Cervicofacial Necrotizing Fasciitis of Odontogenic Origin Following Chemotherapy: A Case report and Implications for Oral Care in Cancer Treatment

Abstract

Background: Cervicofacial necrotizing fasciitis (CNF) is a rapidly spreading and often fatal infection of the soft tissues of head and neck characterized by tissue necrosis and profuse purulent discharge.

Objective: This report describes a cancer patient, who had undergone chemotherapy and developed CNF of odontogenic origin to highlight the need for oral examination before commencement of chemotherapy.

Case description: A 68 years old retired gardener who developed CNF from infected right permanent mandibular first and second molars. He had undergone surgery and had 3 cycles of Cisplastin, 5-Fluorouracil and Adriamycin on account of carcinoma of the head of pancreas. No oral assessment was carried out prior to commencement of chemotherapy to detect a potential source of infection. Management included removal of the causative teeth, incision and drainage, repeated debridement, daily dressing of wound with Povidone-iodine solution and intravenous antibiotic based on pus microscopy, culture and sensitivity report. He however succumbed to the disease 23 days later.

Conclusion: CNF of odontogenic origin is an extremely fatal condition. Early detection and prompt aggressive treatment is a key to successful outcome. Clinicians involved with management of cancer patients should routinely seek the expertise of a dentist for a pre-chemotherapy oral assessment and all potential sources of infections are removed before chemotherapy begins.

 Keywords: Cervicofacial necrotizing fasciitis, chemotherapy, oral care, carcinoma