Necrotising fasciitis of the head and neck

Introduction: Necrotising fasciitis is still a severe disease whose outcome is occasionally fatal. Methods: Between August 1994 and August 1998, 6 patients with necrotising fasciitis, 5 in the neck area and one in the facial area, were treated. The source of the infection was odontogenic in 3 cases, pharyngeal in 3 and an insect sting in the left upper eyelid in one case. Results: Following evaluation by CT scan, immediate surgical exploration with debridement and drainage was performed. Revision proved necessary in most cases. One patient suffered severe complications. Median stay in the intensive care unit was 7 days and in hospital 20 days. Discussion: Deep and extensive neck infections require investigation by CT scan. All affected areas must be explored and drained immediately, including thoracotomy if mediastinitis is present. Apart from appropriate antibiotic therapy, the further course of the disease should he carefully monitored to detect further spread of the infection as well as complications.