A Clinical Study of the Cervical Necrotizing Fasciitis

Yang, Yoon Soo; Lee, Hwa Uk; Kim, Jin Seong; Lee, Jai Keun; Hong, Ki Hwan

Abstract

BACKGROUND AND OBJECTIVES
To clarify the presenting signs and symptoms, clinical course, pathologic organisms, and management of cervical necrotizing fasciitis. SUBJECTS AND METHOD: We retrospectively reviewed the inpatient charts treated at our ENT department for cervical necrotizing fasciitis. Seven such patients were identified as having been treated from January 2002 to December 2004. RESULTS: During the 36-months period, 7 adults consisting of 5 males and 2 females with cervical necrotizing fasciitis were diagnosed and treated. The mean age was 45 years ranging from 25 to 59 years. All patients had infections in more than five fascial spaces. The most commonly involved sites of infection were the superficial neck space (100%), followed by submandibular (85.7%), and parapharyngeal and submental space (57.1%). The most commonly known associated preceding illness were tonsillitis and dental abscess (28.5%). Painful neck swelling and difficulty in moving the neck were the most frequent symptoms and signs. The most common pathogen was Streptococcus species (4/7), followed by Staphylococcus epidermidis and Klebsiella pneumoniae (1/6). The mean duration of hospitalization was 17.2 days (range, 8-24). Leukocytosis (WBC>10000/mm3) was found in all patients. All patients received parenteral antibiotics and surgical drainage after admission. Six patients recovered and one patient died after surgical drainage. Tacheotomy was performed on five patients. CONCLUSION: Cervical necrotizing facilitis is an uncommon but often fatal bacterial infection of the skin, subcutaneous fat, superficial fascia, and deep fascia. It is characterized by marked tissue edema, rapid spread of inflammation, and signs of systemic toxicity. High index of suspicion, prompt aggressive surgery, appropriate antibiotics, and supportive care are the mainstays of management.