Extensive odontogenic deep neck infection complicated by necrotizing fasciitis and bilateral mastitis: A rare case report

Abstract

Objectives: Odontogenic infections are a leading cause of deep neck space infections and may progress rapidly through fascial planes, leading to severe complications such as necrotizing fasciitis, mediastinitis, and sepsis. This case represents an exceptionally rare example of odontogenic deep neck infection complicated by necrotizing fasciitis with bilateral breast involvement, emphasizing its potential for aggressive, life-threatening spread. Case report: We describe a 58-year-old woman with diabetes, hypertension, and coronary artery disease who presented with neck and chest wall swelling, erythema, crepitus, and sepsis after 2 weeks of inadequate treatment for a buccal abscess. Imaging revealed multicompartment spread with subcutaneous emphysema, myositis, abscess formation, and bilateral breast involvement. The patient underwent aggressive resuscitation, broad-spectrum intravenous antibiotics, and serial surgical debridements through extended cervical and anterior chest wall incisions, followed by negative pressure wound therapy (NPWT), resulting in clinical and laboratory improvement. Discussion: This case highlights the potential for odontogenic infections to progress beyond the neck into the thoracic wall and breast tissue, emphasizing the importance of early imaging and comprehensive source control. Diabetes was likely a significant predisposing factor for the rapid and extensive spread observed. Contrast-enhanced CT is critical for mapping disease extent and guiding timely surgical intervention, which is associated with reduced morbidity and mortality. Conclusions: Early recognition, imaging, and a multidisciplinary treatment strategy, including prompt broad-spectrum antibiotic therapy and repeated surgical debridement, are essential to prevent life-threatening complications of odontogenic deep neck infections. Clinicians should maintain a high index of suspicion in patients with systemic symptoms and comorbidities, even when initial dental infections appear minor.