An exceptional thoracolumbar and hypogastric necrotizing fasciitis of dental origin with favourable prognosis: Case report

Thoracolumbar and hypogastric necrotizing fasciitis (TLHNF) due to dental abscess is exceptional case. We report a case using the SCARE guidelines 2020, with the aim of raising awareness of this condition and adding knowledge to the field of surgery. A 32-year-old male farmer with no particular history of pathology presented with cellulitis of dental origin (CDO). History revealed a dental pain for 3 weeks with an auto medication. The therapy resulted with a dental abscess. Our investigation revealed a major asthenia with good parameters. There was an extensive oedema; hot, painful and fluctuating with a snowy crepitus sensation and a normal skin appearance. The patient presented a mouth opening limitation at 1.5 cm with poor oral hygiene and a flow of endobucal fetid pus. A finding of a thoracolumbar and hypogastric necrotizing fasciitis of dental origin was made. Surgical management consisted of iterative extensive debridement and necrosectomy of the entire necrotic surface under a sedation and analgesia. A skin section obtained from the anterior side of the thigh was used to perform a graft following sufficient wound budding and after eradicating the infection. The evolution was uneventful with the resumption of an oral diet and the achievement of complete healing. Prognosis was good one year later. For any dental abscess medical practitioners should absolutely perform a general clinical examination. Apart from resuscitation and appropriate antibiotic therapy, multidisciplinary competence is needed.