62(3):317–22.View ArticlePubMed
  13. Kloth C, Hoefert S, Fischborn T, Schraml C. Dentogene focus as a rare cause of necrotizing fasciitis. Dtsch Med Wochenschr. 2017;142(3):212–5.View ArticlePubMed
  14. Cariati P, Monsalve-Iglesias F, Cabello-Serrano A, Valencia-Laseca A, Garcia-Medina B. Cervical necrotizing fasciitis and acute mediastinitis of odontogenic origin: a case series. J Clin Exp Dent. 2017;9(1):150–2.
  15. Cortese A, Pantaleo G, Borri A, Amato M, Claudio PP. Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature. Aging Clin Exp Res. 2017;29(Suppl 1):159–65.View ArticlePubMed
  16. Zemplenyi K, Lopez B, Sardesai M, Dillon JK. Can progression of odontogenic infections to cervical necrotizing soft tissue infections be predicted? Int J Oral Maxillofac Surg. 2017;46(2):181–88.
  17. Juncar M, Bran S, Juncar RI, Baciut MF, Baciut G, Onisor-Gligor F. Odontogenic cervical necrotizing fasciitis, etiological aspects. Niger J Clin Pract. 2016;19(3):391–6.View ArticlePubMed
  18. Noy D, Rachmiel A, Levy-Faber D, Emodi O. Lemierre’s syndrome from odontogenic infection: review of the literature and case description. Ann Maxillofac Surg. 2015;5(2):219–25.View ArticlePubMedPubMed Central
  19. Botha A, Jacobs F, Postma C. Retrospective analysis of etiology and comorbid diseases associated with Ludwig's angina. Ann Maxillofac Surg. 2015;5(2):168–73.View ArticlePubMedPubMed Central
  20. Muhammad JK, Almadani H, Al Hashemi BA, Liaqat M. The value of early intervention and a multidisciplinary approach in the management of necrotizing fasciitis of the neck and anterior mediastinum of odontogenic origin. J Oral Maxillofac Surg. 2015;73(5):918–27.View ArticlePubMed
  21. Cruz Toro P, Callejo Castillo À, Tornero Saltó J, González Compta X, Farré A, Maños M. Cervical necrotizing fasciitis: report of 6 cases and review of literature. Eur Ann Otorhinolaryngol Head Neck Dis. 2014;131(6):357–9.View ArticlePubMed
  22. Sumi Y. Descending necrotizing mediastinitis: 5 years of published data in Japan. Acute Med Surg. 2014;2(1):1–12.View ArticlePubMedPubMed Central
  23. Novelli G, Catanzaro S, Canzi G, Sozzi D, Bozzetti A. Vacuum assisted closure therapy in the management of cervico-facial necrotizing fasciitis: a case report and review of the literature. Minerva Stomatol. 2014;63(4):135–44.PubMed
  24. van Niekerk C, Khammissa RA, Altini M, Lemmer J, Feller L. Noma and cervicofacial necrotizing fasciitis: clinicopathological differentiation and an illustrative case report of Noma. AIDS Res Hum Retrovir. 2014;30(3):213–6.View ArticlePubMed
  25. Antunes AA, Avelar RL, de Melo WM, Pereira-Santos D, Frota R. Extensive cervical necrotizing fasciitis of odontogenic origin. J Craniofac Surg. 2013;24(6):e594–7.View ArticlePubMed
  26. Bucak A, Ulu S, Kokulu S, Oz G, Solak O, Kahveci OK, Ayçiçek A. Facial paralysis and mediastinitis due to odontogenic infection and poor prognosis. J Craniofac Surg. 2013;24(6):1953–6.View ArticlePubMed
  27. Bali A, Chadha I, Sharma A. Necrotizing fasciitis of the chest wall caused by infected dentigerous cyst: a case report. J Maxillofac Oral Surg. 2012;11(3):347–50.View ArticlePubMed
  28. Chunduri NS, Madasu K, Tammannavar PS, Pushpalatha C. Necrotising fasciitis of odontogenic origin. BMJ Case Rep. 2013;2013:1–2.View Article
  29. Ulu S, Ulu SM, Oz G, Kaçar E, Yücedağ F, Ayçiçek A. Paralysis of cranial nerve and striking prognosis of cervical necrotizing fasciitis. J Craniofac Surg. 2012;23(6):1812–4.View ArticlePubMed
  30. Nanda S, Chakraborty S, Ray A, Inamuddin. Healing of cervical necrotizing fasciitis using amniotic membrane as a dressing material. Natl J Maxillofac Surg. 2011;2(2):147–51.View ArticlePubMedPubMed Central
  31. Park E, Hirsch EM, Steinberg JP, Olsson AB. Ascending necrotizing fasciitis of the face following odontogenic infection. J Craniofac Surg. 2012;23(3):211–4.View Article
  32. Bilodeau E, Parashar VP, Yeung A, Potluri A. Acute cervicofacial necrotizing fasciitis: three clinical cases and a review of the current literature. Gen Dent. 2012;60(1):70–4.PubMed
  33. Kim YJ, Kim JD, Ryu HI, Cho YH, Kong JH, Ohe JY, Kwon YD, Choi BJ, Kim GT. Application of radiographic images in diagnosis and treatment of deep neck infections with necrotizing fasciitis: a case report. Imaging Sci Dent. 2011;41(4):189–93.View ArticlePubMedPubMed Central
  34. Medeiros Júnior R, Melo Ada R, Oliveira HF, Cardoso SM, Lago CA. Cervical-thoracic facial necrotizing fasciitis of odontogenic origin. Braz J Otorhinolaryngol. 2011;77(6):805.View ArticlePubMed
  35. Lorenzini G, Picciotti M, Di Vece L, Pepponi E, Brindisi L, Vessio V, Maffei M, Viviano M. Cervical necrotizing fasciitis of odontogenic origin involving the temporal region--a case report. J Craniomaxillofac Surg. 2011;39(8):570–3.View ArticlePubMed
  36. Juncar M, Popa AR, Lung T, Onişor F. Septic metastases of suppuration of odontogenic origin. Chirurgia (Bucur). 2011;106(3):359–64.
  37. Huang D, Deng W, Li C, Chen S. Craniocervical necrotizing fasciitis of odontogenic origin with thoracic extension. J Craniofac Surg. 2011;22(3):1109–11.View ArticlePubMed
  38. Lopez-Fernandez R, Ramirez-Melgoza J, Martinez-Aguilar NE, Leon-Chavez A, Martinez-Fong D, Gonzalez-Barrios JA. Growth factor-enriched autologous plasma improves wound healing after surgical debridement in odontogenic necrotizing fasciitis: a case report. J Med Case Rep. 2011;5:98.View ArticlePubMedPubMed Central
  39. Maria A, Rajnikanth K. Cervical necrotizing fasciitis caused by dental infection: a review and case report. Natl J Maxillofac Surg. 2010;1(2):135–8.View ArticlePubMedPubMed Central
  40. Zhang WJ, Cai XY, Yang C, Zhou LN, Cai M, Lu XF, Zheng LY, Jiang B. Cervical necrotizing fasciitis due to methicillin-resistant Staphylococcus aureus: a case report. Int J Oral Maxillofac Surg. 2010;39(8):830–4.View ArticlePubMed
  41. Lingaraj JB, Rao S, Kotrashetti SM, Narad C. Necrotizing cervical fasciitis: a case report and review of literature. J Maxillofac Oral Surg. 2010;9(1):54–6.View ArticlePubMedPubMed Central
  42. Ouazzani A, Dequanter D, Buttafuoco F, Raynal P, Lothaire P. Cervical necrotizing fasciitis arising from dental abscess: a rare clinical observation. Rev Med Brux. 2009;30(2):99–105.PubMed
  43. Flanagan CE, Daramola OO, Maisel RH, Adkinson C, Odland RM. Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing fasciitis. Otolaryngol Head Neck Surg. 2009;140(5):730–4.View ArticlePubMed
  44. Subhashraj K, Jayakumar N, Ravindran C. Cervical necrotizing fasciitis: an unusual sequel of odontogenic infection. Med Oral Patol Oral Cir Bucal. 2008;13(12):788–91.
  45. Heath N, Macleod I, Chippindale A, Greenwood M, Ripley C. Severe necrotizing fasciitis complicating odontogenic infection: a case report. Dent Update. 2008;35(5):353–5.View ArticlePubMed
  46. Suehara AB, Gonçalves AJ, Alcadipani FA, Kavabata NK, Menezes MB. Deep neck infection: analysis of 80 cases. Braz J Otorhinolaryngol. 2008;74(2):253–9.View ArticlePubMed
  47. Farrier JN, Kittur MA, Sugar AW. Necrotising fasciitis of the submandibular region; a complication of odontogenic origin. Br Dent J. 2007;202(10):607–9.View ArticlePubMed
  48. Edwards JD, Sadeghi N, Najam F, Margolis M. Craniocervical necrotizing fasciitis of odontogenic origin with mediastinal extension. Ear Nose Throat J. 2004;83(8):579–82.PubMed
  49. Ashar A. Odontogenic cervical necrotizing fasciitis. J Coll Physicians Surg Pak. 2004;14(2):119–21.PubMed
  50. Daniel E, Whang CS, Cohen JT. Radiology quiz case 2. Cervical necrotizing fasciitis (CNF), odontogenic origin. Arch Otolaryngol Head Neck Surg. 2004;130(4):480. 482–3View ArticlePubMed
  51. Shand JM, Breidahl A, Hing NR, Johnstone BR, Wiesenfeld D. Ascending necrotising fasciitis as a result of odontogenic infection: a report of two cases. Aust Dent J. 2001;46(2):134–8.View ArticlePubMed
  52. Tung-Yiu W, Jehn-Shyun H, Ching-Hung C, Hung-An C. Cervical necrotizing fasciitis of odontogenic origin: a report of 11 cases. J Oral Maxillofac Surg. 2000;58(12):1347–52. 1353View ArticlePubMed
  53. Peter B. Cervicofacial necrotizing fasciitis. Schweiz Med Wochenschr Suppl. 2000;116:58S–61S.PubMed
  54. Whitesides L, Cotto-Cumba C, Myers RA. Cervical necrotizing fasciitis of odontogenic origin: a case report and review of 12 cases. J Oral Maxillofac Surg. 2000;58(2):144–51. 152View ArticlePubMed
  55. Helmy AS, Salah MA, Nawara HA, Khatab H, Khalaf HA, Abd el-Maguid N. Life-threatening cervical necrotizing fasciitis. J R Coll Surg Edinb. 1997;42(6):410–3.PubMed
  56. Ficheva M, Marina M, Ivanova K, Tomova M. Odontogenic craniofaciocervical necrotizing fasciitis. Khirurgiia (Sofiia). 1997;50(3):21–2.
  57. Mohammedi I, Ceruse P, Fontaine P, Védrinne JM, Moreon AH, Motin J. Cervical necrotizing fasciitis disclosing HIV infection. Ann Otolaryngol Chir Cervicofac. 1997;114(6):228–30.PubMed
  58. Chin RS, Kaltman SI, Colella J. Fatal necrotizing fasciitis following a mandibular fracture. J Craniomaxillofac Trauma. 1995;1(3):22–9.PubMed
  59. Zbären P, Rothen HU, Läng H, Becker M. Necrotizing fasciitis of soft tissues of the face and neck. HNO. 1995;43(10):619–23.PubMed
  60. Langford FP, Moon RE, Stolp BW, Scher RL. Treatment of cervical necrotizing fasciitis with hyperbaric oxygen therapy. Otolaryngol Head Neck Surg. 1995;112(2):274–8.View ArticlePubMed
  61. Maisel RH, Karlen R. Cervical necrotizing fasciitis. Laryngoscope. 1994;104(7):795–8.View ArticlePubMed
  62. Reed JM, Anand VK. Odontogenic cervical necrotizing fasciitis with intrathoracic extension. Otolaryngol Head Neck Surg. 1992;107(4):596–600.View ArticlePubMed
  63. Rapoport Y, Himelfarb MZ, Zikk D, Bloom J. Cervical necrotizing fasciitis of odontogenic origin. Oral Surg Oral Med Oral Pathol. 1991;72(1):15–8.View ArticlePubMed
  64. Lambade PN, Dolas RS, Virani N, Lambade DP. Cervicofacial necrotising fasciitis of odontogenic origin: a review. Sci Rep. 2012;1:414.
Metadata
Title
Odontogenic necrotizing fasciitis: a systematic review of the literature
Publication date
01-12-2018
Published in
BMC Ear, Nose and Throat Disorders / Issue 1/2018
Electronic ISSN: 1472-6815
DOI
https://doi.org/10.1186/s12901-018-0059-y

Other articles of this Issue 1/2018

BMC Ear, Nose and Throat Disorders 1/2018 Go to the issue

Research article

Frequency of mitochondrial m.1555A > G mutation in Syrian patients with non-syndromic hearing impairment

Research article

The effect of transcutaneous neuromuscular electrical stimulation on laryngeal vestibule closure timing in swallowing

Research article

The role of tonsillectomy in the Periodic Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis syndrome; a literature review

Research article

Generic quality of life in persons with hearing loss: a systematic literature review

Case report

Sinonasal adenoid cystic carcinoma-role of on-site FNAC: a case report

Research article

Allergic rhinitis and periodontitis among Korean adults: results from a nationwide population-based study (2013–2015)