NECROTIZING FASCIITIS OF THE HEAD AND NECK - ROLE OF CT IN DIAGNOSIS AND MANAGEMENT

PURPOSE: To determine the characteristic diagnostic features of necrot izing fasciitis and to evaluate the role of computed tomography (CT) i n its management. MATERIALS AND METHODS: Fourteen patients with surgic ally proved necrotizing fasciitis of the extracranial head and neck we re examined with contrast material-enhanced CT. Clinical, radiologic, surgical, pathologic, and anatomic findings at admission and after ini tial treatment were analysed retrospectively. RESULTS: Constant CT fea tures of necrotizing fasciitis were diffuse thickening and infiltratio n of the cutis and subcutis (cellulitis); diffuse enhancement and/or t hickening of the superficial and deep cervical fasciae (fasciitis); en hancement and thickening of the platysma, sternocleidomastoid muscle, or strap muscles (myositis); and fluid collections in multiple neck co mpartments. Inconstant CT features included gas collections, mediastin itis, and pleural or pericardial effusions. All patients underwent ext ensive surgical debridement. Follow-up CT scans in 11 patients reveale d clinically unsuspected progression of the inflammatory process in pr eviously unaffected areas, a finding that warranted additional surgery in nine patients. Twelve patients survived, and two patients died of septic shock and aspiration pneumonia despite intensive surgical and m edical treatment. CONCLUSION: Early recognition of necrotizing fasciit is with CT enables appropriate surgical treatment. CT may also be a us eful guide in further patient treatment after initial surgical debride ment.