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Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature

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Abstract

Background

Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin.

Methods

In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need.

Conclusions

Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.

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Abbreviations

NF:

Necrotizing fasciitis

CRP:

C-reactive protein

CT:

Computed tomography

NPWT:

Negative pressure wound therapy

LRINEC:

Laboratory Risk Indicator for Necrotizing Fasciitis

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Author information

Authors and Affiliations

  1. Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy

    Antonio Cortese & Antonio Borri

  2. Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy

    Giuseppe Pantaleo

  3. Department of Medicine and Surgery, University of Salerno, Baronissi, SA, Italy

    Massimo Amato

  4. Department of BioMolecular Sciences, School of Pharmacy, National Center for Natural Products Research, University of Mississippi, Oxford, MS, USA

    Pier Paolo Claudio

Authors
  1. Antonio Cortese
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  4. Massimo Amato
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Corresponding author

Correspondence to Antonio Cortese.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Commission No. 38/06.

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This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Cortese, A., Pantaleo, G., Borri, A. et al. 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 29 (Suppl 1), 159–165 (2017). https://doi.org/10.1007/s40520-016-0650-2

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  • DOI: https://doi.org/10.1007/s40520-016-0650-2

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