Descending necrotizing soft tissue infection of periodontal origin.

Descending necrotizing soft tissue infections involving the neck and chest are a rare but hazardous sequela of periodontal infections. These infections are associated with significant mortality.The high mortality rates of this condition are attributed to significant delays in diagnosis and treatment of common periodontal infections that have progressed to severe disease without overt clinical signs or symptoms. As with all necrotizing soft tissue infections, making a timely diagnosis requires that the examining physician maintain a reasonable index of suspicion when the patient with an oropharyngeal infection is encountered. Coverage of the most common infecting organisms with appropriate antibiotics accompanies surgical therapy. Hyperbaric oxygen remains an adjunctive therapy of unproven efficacy. The cornerstone of therapy, however, is surgical with aggressive and complete debridement of all nonviable tissue without regard for the size or complexity of the resulting wound. In the case described below, this goal could not have been achieved without the immediate availability of reconstructive expertise to preserve vital structures in the neck and upper mediastinum.