To the Editor.—We recently treated a case of necrotizing fasciitis of the neck following removal of a tooth that emphasizes the role of aggressive surgical treatment in this entity.
Report of a Case.—A 51-year-old nondiabetic man underwent extraction of a noninfected right upper second molar. Two days later he had marked facial swelling with a temperature of 40.6 C (105 F). Abscesses of the right temporal, buccal, submandibular, submental, and parapharyngeal spaces were drained. Beta-hemolytic streptococci grew from the cultures. Intravenous administration of penicillin was started, and he improved for 48 hours. He then spiked to 39.4 C (103 F) and rapidly developed severe swelling inferiorly to the clavicles. Brawny, noncrepitant induration extending to the nipples appeared within three hours. Roentgenograms showed a widened superior mediastinum and gas in the retropharyngeal space.
A low transverse cervical incision was made, superior and inferior flaps created, and the deep cervical