To the Editor.—We recently treated a case of necrotizing fasciitis of the neck following removal of a tooth that emphasizes the role of aggressive surgical treatment in this entity.
Report of a Case.—A 51-year-old nondiabetic man underwent extraction of a noninfected right upper second molar. Two days later he had marked facial swelling with a temperature of 40.6 C (105 F). Abscesses of the right temporal, buccal, submandibular, submental, and parapharyngeal spaces were drained. Beta-hemolytic streptococci grew from the cultures. Intravenous administration of penicillin was started, and he improved for 48 hours. He then spiked to 39.4 C (103 F) and rapidly developed severe swelling inferiorly to the clavicles. Brawny, noncrepitant induration extending to the nipples appeared within three hours. Roentgenograms showed a widened superior mediastinum and gas in the retropharyngeal space.
A low transverse cervical incision was made, superior and inferior flaps created, and the deep cervical
RICHARDSON JD, Fox GL, GROVER FL, CRUZ AB. Necrotizing Fasciitis Complicating Dental Extraction. Arch Surg. 1975;110(1):129. doi:10.1001/archsurg.1975.01360070129029