Korean Journal of Otorhinolaryngology-Head and Neck Surgery

Korean Society of Otolaryngology-Head and Neck Surgery (대한이비인후과학회)
권호 표지

A Clinical Study of the Cervical Necrotizing Fasciitis

경부에 발생한 괴사성 근막염에 대한 임상적 고찰

Yang, Yoon-Soo;Lee, Hwa-Uk;Kim, Jin-Seong;Lee, Jai-Keun;Hong, Ki-Hwan
양윤수;이화욱;김진성;이재근;홍기환

  • Published : 2005.08.05
⟨ Previous Next ⟩

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

Keywords

References

  1. Wilson B. Necrotizing fasciitis. Am Surg 1952;18:416-31
  2. Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues: Current concepts. N Engl J Med 1996;334:240-5 https://doi.org/10.1056/NEJM199601253340407
  3. Chan CH, McGurk M. Cervical necrotizing fasciitis: A rare complication of periodontal disease. Br Dent J 1997;183:293-6 https://doi.org/10.1038/sj.bdj.4809498
  4. Lanffold FP, Moon RE, Stolp BW, Scher RL. Treatment of cervical necrotizing fasciitis with hyperbaric oxygen therapy. Otolaryngol Head Neck Surg 1995;112:274-8 https://doi.org/10.1016/S0194-5998(95)70250-4
  5. Kalbacha ME, Stankiewicz JA, Clift SE. Severe soft tissue infection of the face and neck: A classification. Laryngoscope 1982:92:1135-9
  6. Martin PR, Hoiby EA. Streptococcal serogroup A epidemic in Norway 1987-88. Scand J Infect Dis 1990;22:421-9 https://doi.org/10.3109/00365549009027073
  7. Banerjee AR, Murty GE, Moir AA. Cervical necrotizing fasciitis: A distinct clinicopathological entity? J Laryngol Otol 1996;110:81-6
  8. Shindo ML, Nalbone VP, Dougherty WR. Necrotizing fasciitis of the face. Laryngoscope 1997:107:1071-9 https://doi.org/10.1097/00005537-199708000-00013
  9. Helmy SA, Salah MA, Nawara HA, Khatab H, Khalaf HA, Abdel-Maguid N. Life-threatening cervical necrotizing fasciitis. J R Coli Surg Edinb 1997:42:410-3
  10. AI-Ammar A, Maqbool Mir S. Cervical necrotizing fasciitis with facial paralysis. J Laryngol Otol 2004:118:573-5
  11. Beerens AJ, Strack van, Schijndel RJ, Mahieu HF, Leemans CR. Cervical necrotizing fasciitis with thoracic extension after total laryngectomy. J Laryngol Otol 2002:116:70-2
  12. Becker M, Zbaren P, Hermans R, Becker CD, Marchal F, Kurt AM, et al. Necrotizing fasciitis of the head and neck: Role of CT in diagnosis and management. Radiology 1997:202:471-6
  13. De Backer T, Bossuyt M, Schoenaers J. Management of necrotizing fasciitis of the neck. J Craniomaxillofac Surg 1996:24:366-71 https://doi.org/10.1016/S1010-5182(96)80038-2
  14. Scher RL. Hyperbaric oxygen therapy for necrotizing cervical infections. Adv Otorhinolaryngol 1998:54:50-8 https://doi.org/10.1159/000059053
  15. Roberson JB, Harper JL, Jauch EC. Mortality associated with cervicofacial necrotizingfasciitis. Oral Surg Oral Med Oral Pathol 1996:82:264-7 https://doi.org/10.1016/S1079-2104(96)80350-7