PERITONSILLAR ABSCESS - AN UNLIKELY CAUSE OF NECROTIZING FASCIITIS

Cervical necrotizing fasciitis is a devastating polymicrobial soft tis sue infection characterized by gas formation and extensive necrosis of subcutaneous fat and fascia with extension to skin and muscle. Involv ement of the head and neck is rare and is typically dental in origin. Despite broad-spectrum antibiotics, mortality rates for this disease r emain high. We report a successfully treated case of necrotizing fasci itis arising from a peritonsillar abscess. Review of the literature re veals only 6 other cases, with 3 successful outcomes. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical debridement are t he cornerstones of therapy. The pathophysiology is typically a mixed a erobic and anaerobic infection. Supportive treatment options such as h yperbaric oxygen therapy and high-calorie supplemental nutrition may b e of benefit. A comprehensive literature review of craniocervical necr otizing fasciitis is presented. Factors associated with poor outcomes include diabetes mellitus, mediastinitis, cardiovascular disease, and peritonsillar abscess.