J Korean Ophthalmol Soc.  2008 Jun;49(6):993-999. 10.3341/jkos.2008.49.6.993.

A Case of Periocular Necrotizing Fasciitis of Odontogenic Origin

• Hwang HB
• Doh SH
• Yang SW

• KMID: 2110882
• DOI: http://doi.org/10.3341/jkos.2008.49.6.993

Abstract

PURPOSE: We report a case of periocular necrotizing fasciitis originating from dontogenic infection.
CASE SUMMARY
A 53-year-old man, who had suffered from severe periodontitis one week prior, visited our clinic due to a 2-day history of rapidly progressing left mandibular and periorbital swelling and pain. By the time of his visit, he had lost vision in the left eye and had moderate swelling, expression of pus, and skin explosion with necrotizing discoloration of the left lid and lower facial area. MRI of the orbits revealed soft tissue necrosis, gas accumulation, and subperiosteal abscess formation of the left orbit.
CONCLUSIONS
Through the diagnosis of necrotizing fasciitis originating from an odontogenic infection, the proper administration of antibiotics and surgical management were achieved. As a result, we were able to preserve the eye.

Keyword

Acute periorbital necrotizing fasciitis; Odontogenic infection

MeSH Terms

Abscess
Anti-Bacterial Agents
Explosions
Eye
Fasciitis, Necrotizing
Humans
Middle Aged
Necrosis
Orbit
Periodontitis
Skin
Suppuration
Vision, Ocular
Anti-Bacterial Agents

Figure

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  Figure 1. Photograph of the patient at the first visit. Showing left periorbital swelling with pus-material discharge.

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  Figure 2. Orbit CT showed marked soft tissue swelling with gas densities in the left inferotemporal fossa (*) and temporoparietal scalp as well as in the left orbit (†).

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  Figure 3. Orbit MRI showed ill defined increased signal density in T2-weighted image (A) and T1-weighted image (B) in the left orbit. Fluid and gas density along the lateral margin of the left orbit suggests subperiosteal abscess formation (white arrows).

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  Figure 4. Photograph of the patient at the operatiing room. Silastic drain tubes were inserted for drainage of pus material after excision of necrotic tissues at the dental clinic (A: frontal view: B: lateral view). After the orbital necrotic tissue material was removed through superior and inferior eyelid incisions at the eye clinic (C).

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  Figure 5. Light microscopic view of periorbital necrotic tissue showing acute necrotizing inflammation with abscess formation (hematoxylin‐ eosin stain, ×100); * predominantly neutrophilic infiltration; † abscess formation.

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  Figure 6. Brain MRI showed an ill‐ defined, patchy area of a bright signal intensity on T2-weighted images (B) and a bright signal intensity on T1-weighted images (A, C) involving the left subfrontal area (white arrows).

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  Figure 7. Photograph of the periocular area taken at postoperative 6 months. Patient is doing well except mild lagophthalmos. Medial and lateral tarsorrhaphies of the left eye are noted.

Reference

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