Necrotizing Soft Tissue Infection (NSTI) of Head and Neck: A Case Report

Reynaldy C. Moksidy, Mendy Hatibie Oley, Christa Tamburian, Stevy Suoth

Abstract


Necrotic soft tissue infection (NSTI) is a rapidly progressing skin infection characterized by necrosis of the fascia and subcutaneous tissue, while Ludwig's angina is a severe connective tissue infection of the floor of the mouth, often a complication of a dental infection, which can cause upper airway obstruction if left untreated. This study presents the case of a 32-year-old female patient with no previous hospitalization who presented to the Emergency Room with a wound and pain radiating from the neck to the chest, lasting for one week. The patient underwent a standard diagnostic and therapeutic protocol, including aggressive debridement under general anesthesia, with skin preservation and reconstruction via partial-thickness skin graft (STSG) for the wound defect. Ludwig's angina is primarily caused by infection of the mandibular molars, particularly the second and third molars, which account for more than 90% of cases. Although relatively rare, NSTI is characterized by rapid necrosis of the fascia and subcutaneous fat, leading to skin necrosis. Vigilance for the development of complications from cellulitis to NSTI, especially in cases thought to be caused by Ludwig's angina, is essential. Factors such as potential window periods for HIV and malnutrition need to be considered, emphasizing the importance of collaboration between reconstructive surgery specialists, epidemiologists, and thoracic and vascular disciplines to improve treatment strategies and preventive measures.

Keywords


necrotizing soft tissue infection, ludwig's angina, debridement, split thickness. skin graft, complications

Full Text:

PDF

References


Abbasi, Z., Inam, H., Das, S., Neel, S., & Fatimi, S. H., 2019. Fungal Cervical Abscess Complicated by Necrotizing Fasciitis Leading to Descending Necrotizing Mediastinitis: A Case Report. Cureus, 11(8), e5369.

Acharya, P. P., Cohn, J. E., Shokri, T., Bundrick, P., Ducic, Y., 2022. Surgical Management of Necrotizing Fasciitis of the Head and Neck. Journal of Craniofacial Surgery, 33(8), e858–e861.

An, J., Madeo, J., Singhal, M., 2023. Ludwig Angina. StatPearls Publishing.

Arif, Yousefi, Vinnard, 2016. Deaths from Necrotizing Fasciitis in The United States, 2003–2013. Epidemiology and Infection, 144(6), 1338–1344.

Brook, I., 2007. Microbiology and Principles of Antimicrobial Therapy for Head and Neck Infections. Infectious Disease Clinics of North America, 21(2), 355–391.

Cecchini, A., Cox, C. J., Cecchini, A. A., Solanki, K., McSharry, R., 2021. Odontogenic Infection Complicated by Cervicofacial Necrotizing Fasciitis in a Healthy Young Female. Cureus, 13(8), e16835.

Coșarcă, A. S., Száva, D., Bögözi, B., Iacob, A., Frățilă, A., Sergiu, G., 2023. Pediatric Cervicofacial Necrotizing Fasciitis A Challenge for a Medical Team. Children, 10(7), 1262.

Di Crescenzo, V., Laperuta, P., Napolitano, F., Carlomagno, C., Danzi, M., Amato, B., Garzi, A., Vitale, M. (2013). Unusual Case of Exacerbation of Sub-Acute Descending Necrotizing Mediastinitis. BMC Surgery, 13(S2), S31.

Dreyer, A. F., de Kock, S. E., Rantloane, J. L., 1990. Ludwig’s Angina: A Case Report and Review. The Journal of the Dental Association of South Africa = Die Tydskrif van Die Tandheelkundige Vereniging van Suid-Afrika, 45(9), 397–400.

Ferzli, G., Sukato, D. C., Mourad, M., Kadakia, S., Gordin, E. A., Ducic, Y., 2019. Aggressive Necrotizing Fasciitis of the Head and Neck Resulting in Massive Defects. Ear, Nose & Throat Journal, 98(4), 197–200.

Goh, T., Goh, L. G., Ang, C. H., Wong, C. H., 2014. Early Diagnosis of Necrotizing Fasciitis. Journal of British Surgery, 101(1), e119–e125.

Gore, M. R., 2018. Odontogenic Necrotizing Fasciitis: A Systematic Review of the Literature. BMC Ear, Nose and Throat Disorders, 18(1), 14.

Hughes, T. M., Luu, M. B., 2015. Acute Appendicitis. In Common Surgical Diseases: An Algorithmic Approach to Problem Solving, Third Edition. Springer New York.

Keung, E. Z., Liu, X., Nuzhad, A., Adams, C., Ashley, S. W., Askari, R., 2013. Immunocompromised Status in Patients With Necrotizing Soft-Tissue Infection. JAMA Surgery, 148(5), 419.

Kim, D., Kim, J., Choi, J., Oh, S., Shin, Y., Jeong, W., 2020. Effective Treatment Using Negative Pressure Wound Therapy for Necrotizing Fasciitis of Scalp Originating from Odontogenic Infection. Journal of Wound Management and Research, 16(1), 68–72.

Kim, Y.-J., Kim, J., Ryu, H.-I., Cho, Y.-H., Kong, J.-H., Ohe, J.-Y., Kwon, Y.-D., Choi, B.-J., Kim, G.-T., 2011. Application of Radiographic Images in Diagnosis and Treatment of Deep Neck Infections with Necrotizing Fasciitis: A Case Report. Imaging Science in Dentistry, 41(4), 189.

Kovalev, V., 2020. A Severe Case of Ludwig’s Angina with a Complicated Clinical Course. Cureus, 12(4), e7695.

Maria, A., Rajnikanth, K., 2010. Cervical Necrotizing Fasciitis Caused by Dental Infection: A Review and Case Report. National Journal of Maxillofacial Surgery, 1(2), 135.

Maruyama, T., Nishihara, K., Saio, M., Nakasone, T., Nimura, F., Matayoshi, A., Goto, T., Yoshimi, N., Arasaki, A., 2017. Kikuchi-Fujimoto Disease in The Regional Lymph Nodes With Node Metastasis in A Patient with Tongue Cancer: A Case Report and Literature Review. Oncology Letters, 14(1), 257–263.

Mazzella, A., Santagata, M., Cecere, A., La Mart, E., Fiorelli, A., Tartaro, G., Tafuri, D., Testa, D., Grella, E., Perrotta, F., Bianco, A., Mazzarella, G., Santini, M., 2016. Descending Necrotizing Mediastinitis in the Elderly Patients. Open Medicine, 11(1), 449–460.

Mohanty, S., Sarkar, S., & Mishra, B., 2020. Melioidosis of the Head and Neck: A Case Series from Eastern India. Infectious Disease Reports, 12(3), 36–45.

Munjal, M., Munjal, S., Budhiraja, N., Talwar, S., Arora, V., Kaur, H., Chawla, D., Gill, R., Gill, Z., Pillai, A., Joshi, T., 2022. Localised Submental Abscess Consequent to an Infected Premolar Socket: A Case Report. International Journal of Otorhinolaryngology and Head and Neck Surgery, 8(11), 927.

Rewis, K., Yang, S., Hurtuk, A., 2023. A Rare Manifestation of Infectious Mononucleosis Tonsillitis. Cureus, 15(7), e41827.

Rusu, M. C., Hostiuc, S., Ceauşu, M., Rentea, I., 2013. Angina Ludovici. Case presentation. BMC Infectious Diseases, 13(S1), P42.

Sivapathasundharam. 2020. Shafer’s Textbook of Oral Pathology E-book. Elsevier India Pvt.

Tantraworasin, A., Khamnuan, P., Chongruksut, W., Jearwattanakanok, K., Patumanond, J., 2015. Necrotizing Fasciitis: Epidemiology and Clinical Predictors for Amputation. International Journal of General Medicine, 14(8), 195–202.

Vallée, M., Gaborit, B., Meyer, J., Malard, O., Boutoille, D., Raffi, F., Espitalier, F., Asseray, N., 2020. Ludwig’s Angina: A Diagnostic and Surgical Priority. International Journal of Infectious Diseases, 93, 160–162

Wong, C.-H., Khin, L.-W., Heng, K.-S., Tan, K.-C., Low, C.-O., 2004. The LRINEC (Laboratory Risk Indicator For Necrotizing Fasciitis) Score: A Tool For Distinguishing Necrotizing Fasciitis From Other Soft Tissue Infections. Critical Care Medicine, 32(7), 1535–1541.




DOI: http://dx.doi.org/10.33087/jiubj.v25i3.5934

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

ADRESS JOURNAL

JURNAL ILMIAH UNIVERSITAS BATANGHARI JAMBI (JIUBJ)
Published by Lembaga Penelitian dan Pengabdian kepada Masyarakat
Adress: Jl.Slamet Ryadi, Broni-Jambi, Kec.Telanaipura, Kodepos: 36122, email: jiubj.unbari@gmail.com, Phone: 0741-670700

Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.