Diagnosis and treatment of craniocervical necrotizing fasciitis.

Background: Necrotizing fasciitis of the head and neck is a rare occurrence . It spreads rapidly along fascial planes causing extensive necrosis; it of ten results in gangrene of the overlying skin. Mostly involved are immunode ficient patients with banal infections of the upper aerodigestive tract, sm all traumas, but also after surgical procedures. The "Federal Health Agency " of the Federal Republic of Germany estimates a number of 40 cases a year in Germany for all regions of the body. The mortality is about 20% - 50% de pendent on the localisation of this soft tissue infection. Patients: Four c ases of necrotizing fasciitis of the head and neck region, which were treat ed at the ENT-Departement of the Martin Luther University Halle-Wittenberg since 1995, were described. Results: Despite aggressive surgical debridemen t and intensive care medicine two patients died because of streptococcus-as sociated-toxic-shock-syndrome. In all patients we found a diabetes mellitus as a known risk factor for this necrotizing soft tissue disease. In two of four patients with cervical involvement mediastinitis was diagnosted as a complication. The CT- scan showed this mediastinal spread only in one case. Conclusions: Only rapid diagnosis and surgical treatment with radical debr idement can influence the disease positively. Thoracal CT-scan is necessary in all cases of cervical necrotizing fasciitis because of the high risk of mediastinal involvement. A strong complication is a streptococcus-associat ed-toxic-shock-syndrome, which should be prevented because it is often asso ciated with a lethal outcome. Penicillin G and clindamycin are advocated fo r antibiotic treatment.