OMFS-0239Rare OMFS casesInfectionadvancedLeft submandibular region and neck

Rapidly spreading neck infection with skin discolouration

58-year-old male

Draft — educational study aid, pending faculty review.

§Chief complaint

Painful neck swelling spreading over 24 hours with dark patches on the skin

§Medical & dental history

01Poorly controlled diabetes
02Heavy alcohol use
03Infected lower left molar for 2 weeks

§Clinical examination

01Tense, very painful swelling of the left neck with dusky skin and blisters
02Crackling under the skin (crepitus); pain beyond the visible redness
03Fever 39.4 C, low blood pressure, confused

§ figuresFigures (3)

Cervicofacial Necrotising Fasciitis — clinical image: The start of Necrotizing Fasciitis in Joe Doetsch. — Fig. 1The start of Necrotizing Fasciitis in Joe Doetsch.
“Beginning of Necrotizing Fasciitis 01” · Doetsch · CC BY-SA 4.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Cervicofacial Necrotising Fasciitis figures pending faculty review.

§Differential diagnosis

Cervical necrotising fasciitisSkin necrosis, crepitus, rapid spread, severe illness

Ludwig's anginaFloor of mouth swelling, no skin necrosis

Simple cellulitisNo crepitus, slower, patient less unwell

§Final diagnosis

Cervical necrotising fasciitis of dental origin with septic shock

Rapid spread along the fascia with skin necrosis, gas in tissues and shock is necrotising fasciitis — a surgical emergency confirmed by greyish dead fascia at operation.

§Investigations

01Blood tests, lactate, blood cultures
02CT neck and chest
03Tissue for culture at surgery

§Radiology

01CT — gas tracking along the fascia of the neck; no chest spread

§Treatment plan

01Resuscitation and intensive care
02Broad-spectrum IV antibiotics
03Urgent wide removal of all dead tissue, repeated as needed
04Removal of the infected tooth; later skin reconstruction

§Surgical procedure

01Tracheostomy, wide debridement of dead fascia and skin, extraction of the source tooth, return to theatre at 48 hours

§Histopathology report

Necrotic fascia with blood vessel clots and mixed bacteria. Consistent with necrotising fasciitis.

§Follow-up & outcome

01Two further debridements
02Week 4 — skin graft
03Month 3 — healed, rehabilitation complete

Outcome: Survived after repeated surgery and intensive care, with healed grafted skin.

§Discussion

01Death rates remain 20-40%; early surgery is the strongest factor in survival.

§Clinical pearls / learning points

01Pain out of proportion with a toxic patient — think necrotising fasciitis and operate early.

§Viva questions

What is the key treatment?

Early and repeated wide surgical debridement with antibiotics and organ support.

§MCQs

Q1A sign strongly suggesting necrotising fasciitis is:

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

L1 · Classification — 1
L4 · Research — 1
L6 · Textbook — 3

2 linked sources were published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

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Current Classification