Oral necrotizing fasciitis of the buccal mucosa

Necrotizing fasciitis can present in the head and neck region with rapid progression after odontogenic infection, but is uncommon. Non-odontogenic necrotizing fasciitis is even more rare and can be difficult to diagnosis initially. Early recognition and surgical intervention are crucial. A 48-year-old male accidentally bit his cheek 5 days prior to coming to our hospital. There was swelling over the right side of his face that involved the submandibular space and submental space for 3 days with high fever. The lower right buccal vestibule showed diffuse swelling with erosion. The underlying systemic diseases were diabetes mellitus and hypertension. On computed tomography scan, there was soft tissue swelling over right mandibular region. After 3 days of antibiotic therapy, the swollen area showed generalized necrotic mucosa formation. Treatment was started immediately including incision, drainage, and full debridement. The tissue biopsy showed generalized necrotic mucosa. The pus culture showed the presence of monomicrobial Klebsiella pneumoniae. Antibiotic therapy was continued in addition to daily irrigation and change of dressing until full recovery. Generally, surgical intervention cannot be as aggressive on the face as in the extremities or trunk, since many vital structures are concentrated in a relatively small area. Broad-spectrum intravenous antibiotics and surgical debridement remain the mainstays of treatment.