Cervical necrotizing fasciitis caused by oral cavity infection: a case report considering therapeutic approach and its morphofunctional implications / Fascitis necrosante cervical causada por infección de la cavidad oral. Reporte de un caso considerando el abordaje terapéutico y sus implicaciones morfofuncionales

SUMMARY: Cervical necrotizing fasciitis (NF) is a rare complication of oral cavity infection with high morbi-mortality. Given its low prevalence, adequately reporting cases of NF, its therapeutic management, and associated morphofunctional modifications to the clinical and scientific community is pivotal. To that end, we herein describe a case of cervical NF in a 60-year-old patient with comorbidities and patient presented large, painful cervical swelling associated with a necrotic ulcer lesion in the anterior neck region. Intraoral examination indicated a periodontal abscess in the right mandibular area, while computed tomography indicated the lesion's extension from the right mandibular to the submandibular region. Following empirical intravenous antibiotic treatment, a broad surgical debridement was performed, and the foci of oral infection were removed. Debridement revealed communication between deep and superficial anatomical regions in the submandibular area, where we subsequently placed a Penrose drain. Biopsies showing acute inflammatory infiltrate associated with necrotic and hemorrhagic regions confirmed the diagnosis of NF. When an antibiogram revealed resistance to the empirical treatment, the antibiotic scheme was replaced with an adequate alternative. After a second debridement, we closed the defect with fascio-mucocutaneous advancement flaps with a lateral base while maintaining suction drainage. Having reacted positively, the patient was discharged 10 days after the operation. Despite an extensive morphofunctional change generated in the treated area, the patient showed no difficulties with breathing, phonation, swallowing, or mobilizing the area during control sessions. Altogether, this report contributes to the highly limited literature describing morphological aspects that can facilitate or delay the spread of infection or the morphofunctional disorders associated with the size and depth of surgical interventions for cervical NF, information that is relevant for the comprehensive, long-term prognosis of the treatment of NF.

La fascitis necrosante (FN) cervical es una rara complicación de una infección proveniente de la cavidad bucal asociada a una alta morbimortalidad. Por lo anterior, es fundamental informar a la comunidad clínica y científica los casos de FN, su manejo terapéutico y las modificaciones morfofuncionales asociadas. Se describe un caso de FN cervical en una paciente de 60 años quien presentó una gran tumefacción dolorosa asociada a una lesión ulcerosa necrótica en la región anterior del cuello. El examen intraoral mostró un absceso periodontal en el área mandibular derecha y la tomografía computarizada mostró la extensión de la lesión hacia la región submandibular. Tras el tratamiento antibiótico empírico, se realizó un desbridamiento quirúrgico extenso y se extirparon los focos de infección oral. El desbridamiento reveló comunicación entre las regiones anatómicas profundas y superficiales del área submandibular, donde se colocó un drenaje Penrose. Las biopsias mostraron un infiltrado inflamatorio agudo asociado con regiones necróticas y hemorrágicas, confirmando el diagnóstico de FN. El antibiograma reveló resistencia al tratamiento empírico, por lo que el esquema antibiótico se sustituyó. Tras un segundo desbridamiento, se cerró el defecto con colgajos de avance fascio-mucocutáneos de base lateral manteniendo drenaje aspirativo. El positivo progreso del paciente permitió su alta 10 días después. Aun cuando se generó una gran modificación morfofuncional en el área tratada, la paciente no presentó dificultades para respirar, hablar, deglutir o movilizar el área cervical intervenida durante las sesiones de control. Este informe contribuye a la limitada literatura que describe los aspectos morfológicos que pueden facilitar o retrasar la propagación de la FN y las consecuencias asociadas a los trastornos morfofuncionales provocadas por el tamaño y profundidad de las intervenciones quirúrgicas requeridas por la FN, información relevante para el pronóstico integral a largo plazo del tratamiento de la FN.

Desenvolvimento de aplicativo como objeto de aprendizagem: Atlas Virtual Interativo para o ensino da anatomia cabeça e pescoço direcionado à Odontopediatria / Development of an Application as a Learning Object: Virtual Interactive Atlas for Teaching the Anatomy of Head and Neck, aimed at Pediatric Dentistry

Este estudo investiga o uso e o desenvolvimento de objetos tecnológicos no aprendizado sobre anatomia humana, em específico, dos ossos que compõem a cabeça. Esta pesquisa tem por motivação determinar se a tecnologia facilita o aprendizado de um conteúdo que é principalmente visual. O uso e as aplicações de interfaces tecnológicas interativas e imersivas propiciam novas ferramentas de estudo para profissionais e alunos da área de saúde. Por meio destas, usuários podem contar com instrumentos de estudo interativos que oferecem ao usuário sensação de imersão e melhor compreensão do ambiente. Este trabalho, portanto, tem como foco o desenvolvimento de um atlas virtual interativo e tridimensional para o estudo da anatomia da cabeça e do pescoço. Por meio desse atlas, denominado Objeto de Aprendizagem (AO), alunos e profissionais da saúde podem estudar a anatomia da estrutura da cabeça e do pescoço por meio de uma ferramenta interativa dotada de recursos de animação, o que fornece ao usuário a sensação de imersão.(AU)

This study investigates the use and the development of technological objects in the learning process related to human anatomy, especially the bones that make up the head. This research is motivated by determining whether this technology facilitates the learning process of a mainly visual content. The use and the application of interactive and immersive technological interfaces provide new study tools for professionals and students of health. As a result, users can rely on interactive study tools that offer the user a sense of immersion and a better understanding of the environment. This paper therefore focuses on the development of an interactive three-dimensional virtual atlas in order to study the anatomy of the head and the neck. With this atlas called Object Learning (AO), students and health professionals can study the anatomy of the head structure and the neck by an interactive tool complemented with animated features, which gives the user a sense of immersion.(AU)