Cervical necrotizing fasciitis: an overlooked diagnosis of a fatal disease

Abstract

Background: Necrotizing fasciitis of the neck is a rare potentially lethal condition if not early diagnosed and managed. We aimed to study the clinical presentation, radiological and microbiological diagnosis, management, and surgical outcome of patients having cervical necrotizing fasciitis (CNF).Materials and methods: We retrospectively studied patients having a final diagnosis of CNF who were treated at Al Ain Hospital during the period of January 2000 to December 2016.Results: Six patients with CNF were studied. Diabetes mellitus was the most common predisposing factor (83.3%). All patients presented with a painful neck swelling. The most common source of infection was odontogenic. Mixed microbiological flora was present in five patients. Five patients underwent CT scan of the head and neck with a positive finding of gas in all of them. Repeated aggressive surgical debridement in combination with antibiotic therapy was adopted. Four patients (66.7%) developed superior mediastinitis, two had septicemia, and one patient had a perforated duodenal ulcer. One patient died (overall mortality 16.7%).Conclusion: Maintaining a high index of suspicion is crucially important for diagnosing CNF. Early diagnosis, timely resuscitation, and aggressive surgical debridement are the key to a successful clinical outcome.