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Facial Paralysis and Mediastinitis Due to Odontogenic Infection and Poor Prognosis

Bucak, Abdulkadir PhD*; Ulu, Şahin PhD*; Kokulu, Serdar PhD; Öz, Gürhan PhD; Solak, Okan PhD; Kahveci, Orhan Kemal PhD*; Ayçiçek, Abdullah PhD*

doi: 10.1097/SCS.0b013e31829ac617
Clinical Studies

Cervical necrotizing fasciitis (CNF) is a rare, rapidly advancing infection that involves the skin, the subcutaneous fibrofatty tissue, as well as the superficial and deep fascia and can cause life-threatening complications. The most frequent initiating factors in the head and neck region are a primary odontogenic infection, a peritonsillar infection, as well as posttraumatic or iatrogenic skin and mucosal injuries. Necrotizing fasciitis (NF) can expand within hours, and the reported mortality rate is up to 75% with delay interference. If the patients have any risk factors, poor prognosis can be seen. In this study, 1 patient with CNF with a history of peritonsillar infection and 2 patients with CNF who had a history of odontogenic infection with spreading to the temporal region and the mediastinum were described, with information of the literature and a clinical experience that was gained from 5 patients with NF who were seen at our clinic in the recent year, despite the fact that CNF was not seen up to last year. None of the patients had any risk factors. One of them had a worse clinical state with ascending infection to the temporal region, cranial nerve paralysis, and descending necrotizing mediastinitis, but he recovered from NF. After the oral intake began, dyspnea due to aspiration was seen and he died because of sepsis and multiorgan dysfunction. We aimed to attract attention to the importance of dental pathologies and increased mortality in a healthy patient.

From the *Departments of Otolaryngology, †Anesthesiology and Reanimation, and ‡Thoracic Surgery, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey.

Received March 6, 2013.

Accepted for publication May 1, 2013.

Address correspondence and reprint requests to Abdulkadir Bucak, PhD, Department of Otorhinolaryngology, Afyon Kocatepe University, Faculty of Medicine Ali Cetinkaya Kampusu Tıp Fakultesi, Izmir Karayolu 03200, Afyonkarahisar, Turkey; E-mail:

The authors report no conflicts of interest.

© 2013 by Mutaz B. Habal, MD.