Management of Unilateral Buccal Necrotizing Fasciitis Superimposed with Submandibular Abscess At Colli Dextra in a Type 2 Diabetes Mellitus patient : A Case Report

Abstract

Background: Necrotizing fasciitis (NF) is a relatively rare infectious disease of soft tissues that is characterized by necrosis of subcutaneous tissue and fascia and can even extend to involve the skin and muscles, with the main spread through odontogenic infections. One of the main comorbidities of necrotizing fasciitis is diabetes mellitus. Proper case management is needed because NF can result in severe morbidity and mortality if not treated at an early stage.

Study Objective: This case report aims to report the management of patients with buccal necrotizing fasciitis complicated by submandibular abscesses with comorbid type 2 diabetes mellitus.

Case Presentation: A 60-year-old woman came to RSHS complaining of swelling on her right cheek 20 days before hospital admission, which further extended to the jaw and neck area. Swelling on the patient's face did not improve after antibiotic treatment, and continued to enlarge to a size of 10x8x7 cm and 8x6x5 cm. The patient has a history of type 2 diabetes mellitus and controlled hypertension. The patient is diagnosed as necrotizing fasciitis and submandibular abscess. Patients are given antibiotic treatment and performed pus-tapping, necrotomy debridement, and tooth extraction.

Conclusion : Necrotizing fasciitis involving the facial (especially buccal) area is rare, with the main cause being odontogenic, peritonsillar, or sinugenic. The main management includes debridement, reconstructive measures, and administration of antibiotics. Extensive tissue involvement, and poly-comorbid conditions can worsen the prognosis of necrotizing fasciitis.

Keywords : Abscess, Buccal, Colli dextra, Necrotizing fasciitis, Submandibular