Necrotizing Fasciitis of the maxillofacial region caused by dental infection. Case report and review.

Necrotizing Fasciitis (NF) is a desctructive and potentially fatal soft tissue infection characterized from the extensive necrosis and gas formation in subcutaneous tissues and fascia with serious involvement of muscles, vessels, nerves, and fat. In maxillofacial region NF is a less common.The process can represent the evolution of a dental infection supported from aerobic and anaerobic bacteria resistant to the antibiotic therapy (multidrug resistance) in immunocompromised patients or the natural evolution of untreated infection . Because of the rarity of the disease, early diagnosis and early treatment is often delayed and it may results in a fatal outcome due to respiratory problems or systemic complications. The cornerstone of treatment is surgical debridement and appropriate high doses antibiotic therapy. We describe a case of facial NF in a female, 59 years old, who developed NF in maxillofacial and neck region following dental infection and consulting our Institute for remarkable swelling of the right cheek, palpebral and parotid regions, submaxillary region and neck, associated to hyperpyrexia, trismus, poor systemic conditions, and serious respiratory difficulty. The prompt clinical diagnosis, early surgical treatment, appropriate antibiotic therapy (culture analysis revealed sensitivity for Imipenem and Levofloxacina), daily local control of the lesion, not only avoiding the serious and fatal evolution of the process, but also limited the tissutal involvement, preventing the further extension of the necrosis to other anatomical structures of the region, obtaining therefore a satisfactory clinical result.