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Pupić-Bakrač J, Pupić-Bakrač A, Matoc L, Kos B. Wide exposure VS. stab surgical incisions in necrotizing fasciitis of the head and neck: a retrospective analysis of 22 cases. Eur Arch Otorhinolaryngol 2025; 282:519-528. [PMID: 39367224 DOI: 10.1007/s00405-024-09015-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 09/26/2024] [Indexed: 10/06/2024]
Abstract
PURPOSE Necrotizing fasciitis of the head and neck is a rare, rapidly progressing bacterial infection with high mortality. Traditional surgical management involves wide exposure incisions, but minimally invasive stab incisions have emerged as a potential alternative. This study aimed to compare outcomes between wide exposure and stab surgical incisions in the management of head and neck necrotizing fasciitis. MATERIALS AND METHODS A retrospective analysis was conducted on 22 patients treated for necrotizing fasciitis of the head and neck between January 2006 and January 2023. Patients were divided into two groups based on the surgical approach: wide exposure incisions (N = 15) and stab surgical incisions (N = 7). Data on mortality, hospital stay, hypertrophic scarring, neck contractures, and tracheostomy tube dependence were collected. RESULTS The overall mortality rate was 9.1%, with 6.7% in the wide exposure group and 14.3% in the stab surgical incision group (p > 0.05). Hypertrophic scarring occurred in 59.1% of patients, all of whom underwent wide exposure incisions. Neck contractures were observed in 9.1% of cases, also in the wide exposure group. Tracheostomy was performed in 63.6% of patients, with successful decannulation achieved in 91.7%. The median hospital stay was longer in the stab surgical incision group (p < 0.05), partly due to the need for revision surgeries. CONCLUSION Wide exposure incisions remain the standard treatment for necrotizing fasciitis of the head and neck due to their effectiveness in managing extensive tissue necrosis. However, stab surgical incisions offer the advantage of reduced morbidity and functional impairment. These benefits are offset by a slightly higher mortality rate and the potential need for additional interventions. Stab incisions may be a viable option in carefully selected patients, particularly those without extensive comorbidities or advanced disease.
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Affiliation(s)
- Jure Pupić-Bakrač
- Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Boze Pericica 5, Zadar, 23 000, Croatia.
| | - Ana Pupić-Bakrač
- Department of Ophthalmology, Dubrava University Hospital, Avenija Gojka Suska 6, Zagreb, 10 000, Croatia
| | - Lovro Matoc
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Boris Kos
- Department of Maxillofacial Surgery, University of Zagreb School of Medicine, Dubrava University Hospital, Avenue Gojka Suska 6, Zagreb, 10000, Croatia
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Khalil B, Borghol I, Chaurasia A. Atypical presentation of polymicrobial cervicofacial necrotizing fasciitis: An extraordinary odontogenic infection in a healthy female patient. Clin Case Rep 2024; 12:e9382. [PMID: 39206071 PMCID: PMC11349817 DOI: 10.1002/ccr3.9382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/28/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
Cervicofacial necrotizing fasciitis (CNF) can occur as a dental complication in young, healthy individuals. Early diagnosis, treatment, and awareness of severe acute cervicofacial pain, rapid swelling, and radiological gas formation are crucial. Broad molecular profiling is recommended for understanding the organisms involved in such infections in future research.
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Affiliation(s)
- Basel Khalil
- Division of Periodontology and Implant Dentistry, Faculty of DentistryThe University of Hong Kong, Prince Philip Dental HospitalHong KongSARChina
- Department of Dental Medicine, Division of Oral Diagnostics and RehabilitationKarolinska InstituteHuddingeSweden
| | - Ibrahim Borghol
- Department of Oral and Maxillofacial SurgeryFalun HospitalFalunDalarna RegionSweden
| | - Akhilanand Chaurasia
- Department of Oral Medicine & Radiology, King George's Medical UniversityLucknowIndia
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Hansen SUB, Jespersen FVB, Markvart M, Hyldegaard O, Plaschke CC, Bjarnsholt T, Nielsen CH, Jensen SS. Characterization of patients with odontogenic necrotizing soft tissue infections in the head and neck area. A retrospective analysis. Acta Odontol Scand 2024; 82:40-47. [PMID: 37688516 DOI: 10.1080/00016357.2023.2254389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/13/2023] [Accepted: 08/27/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE Necrotizing soft-tissue infection (NSTI) in the head and neck area may develop from odontogenic infections. The aim of this study was to characterize patients with NSTI in the head and neck with odontogenic origin in a well-defined prospectively collected cohort. MATERIAL AND METHODS Patients with NSTI in the head and neck, hospitalized between 2013 and 2017 at Copenhagen University Hospital and registered in the Scandinavian INFECT database were included. Medical records of identified patients and from the INFECT database were screened for a defined set of data including the primary focus of infection, comorbidities, predisposing factors, clinical and radiographic diagnostics, course of treatment, and treatment outcome. RESULTS Thirty-five patients with NSTI in the head and neck area were included in the study. A total of 54% had odontogenic origin, primarily from mandibular molars, and 94% had radiographic signs of infectious oral conditions. Overall, comorbidities were reported in 51% with cardiovascular disease being the most prevalent. In 20%, no comorbidities or predisposing conditions could be identified. The overall 30-day mortality rate was 9%. CONCLUSIONS More than half of NSTI cases in the head and neck region had an odontogenic origin, and special attention should be paid to infections related to mandibular molars.
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Affiliation(s)
| | | | - Merete Markvart
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Ole Hyldegaard
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Caroline Plaschke
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - Claus Henrik Nielsen
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
- Institute for Inflammation Research, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simon Storgård Jensen
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
- Deparment of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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Rapoport NA, Lee DS, Lee JJ, Puram SV, Jackson RS, Pipkorn P. Eight Tales of Cervical Necrotizing Fasciitis and Free Tissue Transfer. Ann Otol Rhinol Laryngol 2023; 132:226-232. [PMID: 35373592 PMCID: PMC9526756 DOI: 10.1177/00034894221088179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Aggressive surgical debridement is required in cervical necrotizing fasciitis, and in severe defects, subsequent free tissue transfer might be necessary. However, there is concern that the inflammatory environment of the infection site may threaten free flap viability, particularly with concerns for thrombosis of feeding vessels and compromised tissue integration. Cases in the head and neck area are rare, so there are limited data regarding outcomes of free tissue transfer in these patients. METHODS A retrospective chart review assessed patients with cervical necrotizing fasciitis treated at an academic tertiary hospital between 2015 and 2021. Twenty-five patients were identified, and eight required free tissue transfer after adequate surgical debridement. Treatment, hospital course, and demographic data were collected on these eight patients. RESULTS All flaps had full survival at follow up (median follow up 3 months, range 1-39 months) without concerns for vascular compromise. CONCLUSION These data suggest that in patients with large soft tissue defects due to cervical necrotizing fasciitis, free tissue transfer may be a safe treatment modality.
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Affiliation(s)
- Nicholas A. Rapoport
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave. Campus Box 8115, St. Louis, MO 63110
| | - David S. Lee
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave. Campus Box 8115, St. Louis, MO 63110
| | - Jake J. Lee
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave. Campus Box 8115, St. Louis, MO 63110
| | - Sidharth V. Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave. Campus Box 8115, St. Louis, MO 63110
| | - Ryan S. Jackson
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave. Campus Box 8115, St. Louis, MO 63110
| | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave. Campus Box 8115, St. Louis, MO 63110
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Lee DW, Kwak SH, Choi HJ. Secondary craniofacial necrotizing fasciitis from a distant septic emboli: A case report. World J Clin Cases 2022; 10:11630-11637. [PMID: 36387813 PMCID: PMC9649572 DOI: 10.12998/wjcc.v10.i31.11630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 09/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Craniofacial necrotizing fasciitis (CNF) is an uncommon but fatal infection that can spread rapidly through the subfascial planes in the head and neck region. Symptoms usually progress rapidly, and early management is necessary to optimize outcomes.
CASE SUMMARY A 43-year-old man visited our hospital with left hemifacial swelling involving the buccal and submandibular areas. The patient had fever for approximately 10 d before visiting the hospital, but did not report any other systemic symptoms. Computed tomography scan demonstrated an abscess with gas formation. After surgical drainage of the facial abscess, the patient’s systemic condition worsened and progressed to septic shock. Further examination revealed pulmonary and renal abscesses. Renal percutaneous catheter drainage was performed at the renal abscess site, which caused improvement of symptoms. The patient showed no evidence of systemic complications during the 4-mo post-operative follow-up period.
CONCLUSION As the patient did not improve with conventional CNF treatment and symptoms only resolved after controlling the infection, the final diagnosis was secondary CNF with septic emboli. Aggressive surgical decompression is important for CNF management. However, if symptoms worsen despite early diagnosis and management, such as pus drainage and surgical intervention, clinicians should consider the possibility of a secondary abscess from internal organs.
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Affiliation(s)
- Da-Woon Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Si-Hyun Kwak
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Hwan-Jun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
- Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
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Pantos P, Chrysovitsiotis G, Kyrodimos E, Chrysovergis A. Cervical necrotising fasciitis presenting with mild symptoms. BMJ Case Rep 2021; 14:e241925. [PMID: 33664046 PMCID: PMC7934753 DOI: 10.1136/bcr-2021-241925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pavlos Pantos
- 1st Otorhinolaryngology Dpt, National and Kapodistrian University of Athens School of Medicine, Athens, Attiki, Greece
| | - Georgios Chrysovitsiotis
- 1st Otorhinolaryngology Dpt, National and Kapodistrian University of Athens School of Medicine, Athens, Attiki, Greece
| | - Efthymios Kyrodimos
- 1st Otorhinolaryngology Dpt, National and Kapodistrian University of Athens School of Medicine, Athens, Attiki, Greece
| | - Aristeidis Chrysovergis
- 1st Otorhinolaryngology Dpt, National and Kapodistrian University of Athens School of Medicine, Athens, Attiki, Greece
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Sideris G, Nikolopoulos T, Delides A. Cervical necrotizing fasciitis affects only immunocompromized patients? Diagnostic challenges, treatment outcomes and clinical management of eleven immunocompetent adult patients with a still fatal disease. Am J Otolaryngol 2020; 41:102613. [PMID: 32599441 DOI: 10.1016/j.amjoto.2020.102613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Cervical Necrotizing fasciitis (CNF) has been reported as an unusual rapidly progressive, life-threatening, inflammatory disease that is known to affect predominately immunocompromised patients. Few case reports have been sporadically published involving immunocompetent adults. This is the first study presents a series of immunocompetent CNF patients. MATERIALS AND METHODS A retrospective chart review study was performed on immunocompetent adults with CNF from January 2003 to December 2019. The diagnosis was histologically confirmed. We analyzed epidemiological, clinical, laboratory and imaging findings and discussed them along with the treatment plan. RESULTS A total of eleven adult patients were included in the study. The average age was 43 years, ranging from 17 to 62 years. The average hospitalization time was 28 days, ranging from 10 to 129 days. All patients presented with cervical erythema and odynophagia. The causative factors are known in nine patients. Tissue cultures demonstrated mixed flora in six patients. Seven underwent a temporary tracheostomy. Wide neck exploration incisions were performed in all patients as the diagnosis was established after imaging findings. In nine cases the anterior-upper mediastinum was affected but only in two patients extension of the surgical planes to the mediastinum was performed. Four patients developed polyserositis. Nine patients survived and two developed multiorgan failure and died. CONCLUSION There seem to be no differences between immunocompetent and immunocompromised CNF patients, in regards to clinical, imaging and laboratory findings as well as their treatment plan.
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Affiliation(s)
- Giorgos Sideris
- National & Kapodistrian University of Athens, School of Medicine, 2nd Otolaryngology Department, "Attikon" University Hospital, Athens, Greece.
| | - Thomas Nikolopoulos
- National & Kapodistrian University of Athens, School of Medicine, 2nd Otolaryngology Department, "Attikon" University Hospital, Athens, Greece
| | - Alexander Delides
- National & Kapodistrian University of Athens, School of Medicine, 2nd Otolaryngology Department, "Attikon" University Hospital, Athens, Greece
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Kim HS, Chang YJ, Chung CH. Klebsiella pneumoniae necrotizing fasciitis on the upper lip in a patient with uncontrolled diabetes. Arch Craniofac Surg 2020; 21:127-131. [PMID: 32380815 PMCID: PMC7206462 DOI: 10.7181/acfs.2019.00696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/31/2020] [Indexed: 01/04/2023] Open
Abstract
A 60-year-old woman with a history of diabetes mellitus and chronic renal failure was admitted to the hospital with severe pain in the upper lip, which began 4 days prior to admission, accompanied by a bullous lesion and suspected cellulitis in the upper lip. Immediately after admission, as the patient´s general condition worsened, tests revealed a non-ST elevated myocardial infarction, septic embolism of the lung, as well as septic shock. Her upper lip suddenly presented a gangrenous and necrotic change, which the tissue and blood culture confirmed to be a Klebsiella pneumoniae infection. After a quick response, the patient’s general condition improved. Subsequently, serial debridement was performed to effectively clear away the purulent discharge. While under general anesthesia, the process confirmed full-layer necrosis of the upper lip including the orbicularis oris muscle. Almost half of the entire upper lip sustained a full-layer skin and soft tissue defect, with scar contracture. Six months later, to correct the drooling and lip sealing following the defects, a scar release and an Abbe flap coverage were performed considering both functional and aesthetic aspects. The follow-up revealed a favorable corrective result of the upper lip drooling, and the patient was satisfied from a functional perspective.
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Affiliation(s)
- Hyeong Seop Kim
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Yong Joon Chang
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chul Hoon Chung
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
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9
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Shin J, Park SI, Cho JT, Jung SN, Byeon J, Seo BF. Necrotizing fasciitis of the masticator space with osteomyelitis of the mandible in an edentulous patient. Arch Craniofac Surg 2019; 20:270-273. [PMID: 31462021 PMCID: PMC6715550 DOI: 10.7181/acfs.2019.00311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/11/2019] [Indexed: 11/11/2022] Open
Abstract
Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the subcutaneous tissue and fascia, caused by bacterial infection. Usually presenting in the extremities, trunk, or perineum, it is uncommon in the craniofacial or cervical area. Cervicofacial NF is a potentially fatal infection, which should be managed with early detection and intervention. Most cases have a primary odontogenic source of infection, especially when the masticator space is involved. We report a case of masticator space NF that developed without odontogenic origin in a 78-year old female who was treated with prompt surgical drainage and intravenous antibiotics.
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Affiliation(s)
- Jongweon Shin
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Song I Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Tae Cho
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-No Jung
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junhee Byeon
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bommie Florence Seo
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Gunaratne DA, Tseros EA, Hasan Z, Kudpaje AS, Suruliraj A, Smith MC, Riffat F, Palme CE. Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature. Head Neck 2018; 40:2094-2102. [PMID: 29934952 DOI: 10.1002/hed.25184] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/14/2018] [Accepted: 02/20/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. METHODS A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis." RESULTS There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. CONCLUSION Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.
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Affiliation(s)
- Dakshika A Gunaratne
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Evan A Tseros
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Zubair Hasan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Akshay S Kudpaje
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Anand Suruliraj
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia
| | - Mark C Smith
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten E Palme
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.,Crown Princess Mary Cancer Centre, Westmead Hospital, Australia.,Macquarie University Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
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11
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Cervical Necrotizing Fasciitis of Odontogenic Origin and Hyperbaric Oxygen Therapy. J Craniofac Surg 2018; 28:e691-e692. [PMID: 28857997 DOI: 10.1097/scs.0000000000003842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Necrotizing fasciitis (NF) is an infection of the soft tissues pathology with high mortality that spreads through the fascial planes and rarely seen in head and neck region. The cause of infection is often odontogenic problems. Broad-spectrum antibiotics, surgical debridement, and hyperbaric oxygen therapy (HBO) are important for the treatment of disease. We report a case of cervical NF in a 33-year-old woman who was treated with rapid surgical debridement and simultaneous HBO.
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Bayetto K, Cheng A, Sambrook P. Necrotizing fasciitis as a complication of odontogenic infection: a review of management and case series. Aust Dent J 2017; 62:317-322. [PMID: 28241379 DOI: 10.1111/adj.12508] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aims of the present study were to establish the incidence of head and neck necrotizing fasciitis (NF) in the Adelaide Oral and Maxillofacial Surgery Unit; review the current literature regarding the management of head and neck NF; and determine the evidence for the role of hyperbaric oxygen therapy in the management of NF. METHODS A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006-2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. RESULTS A total of 672 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48/100 000 infections per year. CONCLUSIONS The first-line treatment of severe odontogenic infections remains conventional surgical and medical management; however, hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients.
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Affiliation(s)
- K Bayetto
- Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A Cheng
- Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - P Sambrook
- Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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13
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Mattison G, Leis AR, Gupta SC. Single-specialty management and reconstruction of necrotizing fasciitis of the upper extremities: clinical and economic benefits from a case series. Ann Plast Surg 2014; 72 Suppl 1:S18-S21. [PMID: 24740020 DOI: 10.1097/sap.0000000000000173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Patients with necrotizing fasciitis are managed with multiple prompt, radical surgical debridements and critical care support. Debridement and reconstruction are often provided by different surgical teams. Anecdotally, single-specialty management seemed to be a more efficient management strategy. This study aimed to investigate and compare the outcomes of management by plastic surgery versus multiple disciplines through a retrospective economic and clinical analysis of patients with necrotizing fasciitis treated over 8 years. We also present 3 index cases for which our service functioned as the primary management team. METHODS Necrotizing fasciitis cases evaluated and treated by our department, covering both Level I and Level II Trauma Centers, were reviewed for total charges, length of hospital stay, length of intensive care unit (ICU) stay, and number of procedures. The admission Acute Physiology and Chronic Health Evaluation II score was calculated for each patient. Three comparative index cases of upper extremity necrotizing fasciitis managed primarily by the plastic surgery team are presented in greater detail. RESULTS Patients managed primarily by the plastic surgery service had equivalent Acute Physiology and Chronic Health Evaluation II scores to patients managed by multiple services for their necrotizing fasciitis, with the average score higher for patients managed by plastic surgery alone. In a case-matched series of upper extremity necrotizing fasciitis, the patients admitted directly to plastic surgery had shorter average lengths of hospital and ICU stays as well as decreased total number of procedures, resulting in decreased average total hospital charges. There were no amputations among the cases treated primarily by the plastic surgery. The patients also required smaller areas of reconstruction with skin grafting despite large initial areas of debridement compared to those whose reconstructive teams differed from the team performing the debridement. CONCLUSIONS Improved economic and clinical outcomes-as indicated by the reduced lengths of overall and ICU stay, the reduced number of procedures, none of the cases requiring amputation, and the reduced need for skin grafting-may be attainable when the surgeon eventually performing the reconstruction is involved early in management. We propose that, in the interest of improving patient care, a closer collaboration should be established between the reconstructive and primary managing teams.
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Affiliation(s)
- Gennaya Mattison
- From the *School of Medicine, Loma Linda University; and †Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA
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