Abstract

Background: Necrotizing fasciitis (NF) is a rare and rapidly progressive soft tissue infection with high mortality, particularly without timely intervention. Cervical NF is uncommon due to the rich vascular supply of the neck, with odontogenic sources such as dental infections being the primary etiology.
Case Presentation: A 41-year-old Saudi male with a history of delayed treatment for chronic tooth pain presented with facial swelling, dysphagia, and systemic symptoms. Examination revealed left cervical swelling with overlying erythema, fluctuance, and signs of necrosis. Imaging showed a submandibular abscess with NF extending to the contralateral neck and inferiorly to C7-T1. Cultures isolated Prevotella baroniae, a rare pathogen. The patient underwent emergency surgical debridement and extraction of offending teeth, followed by targeted antibiotic therapy. Acute kidney injury and hyponatremia were managed with supportive care. The patient was discharged after 13 days with complete wound healing and no recurrence.
Discussion: Cervical NF poses diagnostic and therapeutic challenges due to its rarity and aggressive course. Odontogenic sources of cervical NF usually show growth of oral microbiome including Prevotella as shown in this case. Early diagnosis, guided by clinical suspicion and imaging, is vital for initiating surgical intervention.
Conclusion: Timely recognition and multidisciplinary management are critical in cervical NF. Preventive strategies focusing on dental hygiene and public awareness can reduce the burden of odontogenic infections.

Key words: Necrotizing Fasciitis; Cervicofacial Infection; Odontogenic Infection; Case report