Cervicofacial necrotizing fasciitis: can we expect a favourable outcome?

Abstract

Necrotizing fasciitis of the head and neck is an uncommon, progressive, destructive soft tissue infection of mixed aerobic and anaerobic organisms, having high mortality if left untreated (22 to 100 per cent). This study makes an attempt to analyse various factors and management methods determining the overall prognosis.

A retrospective analysis of all cases of necrotizing fasciitis involving the head and neck, with exclusion of those involving the eyelid and the scalp, was undertaken. Various parameters such as demography, aetiology, complications, management and outcome were studied.

Males outnumbered the females with the latter having a greater risk of involvement after 60 years. Odontogenic infection was the primary source of infection. Anaerobes were cultured in seven out of 17 cases, with six others showing mixed Gram positive and Gram negative organisms. Anaemia was the most commonly associated illness, with diabetes affecting four out of 17 cases.Aggressive surgical debridement with triple antibiotic therapy was used in the management of necrotizing fasciitis with an overall mortality of 11.8 per cent. Patients having late referral, anaemia and one or other complication had increased duration of total hospital stay.

Better results can be obtained with proper control of infection by early diagnosis, aggressive surgical debridement and triple antibiotic therapy, along with timely control of complications and associated illnesses.