OBJECTIVES: To describe the clinical, microbiological, serological and radiological findings including the results of treatment in a Danish patient population with necrotizing fasciitis (NF) in the head and neck region. MATERIALS AND METHODS: Data were retrieved from patient records with the ICD3 code DM725A from January 1, 2002-June 30 2007. Demographic data, clinical manifestations, microbiological and serological findings, treatment modalities, complications and sequelae were registered. RESULTS: Twelve patients were identified during the 5-year period at the ENT department, Aarhus University Hospital (median age 54 years; 8 males). Minor head and neck surgery had been performed in 7 patients before development of NF. The classical clinical course included a rapidly-developing erythema associated with extreme tenderness and pain in the region. A diffuse edema in the soft tissues and vaguely differentiated and dilated fat compartments were found on the acute CT scans, including the presence of air within the tissues in many cases. Surgical débridement was performed in all patients within the first two days, including antibiotics and hemodynamic therapy. The majority of the patients were treated with hyperbaric oxygen and immunoglobulin. All the patients survived; half had sequelae such as excessive scar formation, nerve damage and psychological problems. CONCLUSION: With the actual treatment modalities a survival rate of 100% was achieved in patients with NF in the head and neck region. Early diagnosis is of utmost importance and especially the combination of growing erythema and extreme pain supports the diagnosis.
OBJECTIVES: To describe the clinical, microbiological, serological and radiological findings including the results of treatment in a Danish patient population with necrotizing fasciitis (NF) in the head and neck region. MATERIALS AND METHODS: Data were retrieved from patient records with the ICD3 code DM725A from January 1, 2002-June 30 2007. Demographic data, clinical manifestations, microbiological and serological findings, treatment modalities, complications and sequelae were registered. RESULTS: Twelve patients were identified during the 5-year period at the ENT department, Aarhus University Hospital (median age 54 years; 8 males). Minor head and neck surgery had been performed in 7 patients before development of NF. The classical clinical course included a rapidly-developing erythema associated with extreme tenderness and pain in the region. A diffuse edema in the soft tissues and vaguely differentiated and dilated fat compartments were found on the acute CT scans, including the presence of air within the tissues in many cases. Surgical débridement was performed in all patients within the first two days, including antibiotics and hemodynamic therapy. The majority of the patients were treated with hyperbaric oxygen and immunoglobulin. All the patients survived; half had sequelae such as excessive scar formation, nerve damage and psychological problems. CONCLUSION: With the actual treatment modalities a survival rate of 100% was achieved in patients with NF in the head and neck region. Early diagnosis is of utmost importance and especially the combination of growing erythema and extreme pain supports the diagnosis.
Authors: Rui Medeiros Júnior; Auremir da Rocha Melo; Hugo Franklin Lima de Oliveira; Silvana Maria Orestes Cardoso; Carlos Augusto Pereira do Lago Journal: Braz J Otorhinolaryngol Date: 2011 Nov-Dec