Craniofacial necrotizing fasciitis secondary to sinusitis

Abstract

Necrotizing fasciitis is a rare condition which usuallyaffects the trunk, perineum and limbs. Head and neck involvement is very uncommon and in most cases it is secondary to orbital or dental infection. We report a case of craniofacial necrotizing fasciitis (CNF) secondary to a maxillary sinusitis. The patient was treated intensively with antibiotics, surgical procedures and life-support measures.Despite all efforts, the patient died one week after admission. This case highlights early diagnosis and aggressive management as decisivefactors for the outcome of the patient.

Necrotizing Fasciitis of Face in Odontogenic Infection: A Rare Clinical Entity

“…[3][4][5][6][9][10][11][12] The term necrotizing fasciitis (NF) was first coined by Wilson in 1952. 3,6 NF is usually known to occur in the perineum, lower limbs or abdominal wall following surgery or trauma, particularly in individuals with underlying systemic diseases, such as diabetes mellitus, arteriosclerosis, chronic renal failure or malnutrition 1,3,4 NF may affect patients of all ages, without sex or race predilection.…”

“…The skin necrosis is secondary to thrombosis of the nutrient vessels passing through necrotic fascia. [1][2][3][4]11 The patient is acutely ill, with low to medium grade fever associated with tachycardia. All fascial planes of the head and neck can be involved in NF and may not be localized.…”

“…Avascularity of the fascial planes is probably the cause of their involvement and initially sparing the muscles and skin. 3,4 Bacterial necrotoxins might play a role in tissue damage. The hallmarks of NF are widespread fascial necrosis with extensive undermining and serosanguinous, often foul-smelling exudate.…”

“…2 Patients with immunocompromised status like diabetes mellitus, cancer, alcoholism, vascular insufficiencies, organ transplants, HIV or malnutrition are prone to this type of infection. 3,4 Organisms spread from the subcutaneous tissue along the superficial and deep fascial planes, presumably facilitated by bacterial enzymes and toxins. This deep infection causes vascular compression, ischemia and tissue necrosis.…”

Necrotizing Fasciitis Caused by Haemophilus influenzae Type b in an Elderly Patient

“…Mixed aerobic and anaerobic microorganisms or group A streptococci have generally been considered responsible for necrotizing fasciitis (13), and the condition is associated with substantial morbidity and mortality in the absence of aggressive surgical and antibiotic therapy (7). A review of the English literature revealed seven case reports of Haemophilus-associated necrotizing fasciitis (1, 3-5, 8,11,12). Among these cases of necrotizing fasciitis associated with H. influenzae, the first case was of lower limb necrotizing fasciitis caused by H. influenzae type b in a 13-month-old infant (3).…”