Cervicofacial Necrotizing Fasciitis of Odontogenic Origin Following Chemotherapy: A Case report and Implications for Oral Care in Cancer Treatment
Keywords:Cervicofacial necrotizing fasciitis, chemotherapy
Objective: Cervicofacial necrotizing fasciitis (CNF) is a rapidly spreading and often fatal infection of the soft
tissues of head and neck characterized by tissue necrosis and profuse purulent discharge. This report
describes a cancer patient, who had undergone chemotherapy and developed CNF of odontogenic origin to
highlight the need for oral examination before commencement of chemotherapy.
Case description: A 68 years old retired gardener who developed CNF from infected right permanent
mandibular first and second molars. He had undergone surgery and had 3 cycles of Cisplastin, 5-
Fluorouracil and Adriamycin on account of carcinoma of the head of pancreas. No oral assessment was
carried out prior to commencement of chemotherapy to detect a potential source of infection. Management
included removal of the causative teeth, incision and drainage, repeated debridement, daily dressing of
wound with Povidone-iodine solution and intravenous antibiotic based on pus microscopy, culture and
sensitivity report. He however succumbed to the disease 23 days later.
Conclusion: CNF of odontogenic origin is an extremely fatal condition. Early detection and prompt
aggressive treatment is a key to successful outcome. Clinicians involved with management of cancer patients
should routinely seek the expertise of a dentist for a pre-chemotherapy oral assessment and all potential
sources of infections are removed before chemotherapy begins.