"NEVER UNDERESTIMATE THE POWER OF A TOOTH"

Deep Neck Space (DNS) infections are described as inflammation of the tissues with collection of abscess within potential fascial spaces in the head and neck region. Odontogenic infections can spread rapidly into deep neck and mediastinum area. In this case report, we are presenting a 30 years old Indonesian male that complained of pain over the right upper and lower wisdom teeth for the past two weeks. He has no known medical illness. A week later, he developed facial swelling at the right submandibular region which extended to the right neck and chest region. He presented with fever, experienced with odynophagia, therefore lead him to reduce in oral intake. However, due to poor economic status he did not seek for any treatment. As the condition of the patient progressively deteriorated, he attended to Emergency Department (ED) with septic look, necrosed right chest and strong foul smell. Almost 200 cubic centimeter of pus aspirated by ED team from the right neck punctum. This patient was then referred to multi-disciplinary team involving General Surgery, Otorhinolaryngology and Oral and Maxillofacial Surgery. Computerized tomography scan of head, neck and thorax reported with abscess collection involving right DNS, medialization of right pharyngeal wall that extended inferiorly towards right anterior thoracic wall. These strongly suggest to be associated with grossly decayed right upper and lower wisdom teeth. A diagnosis of necrotizing fasciitis at right chest secondary to odontogenic origin was made. Subsequently, emergency operation was commenced on the same day that involved wound debridement at right chest, incision and drainage at right neck and surgical removal of both wisdom teeth. Patient was also administered with systemic antibiotic. At day 10, he was discharged. A week later, patient showed marked improvement in the healing of intra-oral surgical site and right chest region. Conclusively, multi-disciplinary intervention with concurrent systemic antibiotic therapy significantly reduces morbidity and mortality rate in the management of DNS infections.