**9. Treatment**

One of the most dangerous complications is necrotizing fasciitis, which is a rare soft tissue infection characterized by progressive destruction of fascia and adipose tissue that may not involve the skin.[62, 63] Necrotizing fasciitis is characterized by its fulminating, devastating, and rapid-progressing course.[64] Diabetes mellitus, burns and malnutrition are common predisposing factors. Initially, cervical necrotizing fasciitis is predominantly characterized by a "simple" infection in the upper aerodigestive tract like pharyngitis or even tonsillitis. Typically, the general condition gets worse within a very short period of time with cardiovas‐ cular decompensation due to a toxic shock-like condition. Cervical necrotizing fasciitis initially involves the superficial muscular system and superficial fascial planes of the head and neck or it may result from a deep soft tissue infection, such as odontogenic infections or even

If the disease is not recognized in time the infection can rapidly involve the great vessels or mediastinum, producing systemic toxicity and sepsis.[65, 66] The basis of successful treatment comprises aggressive surgical debridement and drainage of the involved necrotic fascia and

The current signs and symptoms presented by patients with severe infections from odonto‐ genic origin are crucial factors for the patient's life maintenance. Sato et al., has shown in their eight-year retrospective study that cases of odontogenic infections call for immediate thera‐ peutics, either clinical or surgical, with precise daily or long-term monitoring of patients until complete resolution of the clinical infection status is reached. The most frequent signs and symptoms found in these patients were trismus (43.33%), fever (28.10%), dysphagy (25.24%), pain (24.76%), and swelling (20%), all of which are classic signs of a dire clinical situation.26

Imaging plays an essential role in the diagnosis and management of head and neck infections since, by clinical examination alone. It is often difficult to determine if a swollen neck is due to cellulitis or an abscess; the location, extent or source of the infection, and whether the process

Radiographs of the cervical segment and the chest may be useful in the demonstration of subcutaneous emphysema in the form of vertical, linear, clear bands of gas extending from the cervical spaces into the mediastinum. The lateral radiograph of the neck can reveal a prever‐ tebral soft tissue opacity pushing the trachea anteriorly. Chest radiograph can demonstrate a widened mediastinum and pleural effusion. However, the modest diagnostic sensibility of cervical and chest plain film should call immediately for computed tomography scanning or

is self-limited or if it is potentially life-threatening is also clinically unclear.[21]

a magnetic resonance of the cervicothoracic areas.[2, 17, 67, 68]

tissue along with intensive broad-spectrum intravenous antibiotic coverage.[63]

pharyngitis, which spreads along the deep fascial planes.

350 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

**7. Signs and symptoms**

**8. Imaging**

Treatment of odontogenic infections includes diagnosis and management of the causative factor, drainage when necessary (Figures 5-6) and, usually, prescription of appropriate antibiotics. It is imperative that the source of infection be addressed immediately. In addition, the patient's medical status must be optimized. The patient's fluid and nutrition status should also be addressed, as many patients with odontogenic infections have decreased oral intake due to pain and difficulty in chewing or swallowing. The clinician must be aware of the most likely causative organisms and prescribe the narrowest spectrum of antibiotics that will cover all possible offending organisms.

**Figure 5.** Sequence of drainage of odontogenic infection – case 1. Note that the most dependent part (under the swel‐ ling) must be incised not the thin most swollen part (to prevent scarring).

**Figure 6.** Figure 6: Sequence of drainage of odontogenic infection – case 2.
