Children · 6 authors, 2 centres
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A 12-year-old boy developed cervicofacial necrotizing fasciitis secondary to second inferior molar pericoronitis, which progressed to the contralateral side and mediastinum within approximately 48 hours despite intravenous antibiotics. Management required repeated surgical debridement, prolonged intubation, and multidisciplinary care complicated by ventilation-assisted bronchopneumonia, aspiration pneumonia, and pressure ulcers.
This case report describes a 12-year-old boy with cervicofacial necrotizing fasciitis (NF) complicating pericoronitis of the lower left second molar. Bacteriology revealed Streptococcus anginosus and Granulicatella adiacens. Despite administration of Ceftriaxone and Metronidazole from admission, the infection spread from the left submandibular space to the contralateral side, infratemporal fossa, and mediastinum within approximately 48 hours. Treatment involved extensive surgical debridement and multiple antibiotic regimen changes. Complications included significant bleeding from the superior thyroid artery during debridement, ventilation-assisted bronchopneumonia, postextubation aspiration pneumonia, negative pressure pulmonary hemorrhage, and pressure ulcers exacerbated by metabolic ketoacidosis and septic shock. Clinical assessment in children is difficult due to vague symptomatology and smaller anatomic landmarks.
