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Abstract
Case summary
A 53-year-old man, who had suffered from severe periodontitis one week prior, visited our clinic due to a 2-day history of rapidly progressing left mandibular and periorbital swelling and pain. By the time of his visit, he had lost vision in the left eye and had moderate swelling, expression of pus, and skin explosion with necrotizing discoloration of the left lid and lower facial area. MRI of the orbits revealed soft tissue necrosis, gas accumulation, and subperiosteal abscess formation of the left orbit.
We administered systemic antibiotics and surgically excised the left periorbital necrotic tissue. A constant expression of pus material was also achieved, decreasing painful swelling. We considered exenteration of the left eye to block the spread of necrosis to adjacent intact tissue; however, the left eye was fairly well-preserved with the exception of mild lagophthalmos developed by the excision of necrotic skin. Streptoccocal species was observed in microbiologic cultures of pus and necrotic tissue and ‘necrotizing inflammation’ was described on tissue biopsy, with the findings consistent with necrotizing fasciitis.
References
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Figure 1.
Photograph of the patient at the first visit. Showing left periorbital swelling with pus-material discharge.
Figure 2.
Orbit CT showed marked soft tissue swelling with gas densities in the left inferotemporal fossa (*) and temporoparietal scalp as well as in the left orbit (†).
Figure 3.
Orbit MRI showed ill defined increased signal density in T2-weighted image (A) and T1-weighted image (B) in the left orbit. Fluid and gas density along the lateral margin of the left orbit suggests subperiosteal abscess formation (white arrows).
Figure 4.
Photograph of the patient at the operatiing room. Silastic drain tubes were inserted for drainage of pus material after excision of necrotic tissues at the dental clinic (A: frontal view: B: lateral view). After the orbital necrotic tissue material was removed through superior and inferior eyelid incisions at the eye clinic (C).
Figure 5.
Light microscopic view of periorbital necrotic tissue showing acute necrotizing inflammation with abscess formation (hematoxylin‐ eosin stain, ×100); * predominantly neutrophilic infiltration; † abscess formation.
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