CERVICAL NECROTIZING FASCIITIS - CLINICAL MANIFESTATIONS AND MANAGEMENT

Forty-five cases of cervical necrotizing fasciitis are reported, and t heir clinical, bacteriologic, and therapeutic implications are conside red. Fasciitis was of dental origin in 78% of cases, pharyngeal in 16% , and surgical or posttraumatic in 6%. The condition extended to the f ace in 22% of cases, to the lower part of the neck in 56%, and to the mediastinum in 40%. Soft-tissue cultures were positive in 78% of cases . Anaerobes were isolated along with aerobes in 49% of cases (mean, 2. 2 isolates per patient) and in pure culture in 22%. Treatment included surgical debridement and drainage and the administration of antibioti cs active against both anaerobic and gram-negative aerobic bacteria. H yperbaric oxygen was used for adjunctive treatment. The bacteria invol ved did not affect clinical manifestations, extension, or mortality. T he survival rate among our patients was 78%. Mortality was significant ly higher among cases with mediastinal extension (44% vs. 7%; P < .01) ; thus the prompt recognition and drainage of sites of mediastinal ext ension are of critical importance. Other risk factors for death were a n age of > 70 years, underlying diabetes, the development of septic sh ock within 24 hours after admission, and prolonged prothrombin time.