[Beta-hemolytic streptococcal periorbital necrotizing fasciitis in a child]

The authors report a case of beta-haemolytic streptococcal periorbital necrosing fasciitis in a two old girl. Extensive cutaneous necrosis of the four eyelids developed after the installation of a major septic syndrome. Excision of the necrotic tissues required removal of the palpebral part of the orbicularis muscle and opening of the orbital septum. A graft was performed on the 23rd day. Active palpebral occlusion was retained by means of the orbital portion of the orbicularis muscle. Two complementary grafts had to be performed to ensure satisfactory palpebral occlusion. The periorbital localization, exceptional in children, must not be confused with periorbital cellulitis, a common disease, which never progresses towards necrosis. The authors stress the necessity of an early diagnosis in view of the importance of medical treatment and surgical drainage with opening of the septum, which is the only way of decompressing the oedema and preventing palpebral necrosis due to tissue ischaemia.