Cervical Necrotizing Fasciitis: An Institutional Experience

Vikas Gupta; Shaila Sidam; Ganakalyan Behera; Aman Kumar; Utkal P Mishra

doi:10.7759/cureus.32382

Cervical Necrotizing Fasciitis: An Institutional Experience

Cureus. 2022 Dec 10;14(12):e32382. doi: 10.7759/cureus.32382. eCollection 2022 Dec.

Authors

Vikas Gupta¹, Shaila Sidam², Ganakalyan Behera³, Aman Kumar⁴, Utkal P Mishra²

Affiliations

¹ Otorhinolaryngology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
² Otolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
³ Otolaryngology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
⁴ Radiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.

Abstract

Introduction Cervical necrotizing fasciitis is an acute, progressive, and rapidly spreading soft tissue infection affecting the fascial planes of the head and neck region. It has high morbidity and mortality rate. In this study, we have reviewed cervical necrotizing fasciitis cases treated in our department and analyzed the various risk factors, laboratory indices, and treatment modalities that affect the prognosis of this deadly disease. Design and method This is a retrospective review. We have reviewed the medical records and charts of seven patients hospitalized in our institute with the diagnosis of cervical necrotizing fasciitis between 2015 and 2019. Results Of the seven patients, six were male and one was female. The mean age was 49.8 years (range: 38-70 years). Etiology was found to be odontogenic infection in five (71%) cases. The presenting feature in all cases was tender cervical swelling. Intraoperatively, the submandibular triangle was found to be involved in all cases (100%) followed by the carotid triangle in five (71%) cases and the submental triangle in three (42%) cases. The most common comorbidities associated with cervical necrotizing fasciitis were found to be uncontrolled diabetes mellitus and anemia. All patients underwent emergency aggressive surgical debridement and culture-directed broad-spectrum antibiotics (100%). Additional procedures in the form of tracheostomy were required in two (28%) cases and skin grafting in two (28%) cases. One patient in our series developed sepsis with descending mediastinitis. The average hospital stay was 27 days. All the patients survived with no mortality. Conclusion Cervical necrotizing fasciitis should be diagnosed early. Early initiation of broad-spectrum antibiotics and aggressive surgical debridement are the two key management strategies that can improve survival. Strict glycemic control and correction of anemia result in a favorable outcome.

Keywords: broad spectrum antibiotics; cervical necrotizing fasciitis; fatal; mortality; necrosis; necrotizing fascitis; urgent debridement.