Cervical necrotizing fasciitis.

Abstract

Necrotizing fasciitis (NF) is a rapidly progressing soft tissue infection that carries a significant mortality rate despite intensive treatment. Terms such as hospital gangrene, streptococcal gangrene, Meleney gangrene, gangrenous erysipelas, necrotizing erysipelas ,a ndsynergistic necrotizing cellulitis have been used as synonyms. More commonly seen in the abdomen, perineum, and lower extremities, the neck, owing to its rich vascular network, is a rare site for this fulminant condition. It is characterized by widespread destruction of the subcutaneous tissues and fasciae and gas formation in anatomic spaces. Overlying skin and muscles are spared initially but may undergo necrosis with disease progression. Cervical NF is most commonly caused by dental infection, especially from the mandibular molars, followed by trauma. 1,2 Less common causes of cervical NF are peritonsillar abscess, insect bites, osteoradionecrosis, and hypodermic needle infection. 3 NF can be caused by a single organism but usually occurs as a polymicrobial infection. Among causative bacteriae are group A b-hemolytic and other types of streptococci, Staphylococcus aureus, Eschericihia coli, Klebsiella spp, and some obligate anaerobes, such as Bacteriodes spp and Peptostreptococcus spp 1,4 In this article, three cases of cervical NF are described and the clinical features and management of this fulminant disease are discussed.