Cervicofacial necrotizing fasciitis (original) (raw)
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Cervical necrotizing fasciitis: Report of 6 cases and review of literature
European Annals of Otorhinolaryngology, Head and Neck Diseases, 2014
Objective: Necrotizing fasciitis in the cervical region is a rare entity, characterized by a fulminant infection that causes extensive necrosis of the subcutaneous tissue and fascial planes, with high mortality and morbidity rates. The origin is generally odontogenic or pharyngeal, involving a mixed flora of microorganisms. Descending infection and mediastinal involvement are usually associated and are the main complications. The aim of the present study was to review the cases treated in our department and analyze diagnosis and treatment, supplementing the understanding of the disease. Methods: A retrospective study was performed on the clinical records of patients admitted to our center between January 2005 and June 2010 with diagnosis of necrotizing cervical fasciitis. Results: Six clinical records were reviewed. The origin of the infection was mainly oropharyngeal and odontogenic, with a mixed flora of Prevotella, Peptostreptococcus and coagulase-negative Staphylococcus. All patients presented mediastinal involvement: superior mediastinitis in 4 patients and superior and postero-inferior mediastinitis in 2 cases. All patients underwent early drainage by bilateral cervicotomy with mediastinal drainage by a cervical approach in those with superior mediastinal affection, and associated thoracotomy, in a single surgical step, for postero-inferior mediastinitis. Temporary tracheotomy was performed in all cases. All received broad spectrum antibiotics, with a medium hospital stay of 37 days. There were no deaths reported. Conclusion: Concerning cervical necrotizing fasciitis, early diagnosis and surgical treatment associated to antibiotics and intensive medical care are essential to obtain a favorable outcome.
Cervical Necrotizing Fasciitis: An Uncommon Fulminant Disease Entity
Annals of International Medical and Dental Research, 2022
Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.
Cervical necrotizing fasciitis caused by dental infection: A review and case report
Necrotizing fasciitis of the head and neck is an uncommon, potentially fatal , soft tissue infection characterized by extensive necrosis and gas formation in the subcutaneous tissue and fascia. The purpose of this report is to heighten the awareness of this infection. The article also outlines an appropriate management strategy for use in the treatment of these patients and reviews the literature along with a report of a case which was successfully managed.
Cervical necrotizing fasciitis
European Archives of Oto-Rhino-Laryngology, 1999
Cervical necrotizing fasciitis is an unusual encounter in the general surgical practice, but is a life-threatening condition requiring early recognition and adequate surgical treatment. We present the case of a 65 year old male patient referred to our department from a General Hospital. Large excisions of both superficial and deep cervical fascia were required together with necrotic skin on a very large surface. Rapid recovery with early sterilization allowed adequate skin grafting with good results. We advocate for aggressive debridment with excision in viable healthy tissue, with no concern for the future reconstruction followe by early grafting of the skin defect.
Odontogenic cervical necrotizing fasciitis
Annals of Emergency Medicine, 1990
Necrotizing fasciitis is a severe soft-tissue infection characterized by diffuse necrosis of fascia and subcutaneous tissue; initially, skin and muscle are usually spared. The trunk, abdomen, perineum, and extremities are the most commorily, involved areas. The case of a 55-year-old man with a cervical necrotizing fasciitis from an infected tooth is presented. The medical history, etiology, anatomy, precipitating factors, clinical presentation, and therapy of this infection are discussed. Early recognition allows effective therapy with aggressive surgical intervention, broad-spectrum antibiotics, and supportive care. Misdiagnosis (eg, as cellulitis) and delayed surgical treatment can result in severe systemic toxicity and a mortality rate that approaches 40%.
Ear, Nose & Throat Journal, 2010
We conducted a retrospective review of 11 cases of adult cervical necrotizing fasciitis that were treated at our institution over a period of 5-plus years. The most common etiology was a dental infection, which was seen in 7 of the 11 patients (64%). Most cultures were sterile because all of these patients had been referred to us after they had already been treated elsewhere with intravenous antibiotics and without surgical intervention. Under our management, patients spent an average of 21.6 days in the hospital, and they underwent an average of 1.6 debridements under general anesthesia. Aggressive wound care, broad-spectrum antibiotic therapy, and timely surgical intervention resulted in an overall survival rate of 91% (10/11), including a 75% survival (3/4) for patients with thoracic extension.
Revista Española de Cirugía Oral y Maxilofacial (English Edition), 2016
To review the clinical experience, management and outcome of cervicofacial necrotizing fasciitis (CNF) in patients treated in our institution. Methods: A retrospective review of patients with CNF from two large health care institutions completed over a 10-year period. Results: Five patients with complete data were identified. CNF was polymicrobial in 4 and monomicrobial in one patient and occurred as a result of odontogenic infection in 3, trauma in 1, and was idiopathic in one patient. All patients were treated with extensive debridement, broad spectrum antibiotics, and reconstruction with flaps. There was one death. Conclusions: Early diagnosis and rapid aggressive debridement are key elements for reducing mortality and optimizing the cosmetic and functional outcome in patients with CNF.
European Journal of Plastic Surgery, 2014
Necrotizing fasciitis is a potentially fatal soft tissue infection characterized by generalized necrosis and gas formation in the subcutaneous tissues and fascia. It is rarely seen in the head and neck area. This report presents the case of a 62year-old diabetic female patient with generalized cervicofacial necrotizing fasciitis extending to the front chest wall. The cause of the disease was the extraction of the infected second molar tooth. Debridement was performed on the generalized necrotic fascia, subcutaneous tissue, and the skin extending from the preauricular area to the front chest wall and nipples. A series of debridement procedures were necessary because of generalized necrosis. The patient received intensive medical supportive treatment. Following the debridement procedures, the defective area from the neck to the front chest wall was closed up with split-thickness skin graft. Abscessed tooth extraction can lead to cervicofacial necrotizing fasciitis. Necrotizing fasciitis still remains as a potentially fatal disease. Early diagnosis, early radical surgical debridement, and a multidisciplinary approach constitute the significant factors in preventing mortality in such patients. Level of Evidence: Level V, therapeutic study Keywords Tooth extraction. Necrotizing fasciitis. Head and neck. Anterior chest wall