[01] Ahmed Issam Abbas Eldawi, Department of Oral and Maxillofacial Surgery, Khartoum Teaching Dental Hospital, Khartoum, Sudan. [02] Safa Abdelazim Ahmed Osman, Department of Oral and Maxillofacial Surgery, Soba Teaching Hospital, Khartoum, Sudan.

Background: Necrotizing Fasciitis or flesh eating bacteria is a rare, rapid and aggressive infection of soft tissues with high morbidity and mortality rates. Rarely it may arise from odontogenic origin in the head and neck. It is not easy to diagnose Necrotizing Fasciitis and it usually involves patients with chronic diseases and compromised immunity. Necrotizing Fasciitis is also polymicrobial or from a single microorganism. Therefore culture and sensitivity tests are of great value. Case report: A 54-year-old female presented with dental infection raised from decayed upper left posterior tooth causing facial swelling and sinuses discharging pus in the face. In the next few days of admission, necrosis of the labial mucosa and vermilion boarder of the lower lip appeared and progressed rapidly despite the intervention done. Results: The patient was treated by hospital admission, frequent radical surgical excisions, medical support, a combination of high doses of antibiotics and frequent wound dressings. The patient was accepting of the lip defect and she refused any reconstructive procedures. Conclusion: Necrotizing Fasciitis is a life threatening infection especially in diabetic patients. Early diagnosis and surgical intervention is considered cornerstone for the treatment of Necrotizing Fasciitis. Hyperbaric oxygen therapy and Intravenous immunoglobulins G also may be considered as an adjunctive therapy whenever possible.

Facial Necrotizing Fasciitis, Necrotizing Fasciitis, Odontogenic Origin, Head and Neck, Labial, CNF, NF

[01] Camino Junior, R., et al., Cervical necrotizing fasciitis of odontogenic origin in a diabetic patient complicated by substance abuse. 2014, SciELO Brasil. p. 69-72. [02] Japatti, S., et al., Extensive cervico-thoracic Necrotizing Fasciitis Secondary to Odontogenic Infection: A Rare case report. 2020. p. 102. [03] Tiwari, M., et al., Cervicofacial necrotizing fasciitis of odontogenic origin: A case report. 2018. [04] Sadasivan, J., N.K. Maroju, and A. Balasubramaniam, Necrotizing fasciitis. 2013, Thieme Medical Publishers. p. 472. [05] Fenton, C.C., et al., Necrotizing fasciitis of the face: a rare but dangerous complication of dental infection. 2004, Canadian Dental Association. p. 611-616. [06] Mastronikolis, N.S., et al., Necrotizing fasciitis of the head and neck: report of 5 cases and review of the literature. 2010. p. 123-134. [07] Misiakos, E.P., et al., Current concepts in the management of necrotizing fasciitis. 2014, Frontiers. p. 36. [08] Adewale, A.O. and O.T. Olamide, Cervicofacial Necrotizing Fasciitis in Patients with No Underlying Medical Conditions: A Review of Four Cases Seen in Twelve Months at a Nigerian Tertiary Hospital. 2018, Shiraz University of Medical Sciences. p. 653. [09] Chandawarkar, R.Y., et al., Necrotizing fasciitis: diagnosis and management of an occult infective focus. 2004, SAGE Publications Sage CA: Los Angeles, CA. p. 149-153. [10] McAllister, P., et al., A presentation of facial necrotizing fasciitis with orbital involvement. 2013, Oxford University Press. [11] Sangamesh, N.C., et al., Necrotizing fasciitis of odontogenic origin in a nonimmunocompromised patient: A rare case report. 2014, Medknow Publications. p. 179. [12] Singh, D.V., et al., Necrotizing fasciitis of face – our experience in its management. 2011, BMJ Publishing Group. p. bcr0720114453. [13] Juncar, M., et al., Odontogenic cervical necrotizing fasciitis, etiological aspects. 2016. p. 391-396. [14] Nugroho, S.S., et al., Surgical management of necrotizing fasciitis due to odontogenic infection with sepsis: a case report. 2017. p. 54-57. [15] Chukwuneke, F.N., et al., Cervico-Facial Necrotizing Fasciitis: A Ten-Year Clinical Evaluation of 80 Cases in Enugu, Eastern Nigeria. 2019. [16] Choi, M.-G., Necrotizing fasciitis of the head and neck: a case report. 2015. p. 90-96. [17] Chou, P.-Y., Y.-H. Hsieh, and C.-H. Lin, Necrotizing fasciitis of the entire head and neck: literature review and case report. 2020, Elsevier. [18] Riaz, N., T. Saeed, and S. Younas, Necrotizing Fasciitis of Head and Neck Region. 2018. p. 2. [19] Jain, S., et al., Minor trauma triggering cervicofacial necrotizing fasciitis from odontogenic abscess. 2008, Wolters Kluwer--Medknow Publications. p. 114. [20] Mohd Mokhtar Shaariyah, M.B.M., et al., Necrotizing fasciitis of the head and neck: surgical outcomes in three cases. 2010, School of Medical Sciences, Universiti Sains Malaysia. p. 51. [21] Sandner, A., et al., Cervical necrotizing fasciitis--the value of the laboratory risk indicator for necrotizing fasciitis score as an indicative parameter. 2015, Elsevier. p. 2319-2333. [22] Eltayeb, A.S., A.G. Ahmad, and E.I. Elbeshir, A case of labio-facial necrotizing fasciitis complicating acne. 2016, BioMed Central. p. 1-4. [23] Lancerotto, L., et al., Necrotizing fasciitis: classification, diagnosis, and management. 2012, LWW. p. 560-566. [24] Lambade, P.N., et al., Cervicofacial necrotising fasciitis of odontogenic origin: a review. 2012. p. 414. [25] Gore, M.R., Odontogenic necrotizing fasciitis: a systematic review of the literature. 2018, Springer. p. 14. [26] Bayetto, K., A. Cheng, and P. Sambrook, Necrotizing fasciitis as a complication of odontogenic infection: a review of management and case series. 2017, Wiley Online Library. p. 317-322. [27] Abdurrazaq, T.O., A.A. Ibikunle, and R.O. Braimah, Cervical necrotizing fasciitis: a potentially fatal disease with varied etiology. 2016, Nigerian Medical Association. p. 251-256. [28] Fernández, E.C. and D.L.E. Gonzalez, Case Report: Necrotizing fasciitis of the neck with odontogenic origin. 2020. p. 24. [29] Goh, T., et al., Early diagnosis of necrotizing fasciitis. 2014, John Wiley & Sons, Ltd Chichester, UK. p. e119-e125. [30] Ferzli, G., et al., Aggressive necrotizing fasciitis of the head and neck resulting in massive defects. 2019, SAGE Publications Sage CA: Los Angeles, CA. p. 197-200. [31] Adesina, O.A., Fascial space infection of Odontogenic Origin: A Review of Cases treated in a Nigerian Teaching Hospital. 2019. [32] K. Anbarasi, S. Sathasiva Subramanian, and B.S. Devi, Necrotizing Fasciitis. 2013. p. 399-403. [33] Wong, C.-H., et al., The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. 2004, LWW. p. 1535-1541.