Necrotising fasciitis of the submandibular region

Abstract

SummaryTwo cases of necrotizing fasciitis (NF) complicating different conditions of the maxillofacial region, treated at the Korle Bu Teaching Hospital are reported. These were managed by an early diagnosis, aggressive surgical exploration, fasciotomies and debridement of necrotic tissue. In addition, frequent irrigation within the fascial planes with eusol and saline solutions plus the administration of broad spectrum antibiotics ensured early containment of the spread of the infection. Our early recognition of the signs and symptoms of NF led to an early intervention resulting in minimal residual skin defects which even though were not skin-grafted healed satisfactorily.

Figure 1

Extensive loss of submandibular tissue exposing necrosed tags of fascia tissues

Figure 2

Clean granulated submandibular wound ready for grafting or closure by local flaps

Figure 3

A clinical photograph showing a rapidly spreading submandibular swelling which on aspiration contained pus and gas. Note the intact darkened overlying necrotic skin and the extensive collateral facial oedema

Figure 4

A photograph following sloughing of overlying skin and control of the advancing NF. The residual wound is ready for skin grafting