Necrotizing fasciitis of head & neck: the Pakistani experience

Necrotizing fasciitis is a potentially life threatening, rapidly spreading polymicrobial infection rarely seen in the head and neck region. We present our experience of managing five patients with necrotizing fasciitis of head and neck at the Aga Khan University Hospital, Karachi, Pakistan. One patient had necrotizing fasciitis of the facial region only; three had necrotizing fasciitis of the neck region; and one patient had necrotizing fasciitis of the neck with extension to the chest. None of these patients was immunocompromised. Dental foci of infection was the root cause in three of the patients. Imaging was not only diagnostic but also helped to identify the extent of the disease. All five patients had early extensive multiple debridments, and received multiple antibiotic therapy and intensive care support. Four patients survived. We conclude that necrotizing fasciitis is a very aggressive infection, which may be misdiagnosed unless imaging examination is performed early. Aggressive medical and surgical treatment results in good survival but extension of disease beyond the neck into the chest carries a poor prognosis.