Cervical necrotizing fasciitis: management challenges in poor resource environment

Abstract

Necrotizing fasciitis of the head and neck is a rare and potentially fatal disease. It is a bacterial infection characterized by spreading along fascia planes and subcutaneous tissue resulting in tissue necrosis and likely death. It is commonly of dental or pharyngeal origin. Factors affecting the success of the treatment are early diagnosis, appropriate antibiotics and surgical debridement. Our study showed eight patients, five males and three females with mean age of 49.25 years (range 20-71 years). Clinical presentations were a rapidly progressing painful neck swelling, fever, dysphagia and trismus. The aetiology varied from idiopathic, pharyngeal/tonsillar infection, trauma and nasal malignancy. There were associated variable comorbidities (diabetes mellitus, HIV infection, hypertension and congestive cardiac failure). All the patients received early and aggressive medical treatment. The earliest time of surgery was 12 h after admission because of the poor financial status of patients. Three cases came in with complications of the disease and were not fit for extensive debridement under general anaesthesia. For them limited and reasonable bed side debridement was done. Mortality was 50 % from multiple organ failure, HIV encephalopathy, aspiration pneumonitis and septicemia. The duration of hospital stay for the patients that died ranged from 1 to 16 days and 4 to 34 days for the survivor. Our study heightens awareness and outlines the management challenges of necrotizing fasciitis of the head and neck in a poor resource setting.

Complications of dental infections due to diagnostic delay during COVID-19 pandemic

“…It is usually more common in immunocompromised patients and in the abdomen, perineum and extremities 17. Although only 1 case with dental infection ends with necrotizing fasciitis per year, 4 out of 1000 necrotising fasciitis cases worldwide are caused by neck infections 18 19. Untreated infection of second and third molar teeth easily spread into the submandibular space and then into the sublingual, submental and parapharyngeal spaces.…”

An adjuvant therapy in cervical necrotising fasciitis: hyperbaric oxygen treatment

“…In literature, odontogenic causes have been shown to be the most common source [10][11][12]. Necrotising fasciitis morbidity and mortality are high in comorbidities [13].…”

Odontogenic cervical necrotizing fasciitis with descending mediastinitis: a case report and discussion

“…1,4,14 These may occur together with anaerobes as well as gram negative bacteria especially in diabetic patients. 5,15 Fungal co-infection in DNM is less common and has only been described twice, one which occurred primarily as a deep neck space infection and another that developed from a surgical site infection after total thyroidectomy. 16,17 Empirical antibiotics for necrotising fasciitis (regardless of location) in our institution includes penicillin G, vancomycin and clindamycin which was adequate to treat the bacteria isolated from initial cultures but repeated cultures should be routinely taken to check for other pathogens and secondary infections.…”