Necrotizing fasciitis of the pharynx following adenotonsillectomy

Necrotizing fasciitis is a rare clinical entity in the head and neck region . We report a case of necrotizing fasciitis following adenotonsillectomy in a previously healthy 2-year-old girl. The child presented in a septic stat e with impending airway compromise. Computed tomography (CT) showed massive soft tissue widening with air in the retropharyngeal, parapharyngeal and r etromandibular spaces. Intraoperative exploration showed necrosis of the po sterior pharyngeal wall from the skull base to the cricoid, with extension into the parapharyngeal and retropharyngeal spaces. Cultures from the debri ded tissues grew two aerobes and three anaerobes. Management involved airwa y support, surgical debridement, broad spectrum antibiotic: coverage and nu tritional support. The patient ultimately developed nasopharyngeal and orop haryngeal stenosis requiring tracheostomy and gastrostomy tube placement. T his case report highlights an extremely rare complication of adenotonsillec tomy. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.