Feasibility analysis of negative pressure wound therapy for odontogenic ascending necrotizing fasciitis: a single-center single-arm retrospective case series

Abstract

Abstract Background Odontogenic ascending necrotizing fasciitis (ANF) is an extremely rare, rapidly progressive, and destructive craniomaxillofacial necrotizing soft tissue infection. Advanced surgical drainage is essential to improve cure rates, shorten the disease course, and alleviate patient suffering. Methods This study was designed as a single-center, single-arm, retrospective feasibility case series. A total of 15 consecutive patients diagnosed with odontogenic ANF and treated with standardized NPWT from March 2016 to March 2024 were enrolled. Uniform standardized perioperative treatment, surgical debridement, and NPWT placement protocols were implemented for all enrolled patients. Clinical data including baseline demographic characteristics, systemic comorbidities, infection distribution, surgical incision selection, NPWT application frequency, intraoperative and postoperative complications, drainage duration, and hospitalization outcomes were systematically collected and descriptively analyzed. Results The enrolled cohort consisted of 10 males and 5 females, with a mean age of 62.5 ± 16.9 years. Most patients presented with underlying systemic comorbidities, including hypertension (8/15) and diabetes mellitus (7/15), which were the most common concurrent diseases. The vast majority of cases (14/15) originated from mandibular dental lesions. Preoperative CT examination detected characteristic soft tissue gas accumulation in 7 patients (46.67%). All patients exhibited multi-space infection involvement, with the infratemporal space being the most commonly involved anatomical site, followed by the superficial temporal space and masseteric space. Individualized surgical incisions were formulated according to the infection scope, including single temporal incision (3 cases), single submandibular incision (1 case), and combined temporal and submandibular incision (11 cases). In terms of NPWT application, 8 patients received one-stage debridement and NPWT treatment, 6 patients underwent secondary debridement and NPWT replacement due to residual necrotic fascia, and 1 patient received three rounds of surgical debridement. The mean NPWT drainage duration was 12.47 ± 5.79 days, the mean dressing change frequency was 3.53 ± 0.64 times, and the average total hospitalization length was 23.40 ± 10.90 days. No severe intraoperative or postoperative complications, in-hospital mortality, or recurrent infection occurred in all patients. Conclusion NPWT appears to possess favorable clinical operability and acceptable perioperative safety in the management of rare odontogenic ANF. Individualized incision planning tailored to the anatomical extent of infection may reduce surgical trauma and yield improved postoperative cosmetic results. Regular NPWT dressing changes combined with staged repeated debridement represent essential procedural measures suitable for the dense anatomical properties of craniomaxillofacial fascia. This single-arm case series only preliminarily demonstrates the potential clinical feasibility of NPWT for odontogenic ANF, with satisfactory short-term wound healing and infection control observed in the cohort. Owing to the limitations inherent to a non-controlled retrospective design, large-scale multicenter prospective controlled trials are still needed to verify its long-term efficacy and establish standardized application protocols.