Diagnosis and Management of Necrotizing Fasciitis of the Head and Neck

Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature

“…32 In addition, multiple sets of blood cultures, wound swabs, and specimens are recommended, ideally before the initiation of empiric antibiotic therapy. 1,[34][35][36] As reflected in our analysis, the most commonly reported source of cervical necrotizing fasciitis is odontogenic (47.05%). Microorganisms are best identified when specimens are obtained from normal appearing tissue at the edge of the affected region and not the necrotic center.…”

“…1 Initial subcutaneous and fascial necrosis compromises penetrating vessels and involvement of the overlying skin and underlying muscle ensues. 1 Initial subcutaneous and fascial necrosis compromises penetrating vessels and involvement of the overlying skin and underlying muscle ensues.…”

Bilateral Dysfunction of Superior Laryngeal Nerves as a consequence of Cervical Necrotising Fasciitis: A case report

“…2 The infection process begins 48 hours after an initial insult. 8 Early clinical signs and symptoms are nonspecific. 4 Initially, there is Klinični primer/Case report a patchy,6 smooth,9 shiny10 erythema of the cervical skin, without sharp demarcation from uninvolved skin.9 It is accompanied by edema, crepitation, tenderness, pain on palpation2 and fever.6 The pain is more severe than expected,4 and may be felt deep in the muscles11, but the affected skin area may also be insensitive.12 Later on, the skin becomes dusky, covered with blisters and bullae and finally necrotises.…”

“…2 Laboratory tests show a very rapid rise of CRP values4 and leukocytosis with a left shift. 8 The CT scan of the neck and chest shows specific signs indicating the CNF and its extent, and offers anatomic information necessary for surgical planning.10 CT findings predicting CNF include diffuse thickening of the skin, subcutaneous tissues, fasciae and muscles, fluid and gas collections8,13 and fascial plane blunting or dissection. 1 The presence of gas within the soft tissues in the absence of previous surgery, radiotherapy14 or trauma is a pathognomonic sign.…”

“…If loose tissue planes, friable muscles,1 murky dishwater discharge, minimal resistance after finger insertion and no bleeding are found, the CNF is diagnosed. 8 Intravenous broad-spectrum antibiotics should be given in high doses. 4 Initially, an antibiotic effective against aerobic and anaerobic bacteria infection is prescribed.…”