[Gas gangrene of dental origin. Report on four cases (author's transl)].
Four patients developed diffuse cervicofacial cellulitis following an acute circumscribed infection of dental origin. Necrosis of skin, subcutaneous and muscle layers was associated with a severe generalised toxic infective syndrome, producing a clinical picture and following a course identical with that observed in gas gangrene of the limbs. Anaerobic germs, normally present in the buccodental region, were at the origin of the affection in all four cases, chronic dental lesions providing favourable anaerobic conditions for an increase in their virulence. Three factors appear to be of importance for the development of gas gangrene from dental abscesses: insufficient or lack of suitable surgical treatment, the use of antibiotics not active against anaerobic germs, treatment with corticoids or anti-inflammatory drugs. Once gas gangrene has developed, possible intramediastinal spread should be investigated. Treatment is essentially surgical (with excision of necrotic tissue and wide drainage), plus penicillin therapy and hyperbaric oxygen. The prophylaxis of these gas gangrene lesions is discussed.