Cervical Necrotizing Fasciitis Research Articles

Cervical Necrotizing Fasciitis and Shock in the Post-Operative Pediatric Patient.

Cervical necrotizing fasciitis (CNF) is a rare infection that can quickly lead to devastating patient outcomes. Considering the vital importance of surrounding neck structures, rapid control of the infection is essential. Infection is most frequently polymicrobial and occurs in the adult patient in the context of certain medical comorbidities. Complications are typically limited to tissue destruction in the form of necrosis. There are no current reports describing CNF complicated by acute shock in the post-operative pediatric patient. Here, we present a pediatric case of CNF complicated by acute shock following Sistrunk procedure for removal of a supposed thyroglossal duct cyst. This case illustrates a potential post-operative complication that can be seen within the pediatric patient. Although most reported examples of CNF are polymicrobial and result from odontogenic infection, providers should be aware of other potential sources of disease. It is important for the pediatric surgeon to rapidly identify CNF and consequent shock, as prompt medical and surgical interventions are critical to offering the best chance of patient survival.

Characteristics of Cervical Necrotizing Fasciitis (CNF) Patient in Oral and Maxillofacial Surgery Department Rsup Dr Hasan Sadikin: 2 Years Retrospective Study

Cervical necrotizing fasciitis (CNF) is a life-threatening bacterial infection that runs aggressively in the subcutaneous tissue and fascia in the head and neck area with clinical presentation of extensive necrotic tissue that develops from infection of the teeth or gingiva and other supporting tissues accompanied by an endosteal or periosteal infection of the jaw. This research aims to obtain information about characteristic patients with cervical necrotizing fasciitis (CNF). This study is an observational study with a retrospective descriptive approach. Based on medical record data, the research was conducted at Hasan Sadikin General Hospital (RSHS) Bandung from March 2019 – March 2021. The data collected include age, gender, onset, nutritional status, region, clinical diagnosis, microbiology, antibiotic sensitivity resistance, length of stay, and source focal infection. In this study, 23 medical records were obtained. The most frequent characteristics of the subjects were elderly aged more than 50 years (47.8%) and males (61%). The most frequent locations were the submandible area (100%), and the most frequent source of focal infection was from mandibular posterior teeth (60.46%). From the onset to the symptoms frequently 7-14 days with the nutritional status, most patients were malnourished (58%). Regarding microbiology gram negative dominantly (66,6%), with the most bacterial that worsening the spread of CNF being Acinobacter Baumanii (26.0%), Tigecycline becomes antibiotic most sensitive (43,47%), Cefazoline is the most resistance (73.91%). Most patients were treated by surgery necrotomy debridement (95, 6 %), and most improved (76 %). The ability to diagnose quickly and take aggressive action is needed to treat patients with Cervical Necrotizing Fasciitis (CNF) because of its high progression.

Cervical necrotizing fasciitis complicated by sepsis case report

Cervical necrotizing fasciitis (CNF) is uncommon, difficult to diagnose, and rapidly progressive severe infection causing necrosis of subcutaneous tissue and fascial compartments, associated with high mortality; early recognition and surgical intervention are crucial. In most cases of nercrotizing fasciitis in the head and neck region the origin is odontogenic or pharyngolaryngeal; predominantly identified bacteria are Streptococci and Staphylococci. A characteristic CT finding is gas demonstration. The main complication is descending necrotizing mediastinitis (DNM), unfrequently vascular entities: internal jugular vein thrombosis, carotid sheath necrosis, carotid artery aneurysm and rupture, and other arterial hemorrhages. A fulminant CNF course requires timely implementation of appropriate treatment. Broad-spectrum antibiotic therapy and repeated surgical interventions with the removal of necrotic tissues constitute the most common treatment. Open wound treatment increases the risk of additional coinfection and sepsis; a modern approach is the use of negative pressure wound therapy or percutaneous catheter drainage. Tracheostomy may be helpful in need of further, repetitive debridement. Loss of soft tissues and skin of the neck may require reconstruction with full- or split-thickness free flap, local flap, or biodegradable dermal substitute. The authors describe the case of a patient with CNF complicated by sepsis. The necrosis resulted in a 10x20-cm defect in the front of the neck, which was covered with a split-thickness graft harvested from the anterolateral surface of the thigh. No complications occurred during the healing of the graft.

Synchronous cervical necrotizing fasciitis and pharyngocutaneous fistula: A case report

Introduction and importanceNecrotizing fasciitis is a fulminant infection that spreads along the fascial planes. It is a rare entity with potentially fatal outcomes. The head and neck involvement is infrequent, with primary source either odontogenic or pharyngeal infection by single or mixed bacterial flora. To our knowledge, synchronous cervical necrotizing fasciitis (CNF) and pharyngocutaneous fistula is rarely reported in pieces of literature.Case presentationWe present a 38-years-old female patient who presented with CNF and pharyngocutaneous fistula. Diabetes mellitus was accidentally discovered during the investigation. The patient was successfully treated with broad-spectrum antibiotics, serial surgical debridement sessions, wound irrigation, and multiple muscular and myocutaneous skin flaps.Clinical discussionRapid diagnosis, radical surgical debridement of all necrotic tissue, intravenous broad-spectrum antibiotics, and close monitoring of patients with CNF are crucial to avoid critical complications and better patient survival. Due to the poor healing process in the neck area, the pharyngocutaneous fistula should be repaired with good musculocutaneous flaps such as the pectoralis major myocutaneous flap. Meticulous suturing of the flap to the mucosa, reinforcement of the repair with muscle, and suturing of the skin without tension are essential to obtaining a successful outcome.ConclusionSynchronous CNF and pharyngocutaneous fistula are rare events. Initial diagnosis and serial surgical debridement, along with aggressive broad-spectrum antibiotics and adequate resuscitation with great attention to the poor healing process in the diabetic patients' neck area, are critical for a beneficial result. In our case, the reconstruction was performed successfully using multiple muscular and skin flaps.

Factors Affecting Patients with Concurrent Deep Neck Infection and Cervical Necrotizing Fasciitis.

Deep neck infection (DNI) is a severe disease of the deep neck spaces, which has the potential for airway obstruction. Cervical necrotizing fasciitis (CNF) is a fatal infection of the diffuse soft tissues and fascia with a high mortality rate. This study investigated risk factors in patients with concurrent DNI and CNF. A total of 556 patients with DNI were included in this study between August 2016 and December 2021. Among these patients, 31 had concurrent DNI and CNF. The relevant clinical variables were assessed. In univariate analysis, age (> 60 years, odds ratio (OR) = 2.491, p = 0.014), C-reactive protein (CRP, OR = 1.007, p < 0.001), blood sugar (OR = 1.007, p < 0.001), and diabetes mellitus (DM, OR = 4.017, p < 0.001) were significant risk factors for concurrent DNI and CNF. In multivariate analysis, CRP (OR = 1.006, p < 0.001) and blood sugar (OR = 1.006, p = 0.002) were independent risk factors in patients with concurrent DNI and CNF. There were significant differences in the length of hospital stay and therapeutic management (intubation, tracheostomy, incision and drainage) between DNI patients with and without CNF (all p < 0.05). While there were no differences in pathogens between the DNI alone and concurrent DNI and CNF groups (all p > 0.05), the rate of specific pathogen non-growth from blood cultures was 16.95% (89/525) in the DNI alone group, in contrast to 0% (0/31) in the concurrent DNI and CNF group (p = 0.008). Higher CRP and blood sugar levels were independent risk factors for the concurrence of DNI and CNF. With regard to prognosis, there were significant differences in the length of hospital stay and therapeutic management between the groups with and without CNF. While there were no significant differences in pathogens (all p > 0.05), no cases in the concurrent DNI and CNF group showed specific pathogen non-growth, in contrast to 89/525 patients in the group with DNI alone.

Cervical necrotizing fasciitis of odontogenic origin

Cervical necrotizing fasciitis (CNF) is a rare, but serious condition that can develop as a result of an odontogenic infection spreading into the deep fascial planes of the neck. The infection is associated with significant morbidity and mortality due to septic shock, disseminated intravascular coagulation (DIC) and consequent multiple organ failure. A case of CNF affecting a 42-year-old woman who was treated with rapid surgical debridement and intravenous antibiotics is presented. She subsequently required further head and neck reconstruction as a result of morbidity from the disease. CPD/Clinical Relevance: Although rare, it is pertinent that dental practitioners recognize that untreated dental infection might trigger necrotizing fasciitis, especially in high-risk patients.

Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: a systematic review and meta‐analysis

Recent studies have attempted to verify the predictive capability of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) for cervical necrotizing fasciitis (CNF). The two authors independently reviewed six databases (PubMed, Cochrane, Embase, Web of Science, SCOPUS and Google Scholar databases were searched). Seven cohort studies were included in the analysis. Sensitivity and specificity were determined by extracting items from binary classification from each paper. The diagnostic accuracy of the included studies was evaluated using QUADAS ver. 2. The diagnostic odds ratio (OR) of LRINEC for CNF with the cutoff value of 6 was 13.9952 (95% CI, 3.8537; 50.8255, I2 =76.7%). The area under the SROC curve was 0.842, suggesting acceptable diagnostic accuracy. The correlation between sensitivity and false positive rate was 0.055, indicating that it was not heterogeneous. The sensitivity, specificity, and negative predictive values were 0.7503 ([0.4637; 0.9126], I2 =79.1%), 0.8455 ([0.7084; 0.9250], I2 =96.0%) and 0.9829 ([0.9089; 0.9970], I2 =93.7%), respectively. In the comparison of subgroups according to a LRINEC score (6-8, and), the cutoff value of 6 showed moderate sensitivity (75%) and high specificity (85%) and greater diagnostic power than other cutoff values. LRINEC is a useful adjunctive tool for predicting CNF in patients with a soft tissue infection. In addition, a more accurate diagnosis is possible by using the LRINEC score with a cutoff value of 6.

Comparison of death and survival cervical necrotizing fasciits cases.

Cervical Necrotizing Fasciitis (CNF) is associated with a high mortality rate. The occurrence of mediastinitis with CNF may increase mortality up to 70%. We aimed to identify the differences between surviving and deceased cases. The present study was conducted retrospectively by scanning the files of 16 patients between the ages of 19-71 who were diagnosed with CNF. Patients were divided into two groups as the surviving patient group (SPG) and the deceased patient group (DPG). Both groups were compared in terms of age, gender, Laboratory Risk Indicator for Necrotizing Fasciitis (LRİNEC) score, duration of symptom onset to hospital admission, use of antibiotherapy prior to admission, duration of hospitalization, presence of diabetes mellitus (DM), presence of dental etiology, mediastinitis, and respiratory distress at the time of admission. Diabetes mellitus was the most common comorbid disease. 5 out of 7 deceased patients had DM. Dental events were the most common etiology. Rapid surgical debridement and airway management was the first treatment method. The most frequently isolated species in the culture was Streptococcus. 6 of 11 patients who developed mediastinitis deceased at the end of the process. Dental pathologies mostly play a role in the etiology. It is obvious that dentists, another occupational group that frequently encounters this patient group, have a critical role in this process. Therefore, precise attention should be given to dental problems in patients with diabetes, and hospitalization and initiation of broad-spectrum antibiotherapy should be considered in case of suspicion of deep neck infection.

Early detecting cervical necrotizing fasciitis from deep neck infections: a study of 550 patients.

The aim of this retrospective review study is to evaluate Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score as an indicative parameter in early detecting cervical necrotizing fasciitis (CNF) from deep neck infections (DNI). We reviewed 12 cases of CNF and 538 cases of non-necrotizing deep neck infection hospitalized in our hospital over the last decade. Cervical necrotizing fasciitis was histologically confirmed. Using an LRINEC score of 6 as a cutoff sensitivity was calculated at 100% (95% CI 99.9-100) and specificity 72.5% (95% CI 72.4-72.6). Negative predicted value (NPV) was 100% and positive predicted value (PPV) was 7.5%. C-reactive protein (CRP), white blood count (WBC), and glucose (Glu) levels have a higher correlation. Haemoglobin (Hb), sodium (Na), and creatinine (Cr) do not seem to have a big impact in our study. LRINEC score proves to be a useful "rule-out" tool that works on the safe side with high sensitivity and poor specificity. WBC, CRP, and Glu seem to be the most significant variables of the LRINEC score. Hb, Na, and Cr make the score safer. Decision for surgery must be based on medical history, clinical symptoms and signs, imaging findings, and laboratory tests and not according to the LRINEC score itself.

Management and postoperative use of double-cannula irrigation–drainage tube in cervical necrotizing fasciitis: a Chinese single-institution experience of 46 patients

This study aimed to analyze a Chinese institution's experience with managing cervical necrotizing fasciitis (CNF) and observe the effects of a new therapeutic approach for postoperative drainage system. A retrospective study was established including a total of 46 CNF patients who underwent surgical debridement between April 2006 and April 2018. Analyses of demographic data, etiology, comorbidity, microbiology, complications, treatment methods, duration of treatment, and treatment outcomes were obtained. There were 16 kinds of microbes cultured in 29 patients. Diabetic patients were more commonly infected by microbes (P < 0.05). There was a significant reduction in the number of operative time (P < 0.05) and length of hospitalization (P < 0.01) with postoperative therapy of double-cannula irrigation-drainage (DCID) system. CNF management includes controlling for comorbidities especially glycemic control and reasonable utilization of antibiotics and aggressive postoperative therapy. DCID system can effectively reduce operative frequency and duration of hospitalization.

Cervical necrotizing fasciitis affects only immunocompromized patients? Diagnostic challenges, treatment outcomes and clinical management of eleven immunocompetent adult patients with a still fatal disease.

Cervical Necrotizing fasciitis (CNF) has been reported as an unusual rapidly progressive, life-threatening, inflammatory disease that is known to affect predominately immunocompromised patients. Few case reports have been sporadically published involving immunocompetent adults. This is the first study presents a series of immunocompetent CNF patients. A retrospective chart review study was performed on immunocompetent adults with CNF from January 2003 to December 2019. The diagnosis was histologically confirmed. We analyzed epidemiological, clinical, laboratory and imaging findings and discussed them along with the treatment plan. A total of eleven adult patients were included in the study. The average age was 43years, ranging from 17 to 62years. The average hospitalization time was 28days, ranging from 10 to 129days. All patients presented with cervical erythema and odynophagia. The causative factors are known in nine patients. Tissue cultures demonstrated mixed flora in six patients. Seven underwent a temporary tracheostomy. Wide neck exploration incisions were performed in all patients as the diagnosis was established after imaging findings. In nine cases the anterior-upper mediastinum was affected but only in two patients extension of the surgical planes to the mediastinum was performed. Four patients developed polyserositis. Nine patients survived and two developed multiorgan failure and died. There seem to be no differences between immunocompetent and immunocompromised CNF patients, in regards to clinical, imaging and laboratory findings as well as their treatment plan.

Necrotizing fasciitis of the entire head and neck: Literature review and case report

Necrotizing fasciitis (NF) is uncommon but potentially lethal when it is associated with systemic disorders. We report a case of odontogenic NF in a patient with uncontrolled diabetes mellitus. The patient was referred on day 10 since the onset of odontogenic NF. Protective tracheostomy, local facial-cervical fasciotomy were conducted and broadspectrum antibiotics were given, subsequent serial surgical drainage and debridement were performed in theater. Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumonia were isolated. Five staged debridements were performed to the targeted anatomic regions thus reducing surgical time and blood loss. The patient survived the acute infection and received subsequent reconstruction. Cervical NF with descending mediastinitis and periorbital NF is associated with high mortality rates. This is the only known report of an adult who survived NF affecting entire scalp, periorbital, cervical, and thoracic region. Early diagnosis and staged surgical planning minimize morbidity and mortality from NF.

Clinical study of cervical necrotizing fasciitis accompanied with descending necrotizing mediastinitis treated with cervical double parallel incision combined with mediastinoscope or thoracoscope

Objective: To summarize the experience of applying cervical double parallel incision combined with mediastinoscope or thoracoscope in the treatment of cervical necrotizing fasciitis (CNF) accompanied with descending necrotizing mediastinitis (DNM), so as to provide a reference for clinical practice. Methods: The clinical data of six patients with CNF accompanied with DNM who were admitted to the Department of Stomatology and the Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Changzhou from September 2014 to September 2018 were retrospectively analyzed. All of the six patients were confirmed by CT of neck and chest, among whom there were two males and four females aged from 48 to 73. Three patients were treated with cervical double parallel incision combined with mediastinoscope to be combined with cervical and thoracic drainage under general anesthesia while the other three with cervical double parallel incision combined with thoracoscope to be combined cervical and thoracic drainage under general anesthesia. The CT of neck and chest as well as infectious indicators including hematology, C-reactive protein (CRP) and procalcitonin (PCT) were reexamined during the postoperative period. Results: The cervical and thoracic combined drainage was unobstructed in all of the six patients, no secondary surgery was performed, and the infectious indicators gradually decreased. All patients had off-bed activities on the first day after the operation, were all cured and discharged after an average of 21 days (16 to 36 days) in hospital and followed up for an average of 18 months (4 to 30 months) after the operation. None of them experienced infection relapse, and they were all satisfied with the appearance of the cervical incision. Conclusions: Cervical double parallel incision combined with mediastinoscope or thoracoscope for the treatment of CNF accompanied with DNM has the advantages of complete drainage, small trauma, excellent efficacy and aesthetic operative area, thus being deserved to be clinically popularized.

EARLY MANAGEMENT AND WOUND DRESSING SELECTION FOR CERVICAL NECROTIZING FASCIITIS: A CASE REPORT

Necrotizing Fasciitis (NF) is a severe soft tissue infection characterized by rapidly progressing necrosis, involving skin, fascia, fat and subcutaneous tissue. NF can develop at head and neck region. This rare condition requires prompt diagnosis, emergency treatment, and precise wound dressing selection. The objective of this study is to describe early management and wound dressing selection in cervical NF case. A 48-years-old female came with swelling and spontaneous drainage at both side of lower jaw, chin, and neck region. Patient was diagnosed with necrotizing fasciitis at cervical region. Aggressive necrotomy debridement was done to manage infection. Wound was treated by modern dressing without requiring skin graft procedure. Patient did not have any complain and fully satisfied with the treatment result. Necrotizing fasciitis is a life-threatening, single or polymicrobial infection of soft tissue. This disease rarely involves the head and neck region; if it occurs, it is usually due to the spread of infection from the teeth or pharynx. Satisfying outcomes can be achieved with early diagnosis, aggressive surgical, empirical antimicrobial therapy, and post operative management with an appropriate dressing. There are many kinds of wound dressing available that challenges operator to choose an appropriate one to treat NF. A correct dressing can decreases healing time, provides cost-effective care, and improves patient quality of life. In conclusion, early management and appropriate wound dressing selection are very important to improve the clinical outcome and decrease patient’s long term morbidity.

Individuals’ quality of life in periodontal maintenance therapy - critical literature review.

Cervical necrotizing fasciitis (NF) is a soft tissue infection with a low incidence, characterized by rapid progression and high morbidity and mortality. The purpose of this report is to communicate the case of a patient diagnosed with cervical NF and its successful management. A 54-year-old male consulted after suffering from the condition for seven days. It was characterized by bilateral submandibular swelling, accompanied by fever, dysphagia, odynophagia, which were severely affecting the patient’s general health. Physical examination revealed a painful, erythematous cervical swelling. A cervical computed tomography scan was performed, revealing a gaseous collection in the left mucosal pharyngeal space, extending to the glottis, associated with significant deep plane soft tissue emphysema onon the left side of the neck and with possible involvement of the danger space; pertinent lab findings include 19,190/uL leukocytes and 219mg/L CRP. Broad-spectrum antibiotic therapy was initiated with ceftriaxone and clindamycin. Exploratory surgery, lavage and drainage of the collected material were performed. Streptococcus anginosus was isolated by culture. The patient recovered appropriately showing improvement in clinical as well as in inflammatory parameters, being discharged on the ninth day. He is currently receiving periodical checkups in the surgery polyclinic.

Odontogenic origin of descending necrotizing mediastinitis – controversies, multidisciplinary approach and personal experience

Introduction Descending necrotizing mediastinitis is usually a polymicrobial process and can lead to a serious clinical condition. It can be caused by formation of an oropharyngeal or odontogenic abscess that spreads the infection to the neck tissues and further via the cervical fascia planes to the mediastinum. Clinically there are two forms of cervical necrotizing fasciitis (CNF): suppurative and gaseous which if diagnosed late can have lethal effects. Multidisciplinary treatment is often essential for the recovery. Material and methods We would like to present our experience in managing a young adult patient who suffered from descending necrotizing mediastinitis (DNM) of odontogenic origin and describe controversies associated with its treatment. Incision and drainage of the neck were performed in the patient, antibiotic therapy was given, and oral cavity was irrigated, as well as parenteral and enteral immunonutrition enriched with omega-3 fatty acids (Omegaven) and glutamine (Dipeptiven) were started. Moreover, dental treatment was carried out, after which the patient’s clinical status improved. Results Dental treatment influenced the postoperative course. Multidisciplinary approach led to a full recovery of the patient. Conclusions Early multidisciplinary aggressive treatment of oropharyngeal infection and cervical necrotizing fasciitis is a life-saving procedure. Thorough surveillance with repeated CT scans, white blood cells and C-reactive protein evaluation, monitoring of bacteriological culture and surgical procedures which are performed in descending necrotizing mediastinitis facilitate the treatment and allow to avoid complications

Cervical necrotizing fasciitis: an overlooked diagnosis of a fatal disease

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.

Cervical Necrotizing Fasciitis—The Value of the Laboratory Risk Indicator for Necrotizing Fasciitis Score as an Indicative Parameter

Cervical necrotizing fasciitis (CNF) is uncommon, difficult to diagnose, and rapidly progressive. The objective of the present study was to determine the predictive value of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for CNF. The LRINEC score for 16 consecutive cases of CNF and 595 cases of severe non-necrotizing neck infections was determined over a 6.5-year period in a single-center retrospective cohort study and case report. CNF was confirmed by histologic examination and operative report documentation. Using a cutoff score of 6, the LRINEC score had a sensitivity of 0.94 (95% confidence interval [CI] 0.92 to 0.96) and specificity of 0.94 (95% CI 0.70 to 1.00). The positive predictive value was 0.29 (95% CI 0.17 to 0.44), and the negative predictive value was 0.99 (95% CI 0.99 to 1.00). The LRINEC score can detect early cases of CNF. Patients with a LRINEC score of ≥6 must be carefully evaluated for the presence of CNF.

Clinical and imaging factors associated with severe complications of cervical necrotizing fasciitis

Cervical necrotizing fasciitis (CNF) is a severe and debilitating disease that requires intensive care unit (ICU) management and prompt surgical treatment to reduce morbidity and mortality. The aim of this study was to estimate the incidence and factors associated with severe complications of CNF. We reviewed the medical records of consecutive patients hospitalized in an ICU from 2007 to 2012. The data were collected retrospectively; initial cervical and thoracic computed tomography (CT) scans, performed on admission, were reviewed by an experienced and blinded radiologist to determine CNF complications. A cohort of 160 patients admitted for CNF was included. The following complications of CNF were found: bilateral extension of CNF (28%), internal jugular vein thrombosis (21%), descending necrotic effusion (14%), mediastinitis (24%), and mortality (4%); 53% had at least one complication, and 48% had at least one cervical complication. On the basis of a univariate analysis, the significant independent factors are odynophagia, dyspnea, oral glucocorticoids intake before admission, and pharyngeal source. Oral nonsteroidal anti-inflammatory drug intake before admission does not have any impact. The initial CNF complications increased both the duration of mechanical ventilation and the length of stay in the ICU. On the basis of a multivariate analysis, the independent factors for severe complications are pharyngeal CNF and oral glucocorticoid intake before admission. Our study demonstrated that an initial cervico-thoracic CT scan revealed a high incidence of cervical and mediastinal CNF complications that all needed immediate management. Those severe complications might be avoidable as they were associated, at least partially, with prehospital oral glucocorticoid intake.

Percutaneous drainage for patients with cervical necrotizing fasciitis with novel CT classification based on extension of fluid collection along the deep cervical space

Cervical necrotizing fasciitis (CNF) is a rapidly evolving and life-threatening condition. Therefore, it is important for physicians to evaluate the severity of illness and to predict clinical outcome exactly in the early phase. We focused on extension of acute fluid collection along the deep cervical space by CT findings. The purpose of this study was to produce the CT grade and to analyze whether our CT grade is related to the clinical features and the responses to treatment of CNF.