Necrotizing fasciitis of the head and neck: A report of two patients and review

Abstract

Necrotizing fasciitis is a disfiguring condition that can be fatal if not diagnosed in a timely fashion. Diagnosis and treatment require a high index of suspicion, immediate operative intervention, broad-spectrum antibiotics, and appropriate supportive care.

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

“…29 Presence of subcutaneous gas has been reported in 31%-64% of cases. Plain film X-ray, ultrasonography, and MRI scanning can be utilized but CT is particularly useful for detailed information delineating extent of disease, relationship with contiguous structures, and potentially the source of infection, to guide surgical intervention in an expedient manner.…”

“…Plain film X-ray, ultrasonography, and MRI scanning can be utilized but CT is particularly useful for detailed information delineating extent of disease, relationship with contiguous structures, and potentially the source of infection, to guide surgical intervention in an expedient manner. 29 Presence of subcutaneous gas has been reported in 31%-64% of cases. 30,31 Our analysis demonstrated 60.34% of plain radiographs and 56.8% of CTs to depict subcutaneous gas, indicating that, although pathognomonic for necrotizing fasciitis, gas is absent in approximately half of all patients and its absence cannot reliably or safely exclude the diagnosis.…”

Cervico‐facial necrotizing fasciitis

“…The necrotic fascia and fat are stripped from the muscle as a jelly like necrotic mass and sent for histology and deep anaerobic and aerobic cultures. Wound cultures and blood cultures are extremely important to direct antibiotic therapy (Chattar‐Cora et al , 2002) in the face of what is usually a polymicrobial infection. The muscle is usually healthy and bleeds readily but if involved, (usually by gas forming organisms) should also be debrided (Figure 7a–c).…”

Cervical necrotizing fasciitis of odontogenic origin: Case report

“…The pathogenic process can also induce local thrombosis which results in ischemic necrosis of overly ing structures such as the subcutaneous fascia and skin [23]. Penetration of antibiotic into ischemic and necrotic tissue is poor and thus antibiotic treatment of conditions such as NF is ineffective without surgery [24].…”