Necrotizing fasciitis of the head and neck: An analysis of 47 cases

Necrotizing fasciitis is an overwhelming infection common to the perineum, abdominal wall, and extremities. It is a surgical emergency related to a hi gh mortality rate that is more often seen in elderly and immunocompromised patients. Necrotizing fasciitis occurs uncommonly in the head and neck regi on. Over a 12-year period. 47 case of necrotizing fasciitis of the head and neck region were collected at this hospital. The demographics, predisposin g factors, clinical presentation and courses, management, complications, an d outcomes were analyzed. The cases were divided into two groups: survivors and nonsurvivors. Statistical comparisons were made of the parameters age, gender, smoking or drinking habit, underlying medical problems, laboratory data, and treatments used. Forty-two patients (89.4 percent) had associate d systemic disease; most of these patients had diabetes (72.3 percent). The clinical manifestations are nonspecific but are often typical for diagnosi s. The necessity of computed tomographic scans is not conclusive in this st udy. Presentation of septic shock (p = 0.004) and association with underlyi ng malignancy (p = 0.03) were the only statistically significant factors th at led to a poor prognosis. The cornerstones of proper management include e arly diagnosis, aggressive surgical debridement, broad-spectrum antibiotics , and intensive supportive care.