• Christopher Kloth, Sebastian Hoefert, Till Fischborn, and Christina Schraml.
• Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen.
• Dtsch. Med. Wochenschr. 2017 Feb 1; 142 (3): 212-215.

AbstractHistory and clinical findings We elaborate the case of a 72-year-old patient who presented with a painful swelling of the lower jaw in the emergency unit. Investigations and diagnosis In the clinical examination and the CT scan, a widespread cervical emphysema was found which raised suspicion for the presence of a necrotizing fasciitis of the head and neck due to aerogenic infection. Close spatial vicinity to the teeth of the left upper and lower jaw was present, so that the necrotizing fasciitis was assumed to be odontogenic. Treatment and course Based on the clinical presentation and the imaging findings the diagnosis of necrotizing fasciitis in the sense of a possible infection with gas building bacteria accompanying with an infection of the mediastinum was made. Immediately performed therapy included sternotomy and extended surgical debridement of necrosis. Conclusion The presented case emphasizes that necrotizing fasciitis due to gas-producing infections should be considered as a differential diagnosis for cervical soft tissue emphysema for which an odontogenic focus is the most common cause. Rapid diagnosis is essential for successful treatment consisting of immediate surgical debridement and intravenous antibiotics.© Georg Thieme Verlag KG Stuttgart · New York.

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