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Shareef M, Ghosn Y, Khdhir M, El Annan T, Alam R, Hourani R. Critical infections in the head and neck: A pictorial review of acute presentations and complications. Neuroradiol J 2024; 37:402-417. [PMID: 35188822 PMCID: PMC11366201 DOI: 10.1177/19714009211059122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Non-traumatic head and neck emergencies include several disease processes such as infectious, inflammatory, and malignant. Infections are among the most common pathological processes that affect the head and neck, and are particularly important due to their acute, severe, and potentially life-threatening nature. Radiologists need to be well acquainted with these entities because any delay or misdiagnosis can lead to significant morbidity and mortality. Having a general understanding of such diseases is crucial, their prevalence, clinical presentation, common causative pathogens, route of spread, potential complications, and multimodality radiological appearance. Furthermore, understanding the relevant anatomy of the region, including the various fascial planes and spaces, is essential for radiologists for accurate image interpretation and assessment of potential complications. Our aim is to review the most common severe infections affecting the head and neck as well as other rare but potentially life-threatening infections. We will also describe their imaging features while focusing on the anatomy of the regions involved and describing their potential complications and treatment options.
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Affiliation(s)
| | - Youssef Ghosn
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Mihran Khdhir
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Raquelle Alam
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Roula Hourani
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
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Kato H, Kawaguchi Y, Saito K, Hamamoto S, Nakamura R, Ohashi K, Kondo S, Nakamura A, Morita A. Differences in the clinical presentation of necrotizing fasciitis depending on the causative pathogen. J Dermatol 2024. [PMID: 38863214 DOI: 10.1111/1346-8138.17325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/15/2024] [Accepted: 05/26/2024] [Indexed: 06/13/2024]
Abstract
Necrotizing fasciitis is a fatal, soft tissue infection of the skin that requires prompt treatment. Historically, most cases have been attributed to group A beta-hemolytic Streptococcus infection. However, in recent years, other bacteria have been identified as causing necrotizing fasciitis. In the current study, we analyzed cases of necrotizing fasciitis and examined the significant differences in symptoms caused by pathogenic bacteria. We included 79 patients (43 males and 36 females, mean age 65.4 years) diagnosed with necrotizing fasciitis who visited our hospital between April 2004 and July 2023. The patients were classified into five groups based on the identified pathogen: group A beta-hemolytic Streptococcus; group B beta-hemolytic streptococcus; group G beta-hemolytic Streptococcus; mixed infection, including anaerobic bacteria; and Staphylococcus (S) aureus. The clinical characteristics of patients, including treatment duration and laboratory values, were analyzed. Group G beta-hemolytic Streptococcus was more common in older patients (Bonferroni method, p < 0.05). Patients with S. aureus tended to be hyperglycemic (Bonferroni method, p < 0.05), had a higher rate of bacteremia (Fisher's direct probability test, p < 0.05), and had a longer treatment duration than the other examined groups (Bonferroni method, p = 0.0132). Although the five groups did not differ in the mortality rate, overall survival was shorter in the mixed infection group than in the other groups (log-rank test, p < 0.05). The legs were the most common site of infection in the non-mixed infection group; in the mixed infection group, the pubic area was identified as the most common site of infection, accompanied by a poor prognosis. Collectively, these findings suggest that necrotizing fasciitis can be characterized by pathogenic bacteria and that these characteristics may inversely predict the pathogen of origin.
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Affiliation(s)
- Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenta Saito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryota Nakamura
- Department of Plastic and Reconstructive Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuki Ohashi
- Division of Infection Prevention & Control, Nagoya City University Hospital, Nagoya, Japan
| | - Shuhei Kondo
- Division of Infection Prevention & Control, Nagoya City University Hospital, Nagoya, Japan
| | - Atsushi Nakamura
- Division of Infection Prevention & Control, Nagoya City University Hospital, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Escandón L, Matsui C, Tanaka T, Nishimura T, Imai T, Mizuno H. Case Report of Gas Gangrene after Reconstructive Surgery with Anterolateral Thigh Flap for Resection of Oral Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5381. [PMID: 37964920 PMCID: PMC10642894 DOI: 10.1097/gox.0000000000005381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/20/2023] [Indexed: 11/16/2023]
Abstract
Necrotizing fasciitis (NF) type I is an acute subcutaneous tissue infection that can promptly disseminate generating crepitus. If not accurately diagnosed and expeditiously treated, it becomes a life-threatening infection. In this report, we present a 65-year-old man who developed a case of NF after a hemiglossectomy resecting a tumor in the dorsal surface of the tongue. A biopsy was performed, and he was pathologically diagnosed with squamous cell carcinoma (T2N1M0). The patient underwent preoperative oral cleaning. Right hemiglossectomy was performed by cervical dissection, pull-through style, with tooth removal on the right mandible and a left anterolateral femoral flap reconstruction. Routine intraoperative lavage was performed with 2000 mL of saline solution. Cefazolin 1gr was administered two times per day postoperatively. Four days after primary surgery, the flap circulation was inadequate; therefore, a computed tomography scan was taken, which indicated gas in the ventral neck area. Tooth extraction was the suspected etiology. Debridement was performed; the abscess was drained and cultured, indicating the presence of Staphylococcus haemolyticus and Escherichia coli. It seems that the abscess was not formed by NF, but rather by leachate reservoir associated with the head and neck tumor. After debridement, re-reconstruction was performed with a deltopectoral flap and pectoralis major myocutaneous flap. When NF is present after a neck dissection, there is a risk of disruption due to the direct invasion and inflammation into the carotid artery. Therefore, it is important to provide adequate oral cleaning care before the surgery and early suspicion of the diagnosis.
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Affiliation(s)
| | - Chihiro Matsui
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takakuni Tanaka
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Takayoshi Nishimura
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Takumi Imai
- Department of Oral and Maxillofacial Surgery, Toyooka Public Hospital, Hyogo, Japan
| | - Hiroshi Mizuno
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Management and postoperative use of double-cannula irrigation-drainage tube in cervical necrotizing fasciitis: a Chinese single-institution experience of 46 patients. Eur Arch Otorhinolaryngol 2020; 278:2975-2981. [PMID: 33078259 DOI: 10.1007/s00405-020-06424-7] [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] [Received: 09/03/2020] [Accepted: 10/05/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Klug TE, Greve T, Hentze M. Complications of peritonsillar abscess. Ann Clin Microbiol Antimicrob 2020; 19:32. [PMID: 32731900 PMCID: PMC7391705 DOI: 10.1186/s12941-020-00375-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background The vast majority of patients with peritonsillar abscess (PTA) recover uneventfully on abscess drainage and antibiotic therapy. However, occasionally patient´s condition deteriorates as the infection spread in the upper airway mucosa, through cervical tissues, or hematogenously. The bacterial etiology of PTA is unclarified and the preferred antimicrobial regimen remains controversial. The current narrative review was carried out with an aim to (1) describe the spectrum of complications previously recognized in patients with peritonsillar abscess (PTA), (2) describe the bacterial findings in PTA-associated complications, and (3) describe the time relation between PTA and complications. Methods Systematic searches in the Medline and EMBASE databases were conducted and data on cases with PTA and one or more complications were elicited. Results Seventeen different complications of PTA were reported. The most frequently described complications were descending mediastinitis (n = 113), para- and retropharyngeal abscess (n = 96), necrotizing fasciitis (n = 38), and Lemierre´s syndrome (n = 35). Males constituted 70% of cases and 49% of patients were > 40 years of age. The overall mortality rate was 10%. The most prevalent bacteria were viridans group streptococci (n = 41, 25%), beta-hemolytic streptococci (n = 32, 20%), F. necrophorum (n = 21, 13%), S. aureus (n = 18, 11%), Prevotella species (n = 17, 10%), and Bacteroides species (n = 14, 9%). Simultaneous diagnosis of PTA and complication was more common (59%) than development of complication after PTA treatment (36%) or recognition of complication prior to PTA (6%). Conclusion Clinicians involved in the management of PTA patients should be aware of the wide range of complications, which may arise in association with PTA development. Especially males and patients > 40 years of age seem to be at an increased risk of complicated disease. In addition to Group A streptococci and F. necrophorum, the current findings suggest that viridans group streptococci, S. aureus, Prevotella, and Bacteroides may also play occasional roles in the development of PTA as well as spread of infection. Complications occasionally develop in PTA patients, who are treated with antibiotics and surgical drainage.
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Affiliation(s)
- Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark.
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Hentze
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 Aarhus N, Aarhus, 8200, Denmark
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Al-Ali MA, Hefny AF, Idris KM, Abu-Zidan FM. Cervical necrotizing fasciitis: an overlooked diagnosis of a fatal disease. Acta Otolaryngol 2018; 138:411-414. [PMID: 29105542 DOI: 10.1080/00016489.2017.1393841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Mohamed A. Al-Ali
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al Ain, Abu Dhabi, United Arab Emirates
- Department of Surgery, Al Ain Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Ashraf F. Hefny
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al Ain, Abu Dhabi, United Arab Emirates
- Department of Surgery, Al Ain Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Kamal M. Idris
- Department of Critical Care, Al Ain Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al Ain, Abu Dhabi, United Arab Emirates
- Department of Surgery, Al Ain Hospital, Al Ain, Abu Dhabi, United Arab Emirates
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Cortese A, Pantaleo G, Borri A, Amato M, Claudio PP. Necrotizing odontogenic fasciitis of head and neck extending to anterior mediastinum in elderly patients: innovative treatment with a review of the literature. Aging Clin Exp Res 2017; 29:159-165. [PMID: 27798811 DOI: 10.1007/s40520-016-0650-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/12/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin. METHODS In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need. CONCLUSIONS Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.
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Affiliation(s)
- Antonio Cortese
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.
| | - Giuseppe Pantaleo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Borri
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Massimo Amato
- Department of Medicine and Surgery, University of Salerno, Baronissi, SA, Italy
| | - Pier Paolo Claudio
- Department of BioMolecular Sciences, School of Pharmacy, National Center for Natural Products Research, University of Mississippi, Oxford, MS, USA
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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
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Nonodontogenic Cervical Necrotizing Fasciitis Caused by Sialadenitis. Case Rep Otolaryngol 2016; 2016:9520516. [PMID: 27822398 PMCID: PMC5086371 DOI: 10.1155/2016/9520516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/30/2016] [Accepted: 09/14/2016] [Indexed: 11/18/2022] Open
Abstract
Necrotizing fasciitis is a rapidly progressive infectious disease of the soft tissue with high mortality and morbidity rates. Necrotizing fasciitis is occasionally located in the head and neck region and develops after odontogenic infections. Factors affecting treatment success rates are early diagnosis, appropriate antibiotic treatment, and surgical debridement. We present a necrotizing fasciitis case located in the neck region that developed after sialoadenitis. It is important to emphasize that necrotizing fasciitis to be seen in the neck region is very rare. Nonodontogenic necrotizing fasciitis is even more rare.
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Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center. Eur Arch Otorhinolaryngol 2016; 273:4461-4467. [DOI: 10.1007/s00405-016-4126-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
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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.
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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
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Malik A, Chakrabarty S, Nair S, Nair D, Chaturvedi P. Necrotizing fasciitis in patients with head and neck cancer. Am J Infect Control 2015; 43:404-5. [PMID: 25721060 DOI: 10.1016/j.ajic.2015.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 12/20/2022]
Abstract
Necrotizing fasciitis is a severe polybacterial infection characterized by necrosis of the fascia and adjacent soft tissues with rapid expansion of the infection along the fascial planes. It is a rare and potentially fatal entity in the head and neck region. We present 2 patients with head and neck cancers who developed necrotizing fasciitis during the postoperative period.
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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]
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Lee JW, Immerman SB, Morris LGT. Techniques for early diagnosis and management of cervicofacial necrotising fasciitis. J Laryngol Otol 2010; 124:759-64. [PMID: 20298644 PMCID: PMC3016424 DOI: 10.1017/s0022215110000514] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cervicofacial necrotising fasciitis carries high rates of morbidity and mortality, and is not often initially suspected due to its rarity and misleadingly innocuous presentation. We propose an algorithm for the timely diagnosis and management of cervicofacial necrotising fasciitis. METHODS Retrospective review of seven patients ultimately diagnosed with cervicofacial necrotising fasciitis. RESULTS In these seven patients, common presenting symptoms included sore throat, fever and neck pain. On initial examination and imaging, only three had obvious findings. One patient's diagnosis was facilitated via a bedside cut-down procedure. Six patients underwent surgical debridement. Four required tracheotomy, and five wounds closed via secondary intention. There were two deaths. CONCLUSION The severity of cervical necrotising fasciitis and its rapid spread necessitate early diagnosis and timely surgical management. The presentation often appears benign. A high index of clinical suspicion should be maintained in cases of neck cellulitis with nonspecific clinical findings, especially in diabetic or otherwise immunocompromised patients. A normal computed tomography scan does not rule out necrotising fasciitis. A cut-down procedure may be critical to early diagnosis in some cases.
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Affiliation(s)
- J W Lee
- Head and Neck Surgery Service, Bellevue Hospital Center and New York University School of Medicine, New York, New York, USA
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Wolf H, Rusan M, Lambertsen K, Ovesen T. Necrotizing fasciitis of the head and neck. Head Neck 2010; 32:1592-6. [PMID: 20848400 DOI: 10.1002/hed.21367] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Henning Wolf
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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Knepil GJ, Fabbroni G. A life-threatening complication of acute parotitis. Br J Oral Maxillofac Surg 2008; 46:328-9. [PMID: 17822812 DOI: 10.1016/j.bjoms.2007.07.204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
Abstract
We present a case of necrotising fasciitis that complicated an episode of acute parotitis caused by Streptococcus milleri infection. Early diagnosis and aggressive therapy is necessary to reduce the incidence of mortality of this severe infection.
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Affiliation(s)
- G J Knepil
- Department of Oral and Maxillofacial Surgery, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
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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]
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Abstract
Imaging the head and neck presents a unique challenge because of the dense concentration of complex anatomy and the importance of lesion localization in formulating the differential diagnosis and prognosis. Critical imaging features such as the ability to define fascial borders of soft tissue neck compartments, the demonstration of intricate anatomy such as the temporal bones and paranasal sinuses, and the noninvasive assessment of vascular integrity have improved greatly in recent years in parallel with the rapid technologic advances in multidetector CT and MRI. After comparing the available imaging techniques, this article explores the imaging findings by anatomic region.
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Affiliation(s)
- Michael C Hurley
- Division of Neuroradiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, BC, Canada V5Z 1M9
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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.
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Affiliation(s)
- Lene Krenk
- Department of Otolaryngology-Head and Neck Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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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.
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Affiliation(s)
- Gino Marioni
- Department of Otolaryngology, Head and Neck Surgery, Padova University, Via Giustiniani 2, Padova, Italy.
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Vinh DC, Embil JM. Rapidly progressive soft tissue infections – Authors' reply. THE LANCET. INFECTIOUS DISEASES 2006. [DOI: 10.1016/s1473-3099(06)70360-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Clement CI, Hassall ME. Necrotizing fasciitis of the face and orbit following complications with a tooth abscess. ANZ J Surg 2004; 74:85-7. [PMID: 14725714 DOI: 10.1046/j.1445-1433.2003.02902.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Colin I Clement
- Department of Plastic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Marioni G, Bottin R, Tregnaghi A, Boninsegna M, Staffieri A. Craniocervical necrotizing fasciitis secondary to parotid gland abscess. Acta Otolaryngol 2003; 123:737-40. [PMID: 12953775 DOI: 10.1080/00016480310000430] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Necrotizing fasciitis is a potentially fatal soft-tissue infection that predominantly affects the abdominal wall, perineum and extremities. It is an uncommon clinical entity in the head and neck region and an exhaustive review of the English language literature disclosed reports on approximately 160 cases. Dental pathology, post-traumatic or iatrogenic skin or mucosa injuries and parapharyngeal or peritonsillar infections were the most frequently described origins. We describe herein the first case of craniocervical necrotizing fasciitis (CCNF) due to a parotid gland abscess. The patient was successfully treated with i.v. broad-spectrum antibiotic therapy and an aggressive surgical approach (drainage of the parotid abscess and exploration of the neck, with drainage and debridement of necrotic tissue). Effective management of CCNF depends on a prompt diagnosis. Intravenous broad-spectrum antibiotic therapy should be instituted immediately. Antibiotic coverage can be narrowed once the culture results are obtained. Aggressive surgical intervention is necessary, involving wide incision, adequate exploration of deep neck spaces and debridement of necrotic tissue until healthy bleeding tissue is encountered.
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Affiliation(s)
- Gino Marioni
- Department of Otolaryngology-Head and Neck Surgery, University of Padua, Padua, Italy.
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