Iran J Med Sci. Abstract Necrotizing fasciitis of the head and neck is a rare but rapidly progressive infection involving the skin, subcutaneous tissue, and fascia. We report 4 cases of cervicofacial necrotizing fasciitis with similar patterns of presentation. All the 4 cases presented with an odontogenic source and no underlying medical condition. All the patients had tooth extraction and serial wound debridement. Three of these patients recovered well, and healing of the wound occurred by secondary intention.
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Iran J Med Sci. Abstract Necrotizing fasciitis of the head and neck is a rare but rapidly progressive infection involving the skin, subcutaneous tissue, and fascia. We report 4 cases of cervicofacial necrotizing fasciitis with similar patterns of presentation.
All the 4 cases presented with an odontogenic source and no underlying medical condition. All the patients had tooth extraction and serial wound debridement. Three of these patients recovered well, and healing of the wound occurred by secondary intention.
One patient had a resultant neck defect, which was repaired with a supraclavicular island flap after the infection had subsided. We advocate the importance of early detection of necrotizing fasciitis with or without an underlying medical condition and an aggressive medical and surgical intervention.
Additionally, eradication of the source of infection is highly indicated to reduce the mortality of this disease. Factors predisposing to necrotizing fasciitis are diabetes, hypertension, obesity, malnutrition, peripheral vascular disease, severe liver disease, alcoholism, and acquired immunodeficiency syndrome. Clinical features of necrotizing fasciitis in the early stages are not specific, so it may not be correctly diagnosed.
Cervicofacial necrotizing fasciitis in these cases had odontogenic origins. Introduction Necrotizing fasciitis is a soft-tissue infection which is, albeit rare, rapidly progressive and potentially fatal. It is usually caused by toxin-producing virulent bacteria and is characterized by widespread fascia necrosis with relative sparing of the skin and the underlying muscle.
The superficial nerves are damaged, producing the characteristic localized anesthesia. Necrotizing fasciitis is commonly seen in the extremities, trunk, and perineum. Infections secondary to surgery or trauma have also been reported. She had been seen previously by a dentist, who prescribed amoxicillin and metronidazole; however, because of her failure to comply with treatment, her symptoms continued to worsen.
There was no significant finding in her past medical history. In addition, she was acyanosed, anicteric, febrile Extraoral examination demonstrated a diffuse fluctuant swelling with pus discharge, and the overlying skin appeared hyperemic. Intraorally, there was mild trismus and grade II mobility of the right second mandibular molar. A diagnosis of CNF involving the right submandibular and upper cervical region was made.
Pediatric intensive care unit. Patients A healthy 5-year-old male who developed NF of the lower lip 36 hours following minor trauma. International Classification of Diseases, Ninth Revision, code Results A pediatric case is presented with a thorough photographic record demonstrating the need for rapid diagnosis and treatment. In a review of the KID from and , the relative risk of being discharged with NF in vs was 1.
Techniques for early diagnosis and management of cervicofacial necrotising fasciitis
What is necrotising fasciitis? Necrotising fasciitis is a very serious bacterial infection of the soft tissue and fascia a sheath of tissue covering the muscle. The bacteria multiply and release toxins and enzymes that result in thrombosis clotting in the blood vessels. The result is destruction of the soft tissues and fascia. The main types of necrotising fasciitis are: Type I polymicrobial i. Type I necrotising fasciitis Bacteria causing type 1 necrotising fasciitis include Staphylococcus aureus , Haemophilus, Vibrio and several other aerobic and anaerobic strains Escherichia coli, Bacteroides fragillis. It is usually seen in the elderly or in patients affected with diabetes or other conditions.
Pediatric Cervicofacial Necrotizing Fasciitis
Epub Jan 4. Noma and cervicofacial necrotizing fasciitis: clinicopathological differentiation and an illustrative case report of noma. Noma predominantly affects malnourished young children. The pathogenesis of noma is complex and multifactorial, involving interaction between local polybacterial infection on the one hand, and malnutrition, immunosuppression, or systemic bacterial or viral infections on the other hand. Noma is considered to be an opportunistic disease, but the immediate cause is uncertain. Cervicofacial necrotizing fasciitis, on the other hand, occurs mainly in adults. It is frequently a consequence of an odontogenic infection and is characterized by an irregular pattern of rapidly spreading necrosis of fascia, muscle, and skin.
Cervico-facial necrotizing fasciitis.