NECROTIZING FASCIITIS OF THE FACE

Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infect ion with high morbidity and mortality rates. Its occurrence in the hea d and neck region is uncommon, the majority of reported cases being li mited to involvement of the neck, usually from infections of dental or pharyngeal origin. Involvement of the face from NF is rare; only 35 s uch cases have been reported in the literature since 1960. It is not o nly associated with a high mortality but can also result in severe dis figurement of the face, posing challenging reconstructive problems. Su ccessful management of facial NF requires early diagnosis, prompt inst itution of broad spectrum antibiotics, aggressive surgical debridement to control the infection, and reconstruction of the resultant soft ti ssue defects. This report describes four additional cases of facial ne crotizing fasciitis. One of the four patients died as a result of seps is and multi-organ system failure. Two of the three surviving patients had significant facial disfigurement. A comprehensive review of the f acial NF cases reported in the literature is also provided. Based on o ur experience with facial NF and the results of all previous case repo rts, the clinical manifestations, pathogenesis, and management of this disease are discussed.