Infratemporal fossa gas gangrene with sepsis: A case report

Abstract

A case of non-clostridial gas gangrene in the infratemporal fossa with sepsis is described. A 49-year-old woman with no history of diabetes presented with persistent fever, left facial puffiness, and trismus. Her physical examination and laboratory tests indicated that she had SIRS (systemic inflammatory response syndrome). CT (computed tomography) scan demonstrated a gas-forming abscess in the left infratemporal fossa that was attributable to a caries tooth in the mandible. Surgical drainage was performed via the subtemporal-preauricular approach combined with the intraoral approach, and antibiotics TAZ 2 g/day, CLDM 1.8 g/day and γ-globulin 5 g/day were given. Thirteen days post operatively, the inflammatory response subsided and she was discharged. Bacterial culture isolated Streptococcus constellatus, Peptostreptococcus micros, and Prevotella intermedia. Gas gangrene in head and neck lesions is usually caused by a non-clostridial organism, and most lesions are not due to a traumatic wound but to infections such as periodontitis, peritonsillitis, and pharingitis. For abscess formation, surgical drainage in the early stage is needed, and for infratemporal fossa lesions, the subtemporal-preauricular approach, intraoral approach and transmaxillary approach have been reported. In this case, surgery was successful via the subtemporal-preauricular approach combined with the intraoral approach. Infratemporal fossa gangrene is a potentially dangerous complication of odontogenic infection, and knowledge of the relevant anatomy and pathway of the spread will facilitate effective diagnosis and treatment of these infections.