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Review
. 2020 Feb;43(1):94-98.
doi: 10.1016/j.bj.2019.08.002. Epub 2020 Feb 27.

Necrotizing fasciitis of the entire head and neck: Literature review and case report

Pang-Yun Chou  1 , Yun-Huan Hsieh  1 , Cheng-Hung Lin  2
Affiliations
Review

Necrotizing fasciitis of the entire head and neck: Literature review and case report

Pang-Yun Chou et al. Biomed J. 2020 Feb.

Abstract

Necrotizing fasciitis (NF) is uncommon but potentially lethal when it is associated with systemic disorders. We report a case of odontogenic NF in a patient with uncontrolled diabetes mellitus. The patient was referred on day 10 since the onset of odontogenic NF. Protective tracheostomy, local facial-cervical fasciotomy were conducted and broadspectrum antibiotics were given, subsequent serial surgical drainage and debridement were performed in theater. Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumonia were isolated. Five staged debridements were performed to the targeted anatomic regions thus reducing surgical time and blood loss. The patient survived the acute infection and received subsequent reconstruction. Cervical NF with descending mediastinitis and periorbital NF is associated with high mortality rates. This is the only known report of an adult who survived NF affecting entire scalp, periorbital, cervical, and thoracic region. Early diagnosis and staged surgical planning minimize morbidity and mortality from NF.

Keywords: Craniocervical; Diabetes mellitus; Necrotizing fasciitis; Odontogenic; Soft tissue infection.

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Figures

Fig. 1
Fig. 1
The findings of necrotizing fasciitis (NF) in computed tomography. (A) Sagittal view. NF is present in the cervical, facial, periorbital, and whole scalp planes. The arrow indicates left periorbital involvement. (B) Coronal view, (Arrow) massive gas accumulated over left facial-cervical region and dissected the scalp from the left side to the right side. (Arrowhead) NF of the entire scalp. (C) Axial view, (Arrow) circumferential emphysematous change and fat-stranding indicated the extent of the NF. (D) (Arrow) Cervical descending NF.
Fig. 2
Fig. 2
Photos of perioperative findings. (A) Initially, left facial necrosis extending to periorbital tissue and entire scalp. (B) Elevated anterior facial and occipital flaps were used to expose the scalp fascial layers as completely as possible. (C) Right side view. (D) Left side view showed left grafted face and partial exposed zygomatic bony tissue.
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