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Necrotizing soft-tissue infections in the head and neck: a clinicopathological study
F Tovi1, D M Fliss, H J Zirkin
1Department of Otolaryngology--Head and Neck Surgery, Soroka University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Abstract:
The clinicopathological aspects of 15 patients with necrotizing soft-tissue infections in the head and neck are reviewed. Our relatively large series suggests that the disease occurs more frequently than described in the literature. Histological studies showed that tissue superficial and deep to the fascia is frequently involved with the infectious inflammatory process, even in early stages of the disease. These pathologic changes were also found in healthy-appearing tissues at the periphery of the lesions. The early recognition of the disease and the prompt and aggressive surgical and medical therapeutic approach have resulted in far lower mortality rates (7%) than those reported in the literature. Frozen-section examination contributed to the maximal eradication of the pathologic process. This successful outcome was achieved in spite of the adverse associated clinical conditions, such as old age, debilitating disease, or complications, observed in half of the patients.
Insights
Necrotizing soft-tissue infections in the head and neck are more common than previously thought. Early recognition and aggressive treatment significantly reduce mortality rates for this serious condition.
Area of Science:
- Head and Neck Surgery
- Infectious Diseases
- Pathology
Background:
- Necrotizing soft-tissue infections (NSTI) of the head and neck are severe conditions.
- The true incidence and early pathological characteristics of NSTI in this region require further elucidation.
Purpose of the Study:
- To review the clinicopathological features of head and neck NSTI.
- To evaluate the effectiveness of early diagnosis and aggressive treatment strategies.
Main Methods:
- Retrospective review of 15 patients with head and neck NSTI.
- Histopathological examination of affected and surrounding tissues.
- Analysis of treatment approaches and patient outcomes.
Main Results:
- NSTI in the head and neck may be more frequent than reported.
- Superficial and deep fascial tissues, even in healthy-appearing periphery, are involved early.
- An aggressive multimodal treatment approach resulted in a 7% mortality rate, lower than literature values.
Conclusions:
- Early recognition and prompt, aggressive surgical and medical management are crucial for improving outcomes in head and neck NSTI.
- Frozen-section examination aids in complete eradication of the disease.
- Successful outcomes are achievable even in patients with significant comorbidities.