Mediastinal and thoracic complications of necrotizing fasciitis of the head and neck

Lalwani, Anil K.; Kaplan, Michael

doi:10.1002/hed.2880130610

Cited by 71 publications

(63 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several adjuvant studies have been used as an aid in detecting the condition, e.g., radiographic study, CT scanning, isotope scanning and frozen section biopsy. 1,7,10,20 Gas in soft tissue, which was disclosed in one of our cases, is highly suggestive but not pathognomonic. 3,6,8,11 Diagnosis of our first case was delayed because of initial unawareness of the disease, and misinterpretation of the obvious clinical picture.…”

Section: Discussionmentioning

confidence: 47%

“…Kronish and McLeish in 1991 found 16 cases of NF reported involving periorbita and face, 26 and several other reports followed this. 14,15,27,28 In the majority of NF cases involving the neck, the disease follows dental or oropharyngeal infection, [1][2][3]12,18,20,22,23,25 whereas in the cases of scalp or face involvement, there is mostly a previous trauma that might be minor. 2,3,14,15,[26][27][28][29][30] The first two cases described here had obvious cause, while the cause of the third one was unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The local and systemic complications of NF are numerous and include extension to the cervical viscera and mediastinum, vessel erosion and functional and cosmetic disfiguring. 1,3,20 Death from necrotizing fasciitis is usually due to overwhelming sepsis, respiratory failure, renal failure or multiorgan failure. 3,6,7,11,12,28 The mortality rate ranges between 8% and 73%.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Necrotizing Fasciitis of the Head and Neck: Report of Three Cases

Ali

Zayed

1997

Ann Saudi Med

View full text Add to dashboard Cite

MH Ali, ME Zayed, Necrotizing Fasciitis of the Head and Neck: Report of Three Cases. 1997; 17(6): 641-645 Necrotizing fasciitis (NF) is a rare but life-threatening multimicrobial soft tissue infection characterized by progressive, usually rapid, necrotizing process of the subcutaneous tissues and fascial planes, with resulting skin gangrene and systemic toxicity.1-6 The condition, commonly described in the extremities, abdominal wall and perineum, is rarely seen in the head and neck. 1,7 Because of the fulminant course of NF, early diagnosis is imperative. Broad spectrum antibiotics, aggressive surgical treatment and supportive therapy are the cornerstones of successful treatment. [5][6][7] The diagnosis of NF depends mainly on clinical features which are not always obvious, while a high index of suspicion is needed. Unfortunately, the disease is often diagnosed late in its course, resulting in high mortality. 6,8 We describe three cases of necrotizing fasciitis of the head and neck, arising from different origins with different courses and outcomes. To the best of our knowledge, there are no previous reported cases from Saudi Arabia. Case 1A 34-year-old insulin-dependent diabetic female patient presented to the emergency room complaining of right mandibular dental pain, associated with a tender right-sided neck swelling. The past medical history was significant for a positive serologic test for hepatitis B and a long-standing right heel ulcer. She was oriented and alert. The head and neck examination showed a diffuse, tender, nonfluctuant swelling of the right submandibular area. Oral examination revealed a painful carious right second mandibular molar. The rest of the examination was essentially normal. The vital signs were as follows: temperature 37.5°C, pulse rate 86 beats/min, blood pressure 110/70 mm Hg and respiratory rate 20/min. The abnormal blood tests were leucocytosis of 18,100/μL and glucose of 15.1 mm/L (271.8 mg/100 mL). Panoramic orthopantomogram revealed a radiolucency at the root of the right mandibular second molar. The patient was admitted to the ENT service with diagnosis of a right submandibular space abscess secondary to dental infection. However, needle aspiration and ultrasonography of the involved area were negative. The patient was started on intravenous antibiotics (metronidazol 500 mg tid, gentamycin 80 mg tid and Velosef 1 g qid). Blood glucose was controlled on subcutaneous insulin according to a sliding scale. On the second day of admission, the carious molar was extracted under local anesthesia. The patient's condition deteriorated over the next two days. The temperature and the leucocytic count increased to 40.2°C and 64,700/μL respectively. Subsequently, the patient developed breathing difficulty. The swelling was spreading to involve the neck regions bilaterally with severe tenderness and crepitation. On the fifth day of admission, the right submandibular area was explored through a transverse incision under general anesthesia. A foul-smelling brownish fluid was found. A sa...

show abstract

Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Necrotizing Fasciitis of the Head and Neck: Report of Three Cases

Ali

Zayed

1997

Ann Saudi Med

View full text Add to dashboard Cite

show abstract

“…Until now, there has been no specific diagnostic method for NF. Several adjuvant studies have been useful as an aid in detecting the condition, e.g., radiographic study, CT scanning, isotope scanning and frozen section biopsy [8]. Gas in soft tissue as seen in our patient is highly suggestive but not pathognomonic [1][2][3].…”

Section: Discussionmentioning

confidence: 98%

Necrotizing Fasciitis: An Unusual Presentation

Sasindran

Joseph

2011

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

Necrotizing fasciitis (NF) is rare but life threatening multimicrobial soft tissue infection characterized by progressive, usually rapid, necrotizing process of the subcutaneous tissues and fascial planes, with resulting skin gangrene and systemic toxicity. The groin, abdomen and extremities are the most frequent sites involved by this disease and it is rarely seen in the head and neck region. NF of the head and neck region has a potentially high morbidity and mortality. Delay in diagnosis leads to poor outcome. Hence early recognition and aggressive management is imperative for successful outcome. Here we present a case of acute onset of cervical necrotizing fasciitis in a young male.Keyword Necrotizing fasciitis Á Soft tissue infections Á Diabetes mellitus Case ReportA 33-year old male presented to the emergency room complaining of painful neck swelling with difficulty in breathing. Patient was apparently alright the previous night and noticed the swelling during the early morning hours. The cervical swelling increased over the next few hours and was brought to the hospital by noon. Patient did not have any associated history of throat pain, trauma, or tooth ache. He was a normotensive and not a diabetic, had family history of diabetes. Examination showed a diffuse swelling of submental and submandibular region with edema of the floor of the mouth with trismus. The skin over the swelling was erythematous, tender and the swelling was fluctuant. Provisionally a diagnosis of Ludwig's angina with submandibular abscess was made. Patient had difficulty in breathing on lying down. A X-ray neck lateral view done else where showed evidence of airway obstruction (Fig. 1). Patient was shifted for CT scan and developed stridor on table. Hence he was immediately rushed to the theatre and an emergency tracheostomy was done. A low tracheostomy was done as none of the landmarks in the neck could be identified (Fig. 2).It was decided to explore the neck on table. A transverse incision was made over the submental region. The whole subcutaneous fat and partly the muscles were found to be necrosed (Fig. 3) and it was foul smelling. A brownish fluid oozed out of the muscle planes and there was no evidence of pus in the submental or submandibular space. Deep cervical fascia was found to be necrosed and the debrided tissues were sent for histopathological examination. Similarly the parapharyngeal spaces were explored on either sides through a separate vertical incision along the sternocleiodomastoid to look for any abscess formation. Necrosed subcutaneous fat from these areas were debrided and a swab was sent for culture sensitivity from these necrosed areas. A dental examination was also done in the same sitting to look for any dental foci. However the oral cavity and oropharynx were normal except for edematous floor of the mouth. The explored areas were left open and antibiotic dressings applied. Blood report showed leukocytosis. His random sugar levels were 350 mg/dl. Glycosylated haemoglobin was 9.5. Patient was started...

show abstract

“…Necrotizing fasciitis of the chest wall is a rare disease that usually takes place as a complication of surgical procedures in the cervical region, spreading downward to the anterior chest wall, pericardium, and even the deep mediastinal structures 1 . Reports in the medical literature are very plentiful regarding necrotizing fasciitis occurring in other topographic body areas but otherwise scarce when focusing primarily on the thoracic incidence and management.…”

mentioning

confidence: 99%

Postoperative necrotizing fasciitis of the thorax in cardiac surgery

Filho¹,

Drews²,

Blacher³

et al. 2001

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Necrotizing fasciitis of the chest wall is a rare disease that usually takes place as a complication of surgical procedures in the cervical region, spreading downward to the anterior chest wall, pericardium, and even the deep mediastinal structures 1 . Reports in the medical literature are very plentiful regarding necrotizing fasciitis occurring in other topographic body areas but otherwise scarce when focusing primarily on the thoracic incidence and management. Although the general therapeutic strategies used in necrotizing fasciitis are also applied to thoracic fasciitis, some special features exist that should be emphasized when dealing with thoracic necrotizing infections, beyond the unique postoperative issues involving either an intra-or extra-cardiac implanted prosthesis. The differential diagnosis between necrotizing fasciitis and non-necrotizing soft tissue infections should be a priority, as they present different prognostic and therapeutic implications 2 . In this brief communication, we focus on a literature review regarding concepts, pathophysiology, and treatment of necrotizing fasciitis and report and discuss a rare case of anterior chest wall necrotizing fasciitis as a complication of cardiac surgery. To our knowledge, no such cases have been reported in the medical literature. Case ReportThe patient is a 38-year-old male with Marfan's Syndrome, who presented with a huge aneurysm of the ascending aorta (8 cm in diameter), severe aortic valve regurgitation, and severe left ventricular dysfunction. His previous medical history included septic shock as a complication in the postoperative period of an orthopedic procedure to the left ankle due to a traumatic fracture. At present, the surgical procedure was an aortoplasty with a composite Dacron and bovine pericardium graft (Labcor Laboratórios Belo Horizonte -Brazil), in which a double leaflet mechanical aortic prosthesis was attached Carbomedics Inc., USA, and coronary ostia reimplantation was performed. The immediate evolution included persistent fever and inflammatory signs at the upper and lower incision limits, with a yellowish discharge. Computerized tomography of the thorax and mediastinum showed a viscid pus-like collection around the aortic graft suggestive of mediastinitis. The sternum was stable. Incision and drainage of 2 incisional abscesses were performed. The infectious process spread through the neighboring tissues with formation of small abscesses, frankly purulent discharge, cellulites, and skin necrosis (Fig. 1). The first wide debridement, with resection of all apparently necrotic tissues, was performed, but soon we realized that it was ineffective (Fig. 2). Septic shock and local crepitus were established, and the diagnosis of necrotizing fasciitis of

show abstract

Mediastinal and thoracic complications of necrotizing fasciitis of the head and neck

Cited by 71 publications

References 29 publications

Necrotizing Fasciitis of the Head and Neck: Report of Three Cases

Necrotizing Fasciitis of the Head and Neck: Report of Three Cases

Necrotizing Fasciitis: An Unusual Presentation

Postoperative necrotizing fasciitis of the thorax in cardiac surgery

Contact Info

Product

Resources

About