Main Articles

Techniques for early diagnosis and management of cervicofacial necrotising fasciitis

J W Lee^a1, S B Immerman^a1 and L G T Morris^a1 c1

^a1 Head and Neck Surgery Service, Bellevue Hospital Center and New York University School of Medicine, New York, New York, USA

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.

(Accepted December 30 2009)

(Online publication March 19 2010)

Key words

• Cervical;
• Cervicofacial;
• Necrotising Fasciitis;
• Diagnosis;
• Management;
• Biopsy

Correspondence:

^c1 Address for correspondence: Dr Luc G T Morris, Head and Neck Surgery Service, Department of Otolaryngology, New York University Medical Center, 550 First Avenue, NBV 5E5, New York, NY 10016, USA. Fax: +1 212 263 8257 E-mail: luc.morris@nyumc.org

Footnotes

Dr L G T Morris takes responsibility for the integrity of the content of the paper.

Competing interests: None declared