Abstract
BackgroundCervicofacial necrotizing fasciitis (NF) is a rare life-threatening infection in the head and neck region that characteristically spreads along the fascial planes to involve subcutaneous tissues, fascia and fat, however, in late stages it can involve muscles and skin. The aim of this study was to determine the occurrence of cervicofacial NF among patients attending treatment at the Muhimbili National Hospital (MNH).MethodsThis was a prospective descriptive cross-sectional hospital-based study which was carried at Muhimbili National Hospital (MNH) from May 2013 to April 2014. It included 42 patients with cervicofacial NF. They were interviewed for demographic information, chief complaints, symptoms, duration and treatment received before reporting at MNH. A thorough assessment of general health condition of the patients and laboratory investigations were followed by management according to MNH protocol. Data obtained from these patients were analyzed using Statistical Package for Social Sciences SPSS 20.ResultsDuring the study period, 151 patients reported at MNH with odontogenic infections. A total of 42 (27.8%) patients satisfied our diagnostic criteria for cervicofacial NF. The age range was 15 years to 83 years (mean 43.95, SD +/− 16.16). Greater (35.7%) proportion was in the age group of 30–39 years with 31 (73.8%) males and 11 (27.2%) females making a male to female ratio of 2.8:1.Fifteen (35.7%) patients had at least one co-existing systemic condition, which included anaemia in 5 (11.9%) patients, followed by diabetes mellitus (DM) and malnutrition 4 (9.5%) patients each and HIV infection 2 (4.8%) patients. Others were combination of; HIV infection and malnutrition, HIV infection and anaemia and diabetes mellitus and anaemia each in one (2.4%) patient. There was a mortality of 42.9% comprising of 14 (33.3%) males and 4 (9.6%) females.ConclusionsCervicofacial NF is a polymicrobial infection, requiring surgery, antibiotics and management of co-existing systemic conditions. Anaemia, diabetes mellitus and malnutrition were the main co-existing systemic conditions. The rather high mortality was mainly attributable to late reporting.
Highlights
Cervicofacial necrotizing fasciitis (NF) is a rare life-threatening infection in the head and neck region that characteristically spreads along the fascial planes to involve subcutaneous tissues, fascia and fat, in late stages it can involve muscles and skin
Cervicofacial necrotizing fasciitis was diagnosed based on the presence of fascial necrosis, undermining of skin, gangrenous tissue, primary involvement of the face and neck
One hundred and fifty-one patients with orofacial infections were seen during the study period
Summary
Cervicofacial necrotizing fasciitis (NF) is a rare life-threatening infection in the head and neck region that characteristically spreads along the fascial planes to involve subcutaneous tissues, fascia and fat, in late stages it can involve muscles and skin. Necrotizing fasciitis (NF) is a rare but life-threatening polymicrobial soft tissue infection characterized by rapid and progressive necrotizing process of the subcutaneous tissues, fats and fascial planes, with resulting skin gangrene and systemic toxicity [1,2,3,4,5,6,7,8]. It commonly affects the extremities, abdominal wall and perineum following surgery or trauma, in individuals with underlying systemic diseases such as diabetes mellitus, arteriosclerosis, chronic renal failure or malnutrition [3,4,5,6]. This type has a rapidly progressive course and, if left untreated, is associated with a mortality of between 22 and 100% [1, 5, 9, 14]
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