Necrotizing fasciitis in the head and neck region: an analysis of standard treatment effectiveness

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.