{"paper_id":"1144b031-9fe7-4e1c-9b39-16db136578ea","body_text":"Necrotizing neck fasciitis after surgery for carcinoma of the gingiva: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Necrotizing neck fasciitis after surgery for carcinoma of the gingiva: A case report Zhenjiang Gong, Huifen Xu, Jiao Sun, Xiaopeng Yin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6434313/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This paper describes a case of necrotizing neck fasciitis (CNF) after surgery for gingival carcinoma and treatment experience. A patient with gingival carcinoma developed necrotizing neck fasciitis after surgery, which is rare in the clinical diagnosis and treatment of oral and maxillofacial surgery. After systematic anti-infection treatment, the patient was finally out of danger and successfully controlled the infection. Gingival carcinoma Necrotizing neck fasciitis (CNF) Anti-infection treatment Descending necrotizing mediastinitis(DNM) Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Necrotizing fasciitis (NF) is an explosive, fatal soft tissue infection caused by a combination of bacterial infections, mostly in the thoracic cavity, extremities, groin and perineum, with the neck being relatively rare. [1-2] The NF was first mentioned by Jones in 1871 during the Civil War, and was officially named by Wilson in 1952. [3-4] Head and neck NF can be further divided into craniofacial necrotizing fasciitis and cervical necrotizing fasciitis (CNF). [5] The onset of CNF is critical, the progression is rapid, the disease is dangerous, and serious complications can occur within a few hours, and the fatality rate is high. CNF is a serious necrotizing infection that mainly affects the superficial and deep fascia of the neck, usually does not involve muscles, often causes thrombosis of small skin veins, and leads to necrosis of the skin and deep tissues. [6] Descending necrotizing mediastinitis (DNM) is one of the most serious complications of CNF. [3] Case Report The patient, a 68-year-old female, was admitted to hospital due to \"the discovery of left mandibular gingival mass for 2 months\". The patient was found to have left mandibular gingival mass accompanied by pain 2 months ago, and underwent pathological biopsy in another hospital. The diagnosis was middle-highly differentiated squamous cell carcinoma in the left mandibular gingiva. Physical examination of patients after admission: From 35 to 37, the gingival mass on the buccal and lingual side was observed, with a size of 3.0cm×1.5cm. The surface was ulcerated, hard and mildly tender (Figure 1). An enlarged lymph node with a size of 1.0cm×1.0cm can be reached in the left submandibular region, with good motion and no tenderness. No swollen lymph nodes in the neck. Maxillofacial enhanced CT showed that it was consistent with left mandibular carcinoma of the gingiva and lymph node enlargement in the left neck area I-II. After preoperative discussion, it was decided to perform \"radical resection of left mandibular gingival carcinoma, including segmental mandibulectomy and left neck lymph node dissection\". The operation was carried out normally. Cefuroxime sodium 1.5g was used 30 minutes before surgery to prevent infection. The results of rapid freezing examination during the operation showed that no tumor cells were found at the incisions. The operation lasts about 160 minutes. Laboratory test on the first day after the operation: White blood cell count was 12.39×10 9 /L, the percentage of neutrophils was 89.19%, albumin was 37.2 g/L. The drainage of the operation area was 100 ml, which was light red bloody fluid. Cephalosporin furoxime sodium 1g was continuously used three times a day for the prevention of infection after the operation. On the third day after the operation, it was observed that the incision on the neck was slightly red and swollen. The negative pressure drainage was 25 ml of exudate, slightly turbid (Figure 2). The secretions in the drainage mouth were dipped and sent for bacterial culture. The results of bacterial culture were: normal oral flora. The patient was continued to receive cefuroxime sodium 1g tid anti-inflammatory symptomatic treatment, and the neck operation area was washed daily for dressing change. Four to five days after surgery, the patient's body temperature increased, up to 38.5℃. Hematological test showed: leukocyte 10.98×10 9 /L, neutrophil percentage 81.34%; C-reactive protein: 88.90mg/L, procalcitonin: 0.05ng/mL. The left side of the patient's face and the lip were swollen, accompanied by sore throat, and the neck skin had sunken edema. The incision secretion was taken again and sent for bacterial culture. The result was Streptococcus suis. One week after surgery, the patient had a large amount of bright red blood overflow at the neck area drainage. Emergency surgery was performed immediately: \" cervical bleeding exploration hemostasis and cervical infection debridement\". During the operation, the bleeding vessels were searched for and then ligation to stop the bleeding. The fascia on the surface of the cervical muscle was necrotic in a large area, which was gray and white with a foul smell, which was considered as necrotizing fasciitis (Figure 3). A large amount of normal saline and iodophor solution were used to flush the necrotic area alternately, and some necrotic fascia tissues were pruned. The surgical area was wiped with 1.5% hydrogen peroxide cotton ball, the necrotic fascia tissue was cleaned again, and the surgical area was rinsed with normal saline again. One negative pressure drainage tube was placed in the left posterior cervical area and one in the left anterior cervical area, and the wound was closed. After operation, cefoperazone sulbactam sodium 3g q12h, metronidazole 0.5g tid intravenous infusion was used to treat infection. And give the patient nutrition, rehydration and other symptomatic treatment. Thereafter, the neck area was rinsed alternately with iodor and saline daily until it was clear, and then pressurized with sterile gauze (Figure 4). The blood routine test on the second day after surgery showed that the white blood cells were 9.91×10 9 /L, the percentage of neutrophils was 89.67%, and the D-dimer was 2.14ug/ml. The dressing was changed and the secretions from the neck incision were taken for bacterial culture. The result was Streptococcus intermedius. Cefoperazone sulbactam sodium 3g q12h and metronidazole 0.5g tid have been used to treat the infection. The blood routine examination on the fifth day after surgery showed that the white blood cells were 4.75×10 9 /L and the percentage of neutrophil was 57.34%. The negative pressure drainage was removed on the eighth day after surgery, and the incision secretion was taken again for bacterial culture. Blood routine examination on the tenth day after surgery showed that white blood cells were 4.47×10 9 /L, neutrophil percentage 62%, D-dimer 3.40ug/ml, and metronidazole was stopped on the same day. The results of bacterial culture after 2 days showed that there was no bacterial growth after 48 hours of culture. The use of cefoperazone and sulbactam sodium was discontinued on the thirteenth day after surgery, at which point the patient recovered well, the neck infection was under control, and the neck incision had healed. After discharge, the patient went to the cancer hospital for further comprehensive treatment. Discussion This case is a cervical necrotizing fasciitis complicated by mandibular gingival carcinoma, which is rare in the clinical diagnosis and treatment of oral and maxillofacial surgery. The early clinical manifestations of cervical necrotizing fasciitis have no obvious specificity, and the diagnosis is based on history, symptoms, signs, imaging and intraoperative findings, and finally confirmed by pathology. When the abscess goes down to the deep neck, it is not easy to find early because of the various cervical spaces and its complex anatomical structure. [7] The incubation period of patients is 2 ~ 5 days, most of them have symptoms such as sore throat and swallowing pain. After that, the cervical skin appears congestion, edema, local fullness, and no obvious boundary with the surrounding normal tissue, and the subcutaneous twirling sensation is felt. If not treated in time, with the progression of the disease, the nutritional vessels around the skin often develop thrombophlebitis due to inflammation. At this time, the local skin color turns dark, greyish-brown, blisters appear and can fuse, and the surface skin necrosis. [8] These symptoms are often accompanied by moderate to high fever. Computed tomography (CT) is essential in the diagnosis of CNF. The CT imaging findings of CNF included disappearance of fat shadow in various cervical spaces, thickening of platysma muscle, partial interruption of platysma muscle, strengthening of the surface fascia of sternocleidomastoid muscle, effusion in deep cervical fascia space, and accumulation of gas in cervical space. On CT scan, the abscess appears as lobed or circular, with blurred edges and low-density shadows, and there is often no clear boundary between the abscess and the surrounding normal tissue. Enhanced CT scan showed that the pus wall was obviously strengthened, and the thickness was uneven, forming a circular enhanced shadow. The \"bubble sign\" produced by aerogenic anaerobic bacteria in subcutaneous tissue is one of the imaging characteristics of CNF. [8-11] For patients with cervical necrotizing fasciitis, timely anti-infection treatment is necessary. The common pathogenic bacteria of necrotizing neck fasciitis are mostly caused by aerobic bacteria, anaerobic bacteria and co-pathogenic bacteria, such as hemolytic streptococcus, staphylococcus, Klebsiella pneumoniae and anaerobic bacteria. [12-13] And bacteria culture and drug sensitivity test should be performed at the same time of timely neck incision and drainage for patients with CNF. It is best to do the culture of anaerobic bacteria at the same time, and then give the sensitive antibiotics according to the results of the drug sensitivity test. Before the specific pathogenic bacteria are identified, antibiotics should be combined to cover Gram-positive, negative and anaerobic bacteria, and then adjust antibiotics according to bacterial culture and drug sensitivity. In summary, CNF progresses rapidly, the condition is dangerous, and the disease is often complicated by the spread of multiple spaces. Clinicians should improve the understanding of the disease, as far as possible to achieve early diagnosis, timely treatment, in order to improve the efficacy of the disease, reduce complications and mortality. For patients who have been diagnosed, surgical exploration, incision and drainage, and removing necrotic fascia tissue should be performed as soon as possible. [14-15] At the same time, multi-disciplinary comprehensive treatment should be carried out in time to prevent respiratory obstruction, sepsis, upper mediastinal infection and other serious complications. Abbreviations CNF, necrotizing neck fasciiti Declarations Ethics approval and consent to participate Not applicable Consent for publication The patient has signed the informed consent and agreed to publish her images in this case report. Availability of data and materials Available, if necessary Competing Interests The authors declare no conflict of interest. Funding There was no funding in this case report. Authors' contributions Zhenjiang Gong: Investigation, case treatment, drafting article. Huifen Xu: Concept, literature support, critical revision of article. Jiao Sun: Drafting article. Xiaopeng Yin: Concept, case collection, case treatment, resources, critical revision of article, approval of article. Acknowledgements Not applicable References Gozal D, Ziser A, Shupak A, Ariel A, Melamed Y: Necrotizing fasciitis. Arch Surg 121(2):233-5, 1986. Goh T, Goh LG, Ang CH, Wong CH: Early diagnosis of necrotizing fasciitis. Br J Surg 101(1):e119-25, 2014. Skitarelić N, Mladina R, Morović M, Skitarelić N: Cervical necrotizing fasciitis: sources and outcomes. Infection 31(1):39-44, 2003. Wong CH, Wang YS. The diagnosis of necrotizing fasciitis: Curr Opin Infect Dis 18(2):101-6, 2005. Lanisnik B, Cizmarevic B: Necrotizing fasciitis of the head and neck: 34 cases of a single institution experience. Eur Arch Otorhinolaryngol 267(3):415-21, 2010. Leyva P, Herrero M, Eslava JM, Acero J: Cervical necrotizing fasciitis and diabetic ketoacidosis: literature review and case report. Int J Oral Maxillofac Surg 42(12):1592-5, 2013. İsmi O, Yeşilova M, Özcan C, Vayisoğlu Y, Görür K: Difficult Cases of Odontogenic Deep Neck Infections: A Report of Three Patients. Balkan Med J 34(2):172-179, 2017. Sarna T, Sengupta T, Miloro M, Kolokythas A: Cervical necrotizing fasciitis with descending mediastinitis: literature review and case report. J Oral Maxillofac Surg 70(6):1342-50, 2012. Elsahy TG, Alotair HA, Alzeer AH, Al-Nassar SA: Descending necrotizing mediastinitis. Saudi Med J 35(9):1123-6, 2014. Chauhan A, Wigton MD, Palmer BA: Necrotizing fasciitis. J Hand Surg Am 39(8):1598-60, 2014. Islam A, Oko M: Cervical necrotising fasciitis and descending mediastinitis secondary to unilateral tonsillitis: a case report. J Med Case Rep 4;2:368, 2008. Antunes AA, Avelar RL, de Melo WM, Pereira-Santos D, Frota R: Extensive cervical necrotizing fasciitis of odontogenic origin. J Craniofac Surg 24(6):e594-7, 2013. Wong CH, Kurup A, Wang YS, Heng KS, Tan KC: Four cases of necrotizing fasciitis caused by Klebsiella species. Eur J Clin Microbiol Infect Dis 23(5):403-7, 2004. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA: Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221(5):558-63, 1995. Krenk L, Nielsen HU, Christensen ME: Necrotizing fasciitis in the head and neck region: an analysis of standard treatment effectiveness. Eur Arch Otorhinolaryngol 264(8):917-22, 2007. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6434313\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":477493338,\"identity\":\"2fcab4e9-9c7e-4a41-a2ee-f20b8e98f2b2\",\"order_by\":0,\"name\":\"Zhenjiang Gong\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Jinan Stamotological Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zhenjiang\",\"middleName\":\"\",\"lastName\":\"Gong\",\"suffix\":\"\"},{\"id\":477493339,\"identity\":\"4a7caae1-a66d-472a-9d77-2db1052b2397\",\"order_by\":1,\"name\":\"Huifen 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for carcinoma of the gingiva: A case report\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eNecrotizing fasciitis (NF) is an explosive, fatal soft tissue infection caused by a combination of bacterial infections, mostly in the thoracic cavity, extremities, groin and perineum, with the neck being relatively rare.\\u003csup\\u003e[1-2]\\u003c/sup\\u003e The NF was first mentioned by Jones in 1871 during the Civil War, and was officially named by Wilson in 1952.\\u003csup\\u003e[3-4]\\u003c/sup\\u003e Head and neck NF can be further divided into craniofacial necrotizing fasciitis and cervical necrotizing fasciitis (CNF).\\u003csup\\u003e[5]\\u003c/sup\\u003e The onset of CNF is critical, the progression is rapid, the disease is dangerous, and serious complications can occur within a few hours, and the fatality rate is high.\\u0026nbsp;CNF is a serious necrotizing infection that mainly affects the superficial and deep fascia of the neck, usually does not involve muscles, often causes thrombosis of small skin veins, and leads to necrosis of the skin and deep tissues.\\u003csup\\u003e[6]\\u003c/sup\\u003e Descending necrotizing mediastinitis (DNM) is one of the most serious complications of CNF.\\u003csup\\u003e\\u0026nbsp;[3]\\u003c/sup\\u003e\\u003c/p\\u003e\"},{\"header\":\"Case Report\",\"content\":\"\\u003cp\\u003eThe patient, a 68-year-old female, was admitted to hospital due to \\\"the discovery of left mandibular gingival mass for 2 months\\\". The patient was found to have left mandibular gingival mass accompanied by pain 2 months ago, and underwent pathological biopsy in another hospital. The diagnosis was middle-highly differentiated squamous cell carcinoma in the left mandibular gingiva.\\u003c/p\\u003e\\n\\u003cp\\u003ePhysical examination of patients after admission: From 35 to 37, the gingival mass on the buccal and lingual side was observed, with a size of 3.0cm\\u0026times;1.5cm. The surface was ulcerated, hard and mildly tender (Figure 1). An enlarged lymph node with a size of 1.0cm\\u0026times;1.0cm can be reached in the left submandibular region, with good motion and no tenderness. No swollen lymph nodes in the neck. Maxillofacial enhanced CT showed that it was consistent with left mandibular carcinoma of the gingiva and lymph node enlargement in the left neck area I-II. After preoperative discussion, it was decided to perform \\\"radical resection of left mandibular gingival carcinoma, including segmental mandibulectomy and left neck lymph node dissection\\\".\\u003c/p\\u003e\\n\\u003cp\\u003eThe operation was carried out normally. Cefuroxime sodium 1.5g was used 30 minutes before surgery to prevent infection. The results of rapid freezing examination during the operation showed that no tumor cells were found at the incisions. The operation lasts about 160 minutes.\\u003c/p\\u003e\\n\\u003cp\\u003eLaboratory test on the first day after the operation: White blood cell count was 12.39\\u0026times;10\\u003csup\\u003e9\\u003c/sup\\u003e/L, the percentage of neutrophils was 89.19%, albumin was 37.2 g/L. The drainage of the operation area was 100 ml, which was light red bloody fluid. Cephalosporin furoxime sodium 1g was continuously used three times a day for the prevention of infection after the operation. On the third day after the operation, it was observed that the incision on the neck was slightly red and swollen. The negative pressure drainage was 25 ml of exudate, slightly turbid (Figure 2). The secretions in the drainage mouth were dipped and sent for bacterial culture. The results of bacterial culture were: normal oral flora. The patient was continued to receive cefuroxime sodium 1g tid anti-inflammatory symptomatic treatment, and the neck operation area was washed daily for dressing change. Four to five days after surgery, the patient's body temperature increased, up to 38.5℃. Hematological test showed: leukocyte 10.98\\u0026times;10\\u003csup\\u003e9\\u003c/sup\\u003e/L, neutrophil percentage 81.34%; C-reactive protein: 88.90mg/L, procalcitonin: 0.05ng/mL. The left side of the patient's face and the lip were swollen, accompanied by sore throat, and the neck skin had sunken edema. The incision secretion was taken again and sent for bacterial culture. The result was Streptococcus suis. One week after surgery, the patient had a large amount of bright red blood overflow at the neck area drainage. Emergency surgery was performed immediately: \\\" cervical bleeding exploration hemostasis and cervical infection debridement\\\". During the operation, the bleeding vessels were searched for and then ligation to stop the bleeding. The fascia on the surface of the cervical muscle was necrotic in a large area, which was gray and white with a foul smell, which was considered as necrotizing fasciitis (Figure 3). A large amount of normal saline and iodophor solution were used to flush the necrotic area alternately, and some necrotic fascia tissues were pruned. The surgical area was wiped with 1.5% hydrogen peroxide cotton ball, the necrotic fascia tissue was cleaned again, and the surgical area was rinsed with normal saline again. One negative pressure drainage tube was placed in the left posterior cervical area and one in the left anterior cervical area, and the wound was closed.\\u003c/p\\u003e\\n\\u003cp\\u003eAfter operation, cefoperazone sulbactam sodium 3g q12h, metronidazole 0.5g tid intravenous infusion was used to treat infection. And give the patient nutrition, rehydration and other symptomatic treatment.\\u003c/p\\u003e\\n\\u003cp\\u003eThereafter, the neck area was rinsed alternately with iodor and saline daily until it was clear, and then pressurized with sterile gauze (Figure 4). The blood routine test on the second day after surgery showed that the white blood cells were 9.91\\u0026times;10\\u003csup\\u003e9\\u003c/sup\\u003e/L, the percentage of neutrophils was 89.67%, and the D-dimer was 2.14ug/ml. The dressing was changed and the secretions from the neck incision were taken for bacterial culture. The result was Streptococcus intermedius. Cefoperazone sulbactam sodium 3g q12h and metronidazole 0.5g tid have been used to treat the infection. The blood routine examination on the fifth day after surgery showed that the white blood cells were 4.75\\u0026times;10\\u003csup\\u003e9\\u003c/sup\\u003e/L and the percentage of neutrophil was 57.34%. The negative pressure drainage was removed on the eighth day after surgery, and the incision secretion was taken again for bacterial culture. Blood routine examination on the tenth day after surgery showed that white blood cells were 4.47\\u0026times;10\\u003csup\\u003e9\\u003c/sup\\u003e/L, neutrophil percentage 62%, D-dimer 3.40ug/ml, and metronidazole was stopped on the same day. The results of bacterial culture after 2 days showed that there was no bacterial growth after 48 hours of culture. The use of cefoperazone and sulbactam sodium was discontinued on the thirteenth day after surgery, at which point the patient recovered well, the neck infection was under control, and the neck incision had healed. After discharge, the patient went to the cancer hospital for further comprehensive treatment.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis case is a cervical necrotizing fasciitis complicated by mandibular gingival carcinoma, which is rare in the clinical diagnosis and treatment of oral and maxillofacial surgery.\\u003c/p\\u003e\\n\\u003cp\\u003eThe early clinical manifestations of cervical necrotizing fasciitis have no obvious specificity, and the diagnosis is based on history, symptoms, signs, imaging and intraoperative findings, and finally confirmed by pathology.\\u0026nbsp;When the abscess goes down to the deep neck, it is not easy to find early because of the various cervical spaces and its complex anatomical structure.\\u003csup\\u003e[7]\\u003c/sup\\u003e The incubation period of patients is 2 ~ 5 days, most of them have symptoms such as sore throat and swallowing pain.\\u0026nbsp;After that, the cervical skin appears congestion, edema, local fullness, and no obvious boundary with the surrounding normal tissue, and the subcutaneous twirling sensation is felt. If not treated in time, with the progression of the disease, the nutritional vessels around the skin often develop thrombophlebitis due to inflammation.\\u0026nbsp;At this time, the local skin color turns dark, greyish-brown, blisters appear and can fuse, and the surface skin necrosis.\\u003csup\\u003e[8]\\u003c/sup\\u003e These symptoms are often accompanied by moderate to high fever.\\u003c/p\\u003e\\n\\u003cp\\u003eComputed tomography (CT) is essential in the diagnosis of CNF.\\u0026nbsp;The CT imaging findings of CNF included disappearance of fat shadow in various cervical spaces, thickening of platysma muscle, partial interruption of platysma muscle, strengthening of the surface fascia of sternocleidomastoid muscle, effusion in deep cervical fascia space, and accumulation of gas in cervical space.\\u0026nbsp;On CT scan, the abscess appears as lobed or circular, with blurred edges and low-density shadows, and there is often no clear boundary between the abscess and the surrounding normal tissue.\\u0026nbsp;Enhanced CT scan showed that the pus wall was obviously strengthened, and the thickness was uneven, forming a circular enhanced shadow.\\u0026nbsp;The \\\"bubble sign\\\" produced by aerogenic anaerobic bacteria in subcutaneous tissue is one of the imaging characteristics of CNF.\\u003csup\\u003e\\u0026nbsp;[8-11]\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFor patients with cervical necrotizing fasciitis, timely anti-infection treatment is necessary.\\u0026nbsp;The common pathogenic bacteria of necrotizing neck fasciitis are mostly caused by aerobic bacteria, anaerobic bacteria and co-pathogenic bacteria, such as hemolytic streptococcus, staphylococcus, Klebsiella pneumoniae and anaerobic bacteria.\\u003csup\\u003e[12-13]\\u003c/sup\\u003e And bacteria culture and drug sensitivity test should be performed at the same time of timely neck incision and drainage for patients with CNF. It is best to do the culture of anaerobic bacteria at the same time, and then give the sensitive antibiotics according to the results of the drug sensitivity test.\\u0026nbsp;Before the specific pathogenic bacteria are identified, antibiotics should be combined to cover Gram-positive, negative and anaerobic bacteria, and then adjust antibiotics according to bacterial culture and drug sensitivity.\\u003c/p\\u003e\\n\\u003cp\\u003eIn summary, CNF progresses rapidly, the condition is dangerous, and the disease is often complicated by the spread of multiple spaces. Clinicians should improve the understanding of the disease, as far as possible to achieve early diagnosis, timely treatment, in order to improve the efficacy of the disease, reduce complications and mortality.\\u0026nbsp;For patients who have been diagnosed, surgical exploration, incision and drainage, and removing necrotic fascia tissue should be performed as soon as possible.\\u003csup\\u003e[14-15]\\u003c/sup\\u003e At the same time, multi-disciplinary comprehensive treatment should be carried out in time to prevent respiratory obstruction, sepsis, upper mediastinal infection and other serious complications.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eCNF, necrotizing neck fasciiti\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eEthics approval and consent to participate\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003eConsent for publication\\u003c/p\\u003e\\n\\u003cp\\u003eThe patient has signed the informed consent and agreed to publish her images in this case report.\\u003c/p\\u003e\\n\\u003cp\\u003eAvailability of data and materials\\u003c/p\\u003e\\n\\u003cp\\u003eAvailable, if necessary\\u003c/p\\u003e\\n\\u003cp\\u003eCompeting Interests\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no conflict of interest.\\u003c/p\\u003e\\n\\u003cp\\u003eFunding\\u003c/p\\u003e\\n\\u003cp\\u003eThere was no funding in this case report.\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors\\u0026apos; contributions\\u003c/p\\u003e\\n\\u003cp\\u003eZhenjiang Gong: Investigation, case treatment, drafting article.\\u003c/p\\u003e\\n\\u003cp\\u003eHuifen Xu: Concept, literature support, critical revision of article.\\u003c/p\\u003e\\n\\u003cp\\u003eJiao Sun: Drafting article.\\u003c/p\\u003e\\n\\u003cp\\u003eXiaopeng Yin: Concept, case collection, case treatment, resources, critical revision of article, approval of article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Acknowledgements\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eGozal D, Ziser A, Shupak A, Ariel A, Melamed Y: Necrotizing fasciitis. \\u003cstrong\\u003eArch Surg\\u003c/strong\\u003e 121(2):233-5, 1986.\\u003c/li\\u003e\\n\\u003cli\\u003eGoh T, Goh LG, Ang CH, Wong CH: Early diagnosis of necrotizing fasciitis. \\u003cstrong\\u003eBr J Surg\\u003c/strong\\u003e 101(1):e119-25, 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eSkitarelić N, Mladina R, Morović M, Skitarelić N: Cervical necrotizing fasciitis: sources and outcomes. \\u003cstrong\\u003eInfection\\u003c/strong\\u003e 31(1):39-44, 2003.\\u003c/li\\u003e\\n\\u003cli\\u003eWong CH, Wang YS. The diagnosis of necrotizing fasciitis: \\u003cstrong\\u003eCurr Opin Infect Dis\\u003c/strong\\u003e 18(2):101-6, 2005.\\u003c/li\\u003e\\n\\u003cli\\u003eLanisnik B, Cizmarevic B: Necrotizing fasciitis of the head and neck: 34 cases of a single institution experience. \\u003cstrong\\u003eEur Arch Otorhinolaryngol\\u003c/strong\\u003e 267(3):415-21, 2010.\\u003c/li\\u003e\\n\\u003cli\\u003eLeyva P, Herrero M, Eslava JM, Acero J: Cervical necrotizing fasciitis and diabetic ketoacidosis: literature review and case report. \\u003cstrong\\u003eInt J Oral Maxillofac Surg\\u003c/strong\\u003e 42(12):1592-5, 2013.\\u003c/li\\u003e\\n\\u003cli\\u003eİsmi O, Yeşilova M, \\u0026Ouml;zcan C, Vayisoğlu Y, G\\u0026ouml;r\\u0026uuml;r K: Difficult Cases of Odontogenic Deep Neck Infections: A Report of Three Patients. \\u003cstrong\\u003eBalkan Med J\\u003c/strong\\u003e 34(2):172-179, 2017.\\u003c/li\\u003e\\n\\u003cli\\u003eSarna T, Sengupta T, Miloro M, Kolokythas A: Cervical necrotizing fasciitis with descending mediastinitis: literature review and case report. \\u003cstrong\\u003eJ Oral Maxillofac Surg\\u003c/strong\\u003e 70(6):1342-50, 2012.\\u003c/li\\u003e\\n\\u003cli\\u003eElsahy TG, Alotair HA, Alzeer AH, Al-Nassar SA: Descending necrotizing mediastinitis. \\u003cstrong\\u003eSaudi Med J\\u003c/strong\\u003e 35(9):1123-6, 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eChauhan A, Wigton MD, Palmer BA: Necrotizing fasciitis. \\u003cstrong\\u003eJ Hand Surg Am\\u003c/strong\\u003e 39(8):1598-60, 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eIslam A, Oko M: Cervical necrotising fasciitis and descending mediastinitis secondary to unilateral tonsillitis: a case report. \\u003cstrong\\u003eJ Med Case Rep\\u003c/strong\\u003e 4;2:368, 2008.\\u003c/li\\u003e\\n\\u003cli\\u003eAntunes AA, Avelar RL, de Melo WM, Pereira-Santos D, Frota R: Extensive cervical necrotizing fasciitis of odontogenic origin. \\u003cstrong\\u003eJ Craniofac Surg\\u003c/strong\\u003e 24(6):e594-7, 2013.\\u003c/li\\u003e\\n\\u003cli\\u003eWong CH, Kurup A, Wang YS, Heng KS, Tan KC: Four cases of necrotizing fasciitis caused by Klebsiella species. \\u003cstrong\\u003eEur J Clin Microbiol Infect Dis\\u003c/strong\\u003e 23(5):403-7, 2004.\\u003c/li\\u003e\\n\\u003cli\\u003eMcHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA: Determinants of mortality for necrotizing soft-tissue infections. \\u003cstrong\\u003eAnn Surg\\u003c/strong\\u003e 221(5):558-63, 1995.\\u003c/li\\u003e\\n\\u003cli\\u003eKrenk L, Nielsen HU, Christensen ME: Necrotizing fasciitis in the head and neck region: an analysis of standard treatment effectiveness. \\u003cstrong\\u003eEur Arch Otorhinolaryngol\\u003c/strong\\u003e 264(8):917-22, 2007.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Gingival carcinoma, Necrotizing neck fasciitis (CNF), Anti-infection treatment, Descending necrotizing mediastinitis(DNM)\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6434313/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6434313/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"This paper describes a case of necrotizing neck fasciitis (CNF) after surgery for gingival carcinoma and treatment experience. A patient with gingival carcinoma developed necrotizing neck fasciitis after surgery, which is rare in the clinical diagnosis and treatment of oral and maxillofacial surgery. After systematic anti-infection treatment, the patient was finally out of danger and successfully controlled the infection.\",\"manuscriptTitle\":\"Necrotizing neck fasciitis after surgery for carcinoma of the gingiva: A case report\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-07-02 11:56:25\",\"doi\":\"10.21203/rs.3.rs-6434313/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"1aeef9d6-03f3-418b-8633-ec6821a08518\",\"owner\":[],\"postedDate\":\"July 2nd, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-17T10:27:27+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-07-02 11:56:25\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6434313\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6434313\",\"identity\":\"rs-6434313\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}