Odontogenic cervicofacial necrotizing fasciitis: diagnostic challenges and management strategies

Necrotizing fasciitis is a rare but life-threatening complication that should be considered in the differential diagnosis of patients presenting with acute dento-alveolar infections. It is a rapidly progressive, polymicrobial infection characterized by widespread soft tissue necrosis and systemic toxicity, with a high risk of mortality if not promptly recognized and treated. Early clinical features are often subtle and non-specific, leading to frequent diagnostic delays. This article provides a comprehensive overview of necrotizing fasciitis secondary to odontogenic infection, including pathophysiology, clinical progression, diagnostic aids and management strategies. A case report is presented to illustrate key considerations in assessing and managing cervicofacial necrotizing fasciitis. We report the case of a 72-year-old woman with cervicofacial necrotizing fasciitis resulting from an odontogenic infection. She was successfully managed with serial surgical debridements, targeted antimicrobial therapies and eventual definitive reconstruction using a pectoralis major myocutaneous pedicled flap. This case highlights the importance of early recognition and aggressive multidisciplinary management in improving outcomes for patients with cervicofacial necrotizing fasciitis, a potentially fatal odontogenic complication. CPD/Clinical Relevance: Early recognition of odontogenic necrotizing fasciitis is vital to prevent catastrophic cervicofacial destruction, morbidity and mortality.