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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
- Publication Year :
- 2017
-
Abstract
- 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. 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. 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.
- Subjects :
- Male
Aging
medicine.medical_treatment
0302 clinical medicine
Thoracotomy
Fasciitis
030223 otorhinolaryngology
Abscess
Tomography
Mediastinum
Stomatognathic Diseases
Soft tissue
Anti-Bacterial Agents
X-Ray Computed
medicine.anatomical_structure
Treatment Outcome
Saline solution
Female
Radiology
Head and neck
High mortality
Necrotizing fasciitis
Aged
Debridement
Humans
Neck
Radiography, Panoramic
Tomography, X-Ray Computed
Fasciitis, Necrotizing
Streptococcal Infections
Geriatrics and Gerontology
medicine.symptom
medicine.medical_specialty
Panoramic
03 medical and health sciences
medicine
Deformity
business.industry
030206 dentistry
medicine.disease
Surgery
Radiography
Clavicle
business
Necrotizing
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....3b41131066b4664db40d2524e5a81077