What Is Gangrenous Cervicofacial Cellulitis?
Cervicofacial cellulitis is a dangerous or life-threatening disease that spreads in the face, head, and neck regions. It is most often linked to a dental infection. In medical terminology, this disease condition or progressive gangrene form in the face, head, and neck is called gangrenous cervicofacial cellulitis. This can be primarily termed a cellulose adipose tissue disorder due to the dental infection pathogenesis, which can progressively spread through the soft tissues, lymph nodes, and the bloodstream. It would be surprising to know that periodontal or dental infections can be capable of causing such life-threatening systemic sequelae.
According to dental and oral pathologic research, the development of cervicofacial cellulitis or gangrenous cervicofacial cellulitis is linked to an untreated dental infection. These include periapical abscess (collection of pus at the tip of the root of a tooth), periapical infections (infections that occur at the root tip of a tooth) that are of chronic and extensive nature dentally, major salivary gland infections (such as parotid, submandibular, and sublingual gland infections), maxillary sinusitis (inflammation of sinus located in cheekbones), in otitis media (inflammation or infection of the middle ear), periodontal tooth abscess, and wisdom tooth infection that is extensive and untreated of chronic nature (extensive pericoronitis).
To name a few implicated dental conditions that are innately linked to this disease progression. When these dental infections are left untreated, they can carry on into the soft tissue layers or muscles that are the cervicofacial fascia irrespective of the dental origin, penetrating the fibrous layers of the face, head, and neck (aponeurotic lamina- a fibrous layer of connective tissue), invading all the weak soft tissue areas diffusely, causing cellulitis (bacterial infection of the skin and underlying tissue).
What Are the Incidence Rates and Complications of Gangrenous Cervicofacial Cellulitis?
According to the current global incidence rates for gangrenous cervicofacial cellulitis, almost a whopping 24 percent of cases or hospital admissions in an emergency are reported from this form of gangrene and cellulitis infection. Septic shock (a life-threatening medical condition caused by infection) is considered to be a life-threatening medical emergency that requires prompt action by the maxillofacial surgeon and the emergency surgeon or physician in charge.
Some of the serious medical complications that are interlinked to gangrenous cervicofacial cellulitis in the emergency department are unfavorable systemic conditions like mediastinitis (Infection of the thoracic cavity's central compartment, the mediastinum), visceral organ (internal organs) involvement that would pertain either to hepatic, gastrointestinal, renal, or respiratory systems, and craniofacial shock. Of these systemic conditions that are interlinked with the development and progression of the disease gangrenous cervicofacial cellulitis, almost 44 percent of deaths in an emergency have been linked to death by mediastinitis infection.
Almost one-third of these cases are reported to have high mortality rates in the emergency department of hospitalized admissions because individuals who are immunocompromised, diabetic, or who have systemic or underlying cardiovascular issues can be highly prone eventually to death. Moreover, when the cellulitis turns diffuse or extends for a prolonged state, despite interdisciplinary management strategies by the physician and maxillofacial surgeons, this condition has a poor prognosis in one-third of the cases (high-risk immunocompromised cases).
What Causes Gangrenous Cervicofacial Cellulitis?
When the local tissues of the regions affected, be it in the face, head, or neck, start rapidly necrosing or dying out, there can be an increased and sudden risk of infected patients dying of septic shock. Septic shock is the aftermath of untreated cellular necrosis or local cell and tissue death in the pivotal face, head, and neck regions in individuals infected. It is a known medical fact that cellulitis is one of the primary conditions in medical literature and research that has been known to have the weakest or worst prognosis, especially when these infections are left untreated. A majority of cellulitis cases in the world are often ignored by the sections or high-risk population groups belonging to the lower socioeconomic status in the geriatric population groups in developing countries. This further leads to emergency hospital admissions once the clinical symptoms start manifesting in severity in the advanced stages because gangrenous cervicofacial cellulitis of the head and neck is a condition that primarily has a predominance of anaerobic flora (bacteria that live in an environment with oxygen). These are termed to be of polymicrobial origins that have the potential to invade local tissues where they infect the host (the human soft tissue region of the face, head, and neck), thereby, initiating a sequence of extensive necrosis of cells or programmed cell death of cells in short.
How Is Gangrenous Cervicofacial Cellulitis Diagnosed and Managed?
The main diagnostic management strategy to detect gangrenous cervicofacial cellulitis is a cervicofacial CT (computed tomography) scan, a radiographic modality. These three-dimensional observations of the extent of infection as well as virtual surgical planning can be beneficial in this radiographic imaging technique. Though radiologic assessment is the preliminary step, it is usually alongside emergency surgical management, which should not be delayed even by a few hours.
In the emergency department of the hospitalized patient, immediate surgical management with broad-spectrum antibiotic therapy regimens is usually advised by the physician. Surgically, the gold standard procedure is cervicotomy (surgical removal of the cervix), which can aid in the effective drainage of purulent necrotic or dead tissues. Thoracotomy (surgical procedure to access and reach the thoracic cavity) can be considered by the general surgeon when there is a high risk of mediastinal diffusion of the infection. Regular post-operative checkups for infected patients after discharge also hold great prognostic value in the maxillofacial surgery department. Consultation with the maxillofacial surgeon for prosthetic dental or facial rehabilitation is an imperative strategy for restoring facial function and esthetics.
Conclusion
In conclusion, gangrenous cervicofacial cellulitis is a severe and fatal soft tissue condition of the face, head, and neck regions with extensive untreated chronic dental infection origin. Interdisciplinary management by the physician and maxillofacial surgeon results in a better prognosis. Remember that as the mouth is the mirror of health, this hence necessitates the need to undergo regular oral prophylaxis, restorative, or prosthetic treatment as per oral health demands and the need for regular dental follow-ups to prevent the local and systemic sequel that the undesired progression seen in high-risk population groups. Dental and maxillofacial surgeons should also spread awareness to their patients and the general public regarding the nature of oral infections and how chronic oral infections can involve the soft tissue regions of the head and neck, initiating anaerobic microorganisms to breach oral and systemic immunity.
