1
|
Grillo R, Balel Y, Brozoski MA, Ali K, Adebayo ET, Naclério-Homem MDG. A global science mapping analysis on odontogenic infections. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101513. [PMID: 37207960 DOI: 10.1016/j.jormas.2023.101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Odontogenic infections are common and a topic of core interest for dentists, and maxillofacial surgeons. The aim of this study was to conduct a bibliometric analysis of the global literature on odontogenic infection and explore the top 100 most cited papers to identify the common causes, sequelae and management trends. METHODS Following a comprehensive literature search, a list of top 100 most cited papers was created. The VOSviewer software (Leiden University, The Netherlands) was used to create a graphical representation of the data, and statistical analyses were performed to analyze the characteristics of the top 100 most cited papers. RESULTS A total of 1,661 articles were retrieved with the first article published in 1947. There is an exponential upward trend on the number of publications (R2 = 0.919) and a majority of papers are in English language (n = 1,577, 94.94%). A total of 22,041 citations were found with a mean of 13.27 per article. The highest number of publications were recorded from developed countries. There was a male predilection in the reported cases and the most common sites included the submandibular and parapharyngeal spaces. Diabetes mellitus was identified as the commonest co-morbidity. Surgical drainage was ascertained to be the preferred method of management. CONCLUSIONS Odontogenic infections remain prevalent and have a global distribution. Although prevention of odontogenic infection through meticulous dental care is ideal, early diagnosis and prompt management of established odontogenic infections is important to avoid morbidities and mortality. Surgical drainage is the most effective management strategy. There is lack of consensus regarding the role of antibiotics in the management of odontogenic infections.
Collapse
Affiliation(s)
- Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Yunus Balel
- Department of Oral and Maxillofacial Surgery, Gaziosmanpasa University, Gaziosmanpasa, Turkey
| | - Mariana Aparecida Brozoski
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil
| | - Kamran Ali
- College of Dental Medicine, Qatar University, Doha, Qatar
| | - Ezekiel Taiwo Adebayo
- Department of Oral and Maxillofacial Surgery, University of Medical Sciences, Ondo, Nigeria
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil
| |
Collapse
|
2
|
Gravensteen IK, Rogde S. Sudden Death Due to Cervical Necrotizing Soft Tissue Infection. Am J Forensic Med Pathol 2022; 43:e26-e27. [PMID: 35900157 DOI: 10.1097/paf.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Ida Kathrine Gravensteen
- From the Division of Laboratory Medicine, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | | |
Collapse
|
3
|
Ahmadzada S, Rao A, Ghazavi H. Necrotizing fasciitis of the face: current concepts in cause, diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2022; 30:270-275. [PMID: 35906981 DOI: 10.1097/moo.0000000000000820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Necrotizing fasciitis of the face is uncommon but potentially life threatening. With adequate multidisciplinary treatment, mortality and has significantly improved. This article highlights current concepts and supporting literature in the management of facial necrotizing fasciitis. RECENT FINDINGS Management of necrotizing fasciitis involving the face requires a multisciplinary team approach, including early medical and surgical intervention. With early haemodynamic support, broad spectrum antibiotics and aggressive surgical debridement, mortality has reduced significantly. Soft-tissue reconstruction can be effectively utilized once the infection has been adequately treated. Although some adjunctive treatment such as vacuum assisted closure dressing has shown to be of benefit, other treatments such as hyperbaric oxygen remains controversial. SUMMARY Necrotizing fasciitis is an aggressive soft tissue involving that rapidly spreads along fascial planes. Necrotizing fasciitis involving the face is rare owing to its rich blood supply but is also difficult to manage due to the complex regional anatomy. Common sources are odontogenic, sinugenic, peritonsillar or salivary gland infections and often polymicrobial. The principles of treatment include early and aggressive haemodynamic support, broad spectrum antibiotics and aggressive surgical debridement. Often times repeat debridements following close monitoring is required. Reconstructive options are viable only after the infection has been adequately treated. Although mortality has significantly improved, mediastinal involvement, multiple comorbidities and delayed treatment confers a worse prognosis.
Collapse
Affiliation(s)
- Sejad Ahmadzada
- University of Sydney, Sydney
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Amshuman Rao
- University of Sydney, Sydney
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Hossein Ghazavi
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
4
|
Nazir H, Ying Chieng C, Rogers SN, Nekrasisus R, Dodd M, Shah N. Outcomes of necrotizing fasciitis in the head and neck region in the United Kingdom-a case series and literature review. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
5
|
Sideris G, Nikolopoulos T, Delides A. Cervical necrotizing fasciitis affects only immunocompromized patients? Diagnostic challenges, treatment outcomes and clinical management of eleven immunocompetent adult patients with a still fatal disease. Am J Otolaryngol 2020; 41:102613. [PMID: 32599441 DOI: 10.1016/j.amjoto.2020.102613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE 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. MATERIALS AND METHODS 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. RESULTS A total of eleven adult patients were included in the study. The average age was 43 years, ranging from 17 to 62 years. The average hospitalization time was 28 days, ranging from 10 to 129 days. 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. CONCLUSION 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.
Collapse
Affiliation(s)
- Giorgos Sideris
- National & Kapodistrian University of Athens, School of Medicine, 2nd Otolaryngology Department, "Attikon" University Hospital, Athens, Greece.
| | - Thomas Nikolopoulos
- National & Kapodistrian University of Athens, School of Medicine, 2nd Otolaryngology Department, "Attikon" University Hospital, Athens, Greece
| | - Alexander Delides
- National & Kapodistrian University of Athens, School of Medicine, 2nd Otolaryngology Department, "Attikon" University Hospital, Athens, Greece
| |
Collapse
|
6
|
Darat HN, Kanodia AK, Yong A, Ram B. A rare case of non-clostridial infection in a non-diabetic patient. BMJ Case Rep 2020; 13:13/1/e233467. [PMID: 31919070 DOI: 10.1136/bcr-2019-233467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 76-year-old man presented with neck swelling associated with pain and fever. On examination, there was a submental neck swelling. His initial CT scan showed multiloculated abscess centred in the left submandibular gland. He remained febrile despite on intravenous ceftriaxone and metronidazole. A repeat CT scan revealed significant worsening with multiple pockets of fluids with gas locules in the deep neck spaces. He subsequently underwent neck exploration and drainage of neck abscess. Extensive necrotic tissue was found intraoperatively and thick pus was drained from the bilateral parapharyngeal, submental spaces and anterior mediastium. Pus culture profusely grew of Eggerthella species. Patient recovered well following further intravenous antibiotic therapy. Diabetes mellitus and odontogenic infections are the common risk factors in deep neck infections. Our patient is however non-diabetic and edentulous. Current case is presented to serve as a rare case of neck abscess with unusual cause in a non-diabetic patient.
Collapse
Affiliation(s)
| | | | - Aiwain Yong
- Radiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Bhaskar Ram
- Otolaryngology, Aberdeen Royal Infirmary, Aberdeen, UK
| |
Collapse
|
7
|
Taneja V, Walker RJ, Tedla M. Necrotising fasciitis of the neck: Unusual presentation with aggressive management – case report with review of literature. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2016.1266636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Virangna Taneja
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Rachel J. Walker
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Miroslav Tedla
- Otorhinolaryngology Department, Warwick University and University Hospital Coventry, Coventry, UK
- Department of ORL-HNS, Faculty of Medicine, Comenius University Bratislava, Slovakia
| |
Collapse
|
8
|
Necrotizing fasciitis of the head and neck: Surgical follow up of 2 cases with the use of LRINEC score. INTERNATIONAL JOURNAL OF SURGERY OPEN 2017. [DOI: 10.1016/j.ijso.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
9
|
Eltayeb AS, Ahmad AG, Elbeshir EI. A case of labio-facial necrotizing fasciitis complicating acne. BMC Res Notes 2016; 9:232. [PMID: 27107717 PMCID: PMC4841958 DOI: 10.1186/s13104-016-2041-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Facial necrotizing fasciitis is extremely rare. Most of the cases reported in literature are related to dental, sinus, tonsillar and salivary glands causes, but rarely as consequence of skin infection. We report a unique case of lower lip cellulitis, which was initially misdiagnosed as angioedema and subsequently progressed into lower lip necrotizing fasciitis. CASE PRESENTATION This is a case report of necrotizing fasciitis involving the lower lip as a consequence of infected skin acne in a 19 year old black female. The patient had been diagnosed earlier as a case of angioedema by a physician and treated accordingly. She was mildly anemic, hyponatremic and hypokalemic. Treatment was started immediately by incision, drainage and full debridement of the whole necrotic tissue. Triple antibiotic therapy was administered and daily irrigation and dressing were performed until full recovery. Complete healing occurred within a month by secondary intention. CONCLUSION This case demonstrates the misdiagnosis of a lip swelling leading to the development of labiofacial necrotizing fasciitis, a serious and life threatening condition. Lip angioedema is a common condition; however, lip fasciitis is rare. A broad differential diagnosis in case of lower lip swelling is essential to avoid inappropriate treatment delay.
Collapse
Affiliation(s)
| | | | - Elnour Ibrahim Elbeshir
- Faculty of Dentistry, The University of Medical Sciences and Technology, P.O Box 12810, Khartoum, Sudan
| |
Collapse
|
10
|
An unusual infection of cervicofacial area caused by dental pathology: flesh-eating syndrome. Am J Emerg Med 2015; 33:1543.e3-6. [PMID: 26298055 DOI: 10.1016/j.ajem.2015.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/19/2015] [Indexed: 11/20/2022] Open
Abstract
Necrotizing fasciitis (NF) of the cervicofacial area is highly rare, but physicians should be familiar with the presentation of this situation owing to the suddenness of its beginning, the rapidness of its spread, and ending with high mortality and morbidity. In this article, 5 patients with NF admitted to emergency department with dental pathology history were discussed with a review of the literature. The purpose of this case series is to raise awareness about NF of the cervicofacial area caused by dental pathologies. Five patients admitted to our emergency department between January 2012 and March 2015 and diagnosed as having cervicofacial NF were identified. All patients had dental pathologies. The parameters of the study were patients' age, sex, complaints, self- and family histories, physical examinations' findings, routine laboratory-computed tomographic findings, treatment, and complications. Two of the patients were older than 70 years. One of the patients was healthy but he lost time because of an inappropriate treatment. These 3 patients died. The remaining patients were discharged at the end of the prolonged and intensive treatment. Necrotizing fasciitis should always be remembered in the diagnosis of the infection of the cervicofacial area. Because of difficulty in its diagnosis, a delay in the treatment may result in a horrific outcome.
Collapse
|
11
|
Bennani-Baïti AA, Benbouzid A, Essakalli-Hossyni L. Cervicofacial cellulitis: The impact of non-steroidal anti-inflammatory drugs. A study of 70 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:181-4. [PMID: 26139417 DOI: 10.1016/j.anorl.2015.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cervicofacial cellulitis (CFC) is a severe infection of the subcutaneous cellular tissue, and is one of the most serious head and neck infectious emergencies. In a series of 70 cases treated between 2007 and 2012, we noticed a strong correlation between use of non-steroidal anti-inflammatory drugs (NSAIDs) and evolution of head and neck infections toward CFC, including two cases of necrotic CFC extending to the mediastinum, which were fatal. MATERIAL AND METHODS The cases included in the series comprised patients admitted to emergency and requiring hospitalization due to the severity of presenting symptoms. There were 70 such cases of CFC between 2007 and 2012; cases managed on an outpatient basis were excluded, as were cases of orbital CFC, CFC of sinus origin and mastoiditis. RESULTS Eighty percent of patients took NSAIDs, on self-medication or by prescription (community physician, dentist, pharmacist). The most frequent molecules were tiaprofenic acid and diclofenac. CFC extension was restricted in most cases to the maxillary and/or ipsilateral subhyoid region, with 5 cases of lower cervical extension and 2 of mediastinal involvement, which both proved fatal. CONCLUSION CFC is a severe infection that can be life-threatening, and represents a diagnostic and therapeutic emergency. Among other risk factors, use of NSAIDs is frequently reported; these should therefore be used with caution if at all in head and neck infection, especially of odonto-stomatological origin.
Collapse
Affiliation(s)
- A A Bennani-Baïti
- Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, faculté de médecine et de pharmacie, hôpital des spécialités Rabat, 10000 Rabat, Morocco.
| | - A Benbouzid
- Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, faculté de médecine et de pharmacie, hôpital des spécialités Rabat, 10000 Rabat, Morocco
| | - L Essakalli-Hossyni
- Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, faculté de médecine et de pharmacie, hôpital des spécialités Rabat, 10000 Rabat, Morocco; UFR d'ORL et de CMF, faculté de médecine et de pharmacie, université Mohmamed V, Rabat, Morocco
| |
Collapse
|
12
|
Choi MG. Necrotizing fasciitis of the head and neck: a case report. J Korean Assoc Oral Maxillofac Surg 2015; 41:90-6. [PMID: 25922821 PMCID: PMC4411734 DOI: 10.5125/jkaoms.2015.41.2.90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/02/2014] [Accepted: 12/09/2014] [Indexed: 11/07/2022] Open
Abstract
Necrotizing fasciitis (NF) is an infection that spreads along the fascial planes, causing subcutaneous tissue death characterized by rapid progression, systemic toxicity, and even death. NF often appears as a red, hot, painful, and swollen wound with an ill-defined border. As the infective process continues, local pain is replaced by numbness or analgesia. As the disease process continues, the skin initially becomes pale, then mottled and purple, and finally, gangrenous. The ability of NF to move rapidly along fascial planes and cause tissue necrosis is secondary to its polymicrobial composition and the synergistic effect of the enzymes produced by the bacteria. Treatment involves securing the airway, broad-spectrum antimicrobial therapy, intensive care support, and prompt surgical debridement, repeated as needed. Reducing mortality rests on early diagnosis and prompt aggressive treatment.
Collapse
Affiliation(s)
- Moon-Gi Choi
- Department of Oral and Maxillofacial Surgery, Wonkwang University School of Dentistry, Iksan, Korea
| |
Collapse
|
13
|
Özkan A, Şentürk S, Topkara A, Tosun Z. Extensive cervicofacial necrotizing fasciitis of odontogenic origin: case report and literature review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-014-1036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
14
|
Muhammad JK, Almadani H, Al Hashemi BA, Liaqat M. The value of early intervention and a multidisciplinary approach in the management of necrotizing fasciitis of the neck and anterior mediastinum of odontogenic origin. J Oral Maxillofac Surg 2014; 73:918-27. [PMID: 25795188 DOI: 10.1016/j.joms.2014.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/16/2022]
Abstract
Necrotizing fasciitis (NF) is a serious clinical condition, which, if diagnosed late, invariably leads to a fatal outcome. A high index of suspicion of the presenting clinical signs and symptoms, supported by knowledge of the clinicopathologic processes that underlie its aggressive nature, should prompt early surgical intervention. Ultimately, the success of treatment requires a robust clinical pathway in which all members of the health care team are aligned by their skill sets and competencies to manage NF. This report describes the management of a case of a young man with aggressive NF of odontogenic origin affecting the neck and anterior mediastinum. A multidisciplinary approach brought about early recognition of the disease and surgical intervention, the use of frozen section biopsies to determine the extent of fascial spread, and aggressive debridement of the affected tissue. Teamwork, critical thinking, and situational awareness ensured that the patient received optimum care in a timely manner. The psychological, clinical, radiologic, pathologic, and microbiological aspects of the patient's care are presented with a literature review.
Collapse
Affiliation(s)
- Joseph Kamal Muhammad
- Consultant and Head, Maxillofacial Surgery Service, Al Rahba Hospital, Abu Dhabi, UAE; formerly at Mafraq Hospital, Abu Dhabi.
| | - Hana Almadani
- Consultant, Department of General Surgery, Mafraq Hospital, Abu Dhabi, UAE
| | - Bader A Al Hashemi
- Consultant and Head, Department of Maxillofacial Surgery, Mafraq Hospital, Abu Dhabi, UAE
| | - Muneezeh Liaqat
- Consultant, Department of Anatomic Pathology, Mafraq Hospital, Abu Dhabi, UAE
| |
Collapse
|
15
|
Horváth T, Horváth B, Varga Z, Liktor B, Szabadka H, Csákó L, Liktor B. Severe neck infections that require wide external drainage: clinical analysis of 17 consecutive cases. Eur Arch Otorhinolaryngol 2014; 272:3469-74. [PMID: 25359195 DOI: 10.1007/s00405-014-3367-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/23/2014] [Indexed: 11/25/2022]
Abstract
Infections in the neck layers and spaces are potentially life-threatening diseases causing further complications, like mediastinitis, airway obstruction, or sepsis. Despite of the need for a conservative approach, they still regularly require surgical intervention. Records of 17 patients with severe neck infections that were treated by wide external incision and open wound management were retrospectively analyzed. The aim of the study was to clinically characterize these most serious neck infections. The most common presenting symptoms were neck pain and tense neck mass (94-94%) regularly with fever (65%), always accompanied by a marked elevation of C reactive protein level (average 192 uG/l). These findings were constant and very similar among both the deep neck infection and necrotizing fasciitis cases. More than half of the patients (53%) had at least one systemic co-morbidity. The parapharyngeal space was most commonly affected (83%), but extended disease involving more than two major neck regions was found in 13 cases (76%). Dental (29%) was the most common primary infection, followed by peritonsillar abscess (23%), Microbiological results showed a wide variety of corresponding bacteria. Mediastinitis was developed in three cases (18%), and airway obstruction requiring tracheostomy in two cases (12%). All the patients survived. Severe neck infections are a heterogenous group of diseases regarding to the primary site of infection, microbiology, localisation and host reaction. However, rapidly developed, painful, tense neck mass with a highly elevated CRP level should always alert for an extended or phlegmonous process in the layers or spaces of the neck.
Collapse
Affiliation(s)
- Tamás Horváth
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary.
| | - Barnabás Horváth
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
| | - Zsuzsa Varga
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
| | - Bálint Liktor
- Department of Otolaryngology and Head and Neck Surgery, County Hospital, Oberwart, Austria
| | - Hajnalka Szabadka
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
| | - László Csákó
- Department of Otolaryngology and Head and Neck Surgery, Jahn Ferenc Hospital, Budapest, Hungary
| | - Bálint Liktor
- Department of Otolaryngology and Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Street 89-91, Budapest, 1106, Hungary
| |
Collapse
|
16
|
Abstract
Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the overlying skin. Periorbital NF is uncommon because of the excellent blood supply to that area; nevertheless, it can sometimes result in death. The aim of this study is to present a systematic review and analyse the factors associated with death. We carried out a systematic literature review of all cases of periorbital NF published in the English language over the past 20 years and present the predisposing conditions, triggering factors, organisms causing NF, presence or absence of toxic shock and the prognosis. The significance of various risk factors leading to death was analysed. We traced a total of 94 patients with periorbital NF from 61 reports. There were no triggering incidents in 25 cases (26.6%). In 48 cases (51.1%), the organism responsible for NF was Group A beta haemolytic Streptococcus. Toxic shock occurred in 29 (30.9%) cases, and loss of vision in 13 (13.8%). Surgical debridement was carried out in 80 (85.1%) cases. There were eight cases (8.5%) of death. This seems to be less than previously reported figures. Toxic shock syndrome (p < 0.001), type 1 infections (p = 0.018), facial involvement (p = 0.032) and blindness because of periorbital NF (p = 0.035) were significantly associated with mortality. Mortality caused by NF arising from the periorbital area seems to be on the decline. However, it is important to recognize it early and institute treatment to avoid toxic shock that leads to death. Type 1 infections, although rare in periorbital area, are not associated with immunocompromised status and nevertheless carry a significant risk of mortality. Major morbidity is loss of vision followed by soft-tissue defects affecting function and cosmesis.
Collapse
Affiliation(s)
- Shantha Amrith
- Department of Ophthalmology, National University Health System, Singapore City, SingaporeDepartment of Ophthalmology, Kasturba Medical College, Manipal University, Manipal, IndiaSingapore Eye Research Institute, Singapore National Eye Center, Singapore City, Singapore
| | | | | |
Collapse
|
17
|
|
18
|
Sarna T, Sengupta T, Miloro M, Kolokythas A. Cervical Necrotizing Fasciitis With Descending Mediastinitis: Literature Review and Case Report. J Oral Maxillofac Surg 2012; 70:1342-50. [DOI: 10.1016/j.joms.2011.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 10/17/2022]
|
19
|
Jain S, Nagpure PS, Singh R, Garg D. Minor trauma triggering cervicofacial necrotizing fasciitis from odontogenic abscess. J Emerg Trauma Shock 2011; 1:114-8. [PMID: 19561990 PMCID: PMC2700617 DOI: 10.4103/0974-2700.43197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 06/21/2008] [Indexed: 11/04/2022] Open
Abstract
Necrotizing fasciitis (NF) of the face and neck is a very rare complication of dental infection. Otolaryngologists and dentists should be familiar with this condition because of its similarity to odontogenic deep neck space infection in the initial stages, its rapid spread, and its life-threatening potential. Trauma has been reported to be an important predisposing factor for NF of the face. In this paper, we describe the presentation and treatment of a 62-year-old man who developed NF of the face and neck following bilateral odontogenic deep neck space abscesses. The disease progressed rapidly, with necrosis of the skin, after the patient inflicted minor trauma in the form of application of heated medicinal leaves. The organism isolated in culture from pus was Acinetobacter sp. The comorbid conditions in our patient were anemia and chronic alcoholism. The patient was managed by immediate and repeated extensive debridements and split-skin grafting.
Collapse
Affiliation(s)
- Shraddha Jain
- Department of Otorhinolaryngology and HNS, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
| | | | | | | |
Collapse
|
20
|
Necrotizing fasciitis: review of the literature and case report. J Oral Maxillofac Surg 2011; 69:2786-94. [PMID: 21367503 DOI: 10.1016/j.joms.2010.11.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/21/2010] [Accepted: 11/23/2010] [Indexed: 11/20/2022]
|
21
|
Cervical necrotizing fasciitis due to methicillin-resistant Staphylococcus aureus: a case report. Int J Oral Maxillofac Surg 2010; 39:830-4. [PMID: 20417058 DOI: 10.1016/j.ijom.2010.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 12/17/2009] [Accepted: 03/18/2010] [Indexed: 11/21/2022]
Abstract
Cervical necrotizing fasciitis is an uncommon but potentially fatal infection characterized by rapidly progressive, widespread necrosis of the superficial fascia. The authors report a case of cervical necrotizing fasciitis of odontogenic origin in a male with uncontrolled diabetes mellitus. An early diagnosis was based on clinical examination, confirmed by computed tomography (CT) scan, which showed multiple collections of air in the left submandibular, submental and cervical region. Broad spectrum antibiotic therapy was started quickly followed by surgical drainage and debridement. Pus culture was positive for methicillin-resistant Staphylococcus aureus. Four days after admission, mediastinitis was revealed by CT and drainage was conducted through a transcervical incision. The patient was treated successfully with antimicrobial therapy, repeated surgical debridement and supportive care.
Collapse
|
22
|
Delaney P, Rafiq R, Dodd M. Craniocervical necrotising fasciitis--an interesting case with review of the literature. Br J Oral Maxillofac Surg 2010; 48:e1-4. [PMID: 20392550 DOI: 10.1016/j.bjoms.2010.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 01/18/2010] [Indexed: 11/17/2022]
Abstract
Craniocervical necrotising fasciitis (CCNF) is an aggressive and potentially fatal infection associated with high morbidity and mortality if early intervention is not implemented. Patients are often unwell at presentation, the clinical picture is often unclear thus presenting with diagnostic difficulty. We report a case of CCNF presenting at an advanced stage and discuss the condition including its management and associated complications.
Collapse
Affiliation(s)
- Paddy Delaney
- Oral and Maxillofacial Surgery, Regional Maxillofacial Unit, University Hospital Aintree Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK.
| | | | | |
Collapse
|
23
|
Necrotizing fasciitis of the head and neck: 34 cases of a single institution experience. Eur Arch Otorhinolaryngol 2009; 267:415-21. [PMID: 19551399 DOI: 10.1007/s00405-009-1007-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
Abstract
We analyzed 34 patients with necrotizing fasciitis (NF) of the head and neck. According to the clinical presentation, we classified NF into the cervical and cranial type. Infection can spread along the superficial lamina or along the pretracheal lamina of the deep cervical fascia. In the first type, skin necrosis is the main sequelae, while in the second case, descending infection and mediastinitis are the main complications. Of the 34 patients, in 17 the infection progressed in the mediastinum. Due to aggressive surgical therapy and postoperative intensive care, the mortality rate remained low (1/17; 6%). In this analysis, we emphasize the importance of an accurate and fast diagnosis, followed by aggressive surgical therapy and a multidisciplinary approach.
Collapse
|
24
|
Eter EG, Khazzaka A, Mneimneh W, Karam-Sarkis D, Haddad A, Sarkis R. Does diclofenac increase the risk of cervical necrotizing fasciitis in a rat model? Int J Exp Pathol 2009; 90:58-65. [PMID: 19200252 DOI: 10.1111/j.1365-2613.2008.00594.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are known for aggravating in vitro infections and were reported in many cases of cervical necrotizing fasciitis (CNF). We developed a rat model of CNF, mimicking as closely as possible the human-CNF, to study the effect of a NSAIDs, diclofenac, as a promoting factor. Twenty rats were injected bilaterally in the neck with peptostreptococcus and with a fresh saliva specimen for another 20 rats. Half of each group was given an intramuscular injection of 4 mg/kg diclofenac at the time of inoculation and 24 h later, and the other half saline injections; rats were killed at day 7 and clinical, bacterial and histological studies were performed to assess the infectious process and the incidence of CNF. No statistically significant difference was found between groups treated with diclofenac vs. the saline injection groups. However a significant correlation was noted between clinical observation, bacterial density and histological signs of inflammation. CNF has a high mortality rate and the use of NSAIDs in conditions potentially leading to CNF is very common. However, our rat model does not support the hypothesis of a promoting role of diclofenac which was occasionally suggested in the medical literature. This study suggests that diclofenac does not seem to increase the risk of occurrence of CNF. Nonetheless, NSAIDs can mask inflammatory signs of an already spreading CNF.
Collapse
Affiliation(s)
- Elie G Eter
- Department of Otolaryngology Head and Neck Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Craniofacial necrotizing fasciitis: reconstruction after radical surgery. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-007-0197-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
27
|
Hwang HB, Doh SH, Yang SW. A Case of Periocular Necrotizing Fasciitis of Odontogenic Origin. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.6.993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyung Bin Hwang
- Department of Ophthalmology, St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Hee Doh
- Department of Ophthalmology, St. Paul Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Woo Yang
- Department of Ophthalmology, Kangnam St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Kore
| |
Collapse
|
28
|
Krenk L, Nielsen HU, Christensen ME. Necrotizing fasciitis in the head and neck region: an analysis of standard treatment effectiveness. Eur Arch Otorhinolaryngol 2007; 264:917-22. [PMID: 17340128 DOI: 10.1007/s00405-007-0275-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Accepted: 01/10/2007] [Indexed: 10/23/2022]
Abstract
A standard treatment procedure for necrotizing fasciitis in the head and neck region was introduced in 1999 at Rigshospitalet (National Hospital of Denmark) Copenhagen. The new procedure introduced more drastic surgical debridement than before, combined with a set antibiotic regime and intravenous gamma globulin and adjunctive hyperbaric oxygen treatment (HBO). To evaluate the effect of this, a retrospective study was undertaken, involving 19 patients treated for NF at the ENT department from 1996-2004. Between 1996 and 1999 eight patients were treated (non-HBO) from 1999-2004 eleven patients were treated (HBO group). Length of antibiotic treatment was very similar in the two groups (mean 22.5 days) as was bacteriology. Aetiological focus differed marginally with the HBO group showing a clear tendency towards odontogen focus. The HBO group was found to undergo significantly more debridement procedures (3.36). The most drastic difference in the two groups however, was the reduction in mortality. The non-HBO group had a mortality of 75% and in the HBO group they all survived. This obviously resulted in a prolonged hospital stay for the HBO group (mean 30.8 days). The study concluded that the reduction in mortality was due to the combined effects of the different entities in the new treatment guidelines. It was not possible to isolate a specific factor responsible for the change.
Collapse
Affiliation(s)
- Lene Krenk
- Department of Otolaryngology-Head and Neck Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | | | | |
Collapse
|
29
|
Marioni G, Rinaldi R, Ottaviano G, Marchese-Ragona R, Savastano M, Staffieri A. Cervical necrotizing fasciitis: A novel clinical presentation of Burkholderia cepacia infection. J Infect 2006; 53:e219-22. [PMID: 16545459 DOI: 10.1016/j.jinf.2006.01.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 01/28/2006] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
Necrotizing fasciitis is a soft-tissue infection characterized by progressive destruction of fascia and adipose tissue which may not involve the skin. Cervical necrotizing fascitis (CNF) is an uncommon clinical entity. The development of CNF is frequently related to synergistic infections of aerobic and anaerobic organisms of the upper aerodigestive tract. We describe the first case of CNF due to multi-drug resistant Burkholderia cepacia and Peptostreptococcus infection in an immuno-competent patient without cystic fibrosis.
Collapse
Affiliation(s)
- Gino Marioni
- Department of Otolaryngology, Head and Neck Surgery, Padova University, Via Giustiniani 2, Padova, Italy.
| | | | | | | | | | | |
Collapse
|
30
|
Oczenski W, Waldenberger F, Nehrer G, Kneifel W, Swoboda H, Schwarz S, Fitzgerald RD. Vacuum-assisted closure for the treatment of cervical and mediastinal necrotizing fasciitis. J Cardiothorac Vasc Anesth 2004; 18:336-8. [PMID: 15232816 DOI: 10.1053/j.jvca.2004.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wolfgang Oczenski
- Department of Anesthesia and Intensive Care, Lainz Hospital-Vienna, Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
31
|
Sakran W, Mazzawi S, Merzel Y, Colodner R. Streptococcal necrotizing fasciitis with toxic shock syndrome following cervical adenitis. Int J Pediatr Otorhinolaryngol 2004; 68:1209-13. [PMID: 15302155 DOI: 10.1016/j.ijporl.2004.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2004] [Revised: 04/06/2004] [Accepted: 04/07/2004] [Indexed: 10/26/2022]
Abstract
In the recent years an increase of serious invasive infections due to Group A Streptococcus have been reported. Necrotizing fasciitis is a rapidly progressive soft tissue infection characterized by necrosis of the subcutaneous tissues and superficial fascia. We report a case of necrotizing fasciitis and toxic shock syndrome following cervical adenitis in a previously healthy 11-month-old boy. Cultures from blood and the necrotic lymph node grew Group A Streptococcus. Group A Streptococcus belonging to M1 serotype and producing streptococcal pyrogenic exotoxin, SPE A was identified. Full recovery was achieved by aggressive treatment, which included intensive care support, extensive surgical debridement of necrotic lesions and antibiotic treatment with the combination of penicillin and clindamycin.
Collapse
Affiliation(s)
- Waheeb Sakran
- Department of Otolaryngology, Ha'Emek Medical Center, Afula, Israel.
| | | | | | | |
Collapse
|
32
|
Abstract
PURPOSE To report a case of progressive necrotizing fasciitis of the face following acute dacryocystitis. DESIGN Interventional case report. METHODS A 60-year-old woman presented with left acute dacryocystitis with abscess formation that had ruptured; a small wound remained. Erythematous swelling of the left eyelid and face developed 3 days later. Clinical progression and computed tomographic findings led to the diagnosis of necrotizing fasciitis with abscess formation. Early intravenous antibiotics and repeated surgical debridements were performed. RESULTS Soft tissue necrosis was found the fascial planes extending deep to the maxilla bone and periorbital fat. The patient was successfully treated without ocular, orbital, or facial complications. CONCLUSIONS Necrotizing fasciitis of the eyelid and face progresses rapidly. Early diagnosis, prompt intravenous antibiotic administration, and aggressive surgical debridement will prevent the associated morbidity and mortality.
Collapse
|
33
|
Nouraei SAR, Hodgson ELB, Malata CM. Cervicofacial necrotising fasciitis: management with neck dissection and topical negative pressure. J Wound Care 2003; 12:147-9. [PMID: 12715487 DOI: 10.12968/jowc.2003.12.4.26489] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Copious exudate prevented skin-graft take following a bilateral neck dissection in a case of cervicofacial necrotising fasciitis. The use of topical negative pressure avoided extensive skin excision and complicated reconstructive surgery.
Collapse
Affiliation(s)
- S A R Nouraei
- Gonville and Caius College, Cambridge University, Cambridge, UK
| | | | | |
Collapse
|
34
|
Umeda M, Minamikawa T, Komatsubara H, Shibuya Y, Yokoo S, Komori T. Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:283-90. [PMID: 12627098 DOI: 10.1067/moe.2003.85] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Necrotizing fasciitis of the head and neck is an uncommon, potentially fatal soft tissue infection characterized by extensive necrosis and gas formation in the subcutaneous tissue and fascia. The aims of this study were to describe the condition of this rare disease and to find factors affecting the mortality. STUDY DESIGN Nine of our new cases and 125 reported cases in the English-language literature with necrotizing fasciitis of dental origin were reviewed. RESULTS Two of our 9 patients had some form of systemic disease such as diabetes, cardiac insufficiency, renal failure, or cerebral infarction, whereas the other 7 had no particular general complications. A computed tomography examination was useful for detecting gas formation in the deep neck. All 9 patients underwent extensive debridement within 24 hours, and good results were obtained. In contrast, 24 of the 125 reviewed patients died despite therapy. Factors affecting the mortality were associated diseases such as diabetes or alcohol abuse, delay of surgery, and the complication mediastinitis. CONCLUSION Necrotizing fasciitis is still a potentially fatal disease. Early and aggressive debridement may reduce mortality.
Collapse
Affiliation(s)
- Masahiro Umeda
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kobe University.
| | | | | | | | | | | |
Collapse
|
35
|
Newton CL, deLEMOS D, Abramo TJ, Murrey A, Noell C. Cervical necrotizing fasciitis caused by Serratia marcescens in a 2 year old. Pediatr Emerg Care 2002; 18:433-5. [PMID: 12488837 DOI: 10.1097/00006565-200212000-00007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report an unusual, life-threatening complication of producing fulminant cervical necrotizing fasciitis in a previously healthy 2-year-old girl. We reviewed the literature for necrotizing fasciitis in children and its morbidity, mortality, and treatment. This case illustrates the necessity of prompt recognition and aggressive management in patients presenting with cervical necrotizing fasciitis.
Collapse
Affiliation(s)
- Christopher L Newton
- University of Texas Southwestern Medical Center, Division of Pediatric Emergency Medicine, Children's Medical Center of Dallas, Texas 75235, USA
| | | | | | | | | |
Collapse
|
36
|
Beeson WH, Slama TG, Beeler RT, Rachel JD, Picerno NA. Group A streptococcal fasciitis after submental tumescent liposuction. ARCHIVES OF FACIAL PLASTIC SURGERY 2001; 3:277-9. [PMID: 11710866 DOI: 10.1001/archfaci.3.4.277] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Tumescent liposuction is a procedure with a good safety record. Local infection is rare but can result in devastating consequences. We report a rare case of group A streptococcal fasciitis complicating tumescent liposuction and highlight the importance of early diagnosis and treatment of this condition. A 62-year-old woman presented 8 days after submental liposuction and a platysmal plication procedure with signs and symptoms of cervical fasciitis. Microbiological analysis confirmed a group A streptococcal infection. By using early aggressive medical and surgical treatments, the disease was arrested before the onset of any necrotizing process. A high index of suspicion is required to make an early diagnosis of this potentially disfiguring and life-threatening infection.
Collapse
Affiliation(s)
- W H Beeson
- Beeson Aesthetic Surgery Institute, 13590 N Meridian St, Carmel, IN 46032, USA.
| | | | | | | | | |
Collapse
|
37
|
Bahu SJ, Shibuya TY, Meleca RJ, Mathog RH, Yoo GH, Stachler RJ, Tyburski JG. Craniocervical necrotizing fasciitis: an 11-year experience. Otolaryngol Head Neck Surg 2001; 125:245-52. [PMID: 11555761 DOI: 10.1067/mhn.2001.118182] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We review our experience and present our approach to treating craniocervical necrotizing fasciitis (CCNF). STUDY DESIGN All cases of CCNF treated at Wayne State University/Detroit Receiving Hospital from January 1989 to April 2000 were reviewed. Patients were analyzed for source and extent of infection, microbiology, co-morbidities, antimicrobial therapy, hospital days, surgical interventions, complications, and outcomes. RESULTS A review of 250 charts identified 10 cases that met the study criteria. Five cases (50%) had spread of infection into the thorax, with only 1 (10%) fatality. An average of 24 hospital days (7 to 45), 14 ICU days (6 to 21), and 3 surgical procedures (1 to 6) per patient was required. CONCLUSION Aggressive wound care, broad-spectrum antibiotics, and multiple surgical interventions resulted in a 90% (9/10) overall survival and 80% (4/5) survival for those with thoracic extension. SIGNIFICANCE This is the largest single institution report of CCNF with thoracic extension identified to date.
Collapse
Affiliation(s)
- S J Bahu
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | | | | | | | | | | |
Collapse
|
38
|
Fatal Cervical Necrotizing Fasciitis (A Report of Two Cases of Confirmed Odontogenic Origin and One of Possible Odontogenic Origin). J Forensic Sci 2001. [DOI: 10.1520/jfs15077j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
39
|
Lin C, Yeh FL, Lin JT, Ma H, Hwang CH, Shen BH, Fang RH. Necrotizing fasciitis of the head and neck: an analysis of 47 cases. Plast Reconstr Surg 2001; 107:1684-93. [PMID: 11391186 DOI: 10.1097/00006534-200106000-00008] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Necrotizing fasciitis is an overwhelming infection common to the perineum, abdominal wall, and extremities. It is a surgical emergency related to a high mortality rate that is more often seen in elderly and immunocompromised patients. Necrotizing fasciitis occurs uncommonly in the head and neck region. Over a 12-year period, 47 cases of necrotizing fasciitis of the head and neck region were collected at this hospital. The demographics, predisposing factors, clinical presentation and courses, management, complications, and outcomes were analyzed. The cases were divided into two groups: survivors and nonsurvivors. Statistical comparisons were made of the parameters age, gender, smoking or drinking habit, underlying medical problems, laboratory data, and treatments used. Forty-two patients (89.4 percent) had associated systemic disease; most of these patients had diabetes (72.3 percent). The clinical manifestations are nonspecific but are often typical for diagnosis. The necessity of computed tomographic scans is not conclusive in this study. Presentation of septic shock (p = 0.004) and association with underlying malignancy (p = 0.03) were the only statistically significant factors that led to a poor prognosis. The cornerstones of proper management include early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and intensive supportive care.
Collapse
Affiliation(s)
- C Lin
- Division of Plastic and Reconstructive Surgery, Veterans General Hospital-Taipei and the National Yang-Ming University, Taiwan, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
40
|
Tung-Yiu W, Jehn-Shyun H, Ching-Hung C, Hung-An C. Cervical necrotizing fasciitis of odontogenic origin: a report of 11 cases. J Oral Maxillofac Surg 2000; 58:1347-52; discussion 1353. [PMID: 11117681 DOI: 10.1053/joms.2000.18259] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Although most cases of cervical necrotizing fasciitis (CNF) are odontogenic in origin, reports of this disease in the dental literature are sparse. The purpose of this study was to review the cases treated on our service, and to analyze the features of this disease and the responses to management, to supplement the understanding of this relatively rare and life-threatening disease. PATIENTS AND METHODS All cases of infection admitted to the OMS service in a period of 10.5 years were studied retrospectively. The diagnosis of CNF was established by the findings on surgical exploration and histologic examination. The patients' age, sex, medical status, causes of the infection, bacteriology, computed tomography scan findings, surgical interventions, complications, survival, and other clinical parameters were reviewed. RESULTS A total of 422 cases of infection were admitted, and 11 cases of cervical necrotizing fasciitis were found. The incidence of CNF was 2.6% among the infections hospitalized on the OMS service. There were 7 male and 4 female patients. Eight patients were older than 60 years of age. Seven patients had immunocompromising conditions, including diabetes mellitus in 4, concurrent administration of steroid in 2, uremia in 1, and a thymus carcinoma in 1. All patients showed parapharyngeal space involvement; four also showed retropharyngeal space involvement. Gas was found in the computed tomography scan in 6 patients, extending to cranial base in 3 of them. Anaerobes were isolated in 73% of the infections, whereas Streptococcus species were uniformly present. All patients received 1 or more debridements. Major complications occurred in 4 patients, including mediastinitis in 4, septic shock in 2, lung empyema in 1, pleural effusion in 2, and pericardial effusion in 1. All major complications developed in the immunocompromised patients, leading to 2 deaths. CONCLUSION The mortality rate in this study was 18%. Early surgical debridement, intensive medical care, and a multidisciplinary approach are advocated in the management of CNF.
Collapse
Affiliation(s)
- W Tung-Yiu
- Department of Dentistry, National Cheng Kung University Hospital, Tainan, Taiwan ROC
| | | | | | | |
Collapse
|
41
|
Whitesides L, Cotto-Cumba C, Myers RA. Cervical necrotizing fasciitis of odontogenic origin: a case report and review of 12 cases. J Oral Maxillofac Surg 2000; 58:144-51; discussion 152. [PMID: 10670592 DOI: 10.1016/s0278-2391(00)90327-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE This article reviews the demographics, presentation, cause, clinical findings, and treatment of 12 cases of cervical necrotizing fasciitis of odontogenic origin. PATIENTS AND METHODS A retrospective chart review of 12 cases treated between 1987 and 1997 was done. RESULTS Most cases resulted from an abscessed mandibular molar. The most common significant medical conditions in the patient's history were diabetes, hypertension, obesity, and substance abuse. All patients were treated surgically within 24 hours of admission. Hyperbaric oxygen (HBO) was used as adjunctive treatment in all cases. The average length of hospital stay was 31 days. All patients recovered. CONCLUSION Early surgical intervention and the use of HBO decreases morbidity and improves the clinical outcome.
Collapse
Affiliation(s)
- L Whitesides
- Hyperbaric Medicine, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore 21201, USA
| | | | | |
Collapse
|
42
|
Raboso E, Llavero MT, Rosell A, Martinez-Vidal A. Craniofacial necrotizing fasciitis secondary to sinusitis. J Laryngol Otol 1998; 112:371-2. [PMID: 9659501 DOI: 10.1017/s0022215100140496] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Necrotizing fasciitis is a rare condition which usually affects the trunk, perineum and limbs. Head and neck involvement is very uncommon and in most cases it is secondary to orbital or dental infection. We report a case of craniofacial necrotizing fasciitis (CNF) secondary to a maxillary sinusitis. The patient was treated intensively with antibiotics, surgical procedures and life-support measures. Despite all efforts, the patient died one week after admission. This case highlights early diagnosis and aggressive management as decisive factors for the outcome of the patient.
Collapse
Affiliation(s)
- E Raboso
- ENT Department, Hospital Ramon y Cajal, Madrid, Spain.
| | | | | | | |
Collapse
|
43
|
Mortimore S, Thorp M. Cervical necrotizing fasciitis and radiotherapy: a report of two cases. J Laryngol Otol 1998; 112:298-300. [PMID: 9624386 DOI: 10.1017/s0022215100158414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Two cases of cervical necrotizing fasciitis are presented. Both are unusual in that they had had radiotherapy for head and neck malignancy six and 14 years previously with no evidence of tumour recurrence. One case of necrotizing fasciitis has previously been cited in the literature associated with radiotherapy (Krespi et al., 1981). The two cases are discussed along with a review of the literature.
Collapse
Affiliation(s)
- S Mortimore
- Department of Otolaryngology, Groote Schuur Hospital, Cape Town, South Africa
| | | |
Collapse
|