Necrotising fasciitis of the head and neck: a review of the literature.

Necrotising fasciitis is a severe life threatening bacterial infection of the fascial planes which is relatively rare in the head and neck region. The hallmark of the disease is selective necrosis of the fascia overlying skin and adjacent vasculature. Primary odontogenic infection due to aerobes and obligate anaerobes and trauma amongst other factors, are frequently responsible for this condition. Similarly, affected individuals often have an underlying systemic disease, the most common of which is diabetes mellitus. Treatment usually involves appropriate antimicrobial therapy, control of systemic disease, thorough surgical debridement, gamma globulin administration and hyperbaric oxygen where facilities exist. Significant morbidity and mortality attends necrotising fasciitis when treatment is delayed due to toxaemia, dehydration and severe biochemical disturbances. Prompt diagnosis, adequate resuscitation, thorough and frequent surgical debridement remains the cornerstone to a successful outcome.