Imaging Sci Dent.  2011 Dec;41(4):189-193. 10.5624/isd.2011.41.4.189.

Application of radiographic images in diagnosis and treatment of deep neck infections with necrotizing fasciitis: a case report

• Kim YJ
• Kim JD
• Ryu HI
• Cho YH
• Kong JH
• Ohe JY
• Kwon YD
• Choi BJ
• Kim GT

• KMID: 2167406
• DOI: http://doi.org/10.5624/isd.2011.41.4.189

Abstract

The advent and wide use of antibiotics have decreased the incidence of deep neck infection. When a deep neck infection does occur, however, it can be the cause of significant morbidity and death, resulting in airway obstruction, mediastinitis, pericarditis, epidural abscesses, and major vessel erosion. In our clinic, a patient with diffuse chronic osteomyelitis of mandible and fascial space abscess and necrotic fasciitis due to odontogenic infection at the time of first visit came. We successfully treated the patient by early diagnosis using contrast-enhanced CT and follow up dressing through the appropriate use of radiographic images.

Keyword

Abscess; Fasciitis, Necrotizing; Osteomyelitis; Tomography, X-Ray, Computed

MeSH Terms

Abscess
Airway Obstruction
Anti-Bacterial Agents
Bandages
Early Diagnosis
Epidural Abscess
Fasciitis
Fasciitis, Necrotizing
Follow-Up Studies
Glycosaminoglycans
Humans
Incidence
Mandible
Mediastinitis
Neck
Osteomyelitis
Pericarditis
Porphyrins
Anti-Bacterial Agents
Glycosaminoglycans
Porphyrins

Figure

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  Fig. 1 Panoramic radiograph shows ill-defined bone destruction on left mandibular canine area. The lesion has ragged border and shows sclerotic change on the surrounding trabecular bone.

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  Fig. 2 Soft tissue neck AP view shows that the airway is severely narrowed by soft tissue (arrow).

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  Fig. 3 Preoperative contrast-enhanced CT images show submandibular and sublingual abscess formation. Inflammation of subcutaneous fat is found on submental and neck area.

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  Fig. 4 Contrast-enhanced CT images at two days after first operation show the increased extent of right submandibular abscess to prevertebral space and posterior to the right sternocleidomastoid muscle, and cellulitis and myositis of left submental and submandibular.

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  Fig. 5 Contrast-enhanced CT image at 10 days after third operation shows that the abscess in the submandibular and sublingual space is almost dissolved.

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