Martwicze zapalenie tkanek twarzoczaszki (tzw. rak wodny)

Abstract Cancrum oris is a devastating opportunistic infection which destroys the tissues of the face. The risk factors are poverty, malnutrition, poor oral hygiene, diabetes, recent illness, alcohol abuse and smoking, low birth weight, Acquired Immune Deficiency Syndrome or other conditions with impaired immune system. Without appropriate treatment, the mortality rate from noma is 70–90% especially among children. It evolves from a necrotizing gingivostomatitis to widespread orofacial gangrene causing grotesque deformation. This is very rare but serious condition occurring mostly in Africa but single cases were reported worldwide. After healing the stadium of inflammation the patient require multiple reconstructive surgery. Microbiological etiology depends on area where patient got infected but mostly involves Fusobacterium necrophorum , Pseudomonas aeruginosa , Prevotella intermedia and Staphylococcus spp. The 32-year-old male was admitted to Internal Medicine Department in very bad condition, unconscious, feverish, in diabetic coma. After stabilization he was transferred to ENT Department in order to treat widespread inflammation of the face. In differential diagnostic procedure conditions such as cancer, Wegener syndrome, AIDS, actinomycosis and mycosis were excluded. Examination of culture showed growth of Pseudomonas aeruginosa , Escherichia coli and Proteus mirabilis . Despite of intensive treatment the inflammatory infiltration spreaded. The CT scans showed advanced inflammatory process in temporal region, cheek, eyelids, optic nerve, extraocular muscles and orbital cavity. The removal of the entire orbital contents was decided and proceeded together with ophthalmologists. After widespread surgical treatment of the orbital, sphenoidal, temporal, nasal, ethmoidal and maxillar region the inflammation was cured.