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.