The Burden of Care for Cervical Necrotizing Fasciitis in a Resource-constrained Setting

Necrotizing fasciitis (NF) is a soft tissue infection that is primarily characterized by fast spread along the fascial planes and adjacent cutaneous tissues. Cervico-facial necrotizing fasciitis (CNF) usually presents with severe intense pain with a polymicrobial odontogenic source. Early diagnosis with aggressive management, usually involving appropriate antibiotic selection, surgical debridement, and wound care, is key to achieving a good outcome. Management of CNF requires a multidisciplinary approach and poses several challenges in resource-constrained settings, especially in developing countries. This problem is further compounded by the late presentation and uncontrolled and indiscriminate use of herbal medications in the tropics. A 65-year-old Ghanaian woman with no known comorbidity reported to the Accident and Emergency Unit of Sunyani Teaching Hospital with a chief complaint of recurrent toothache for two years and left facial swelling of 1-week duration. On physical examination, she was chronically ill, febrile (39.5 °C), and anicteric but not pale. There was a soft, fluctuant, tender swelling involving both submandibular and submental areas with increased local temperature. The swelling also extended to the anterior cervical and anterior chest walls, which were overlaid with necrotic skin. Overlying such diseased skin was also prevalent over the mammary glands. Following the clinical diagnosis of NF spread, debridement was performed, and appropriate antibiotic therapy with daily wound care management was instituted. This continued until the patient's general condition improved, and good wound healing with the formation of granulation tissue was observed. The patient was subsequently referred to a tertiary facility for skin graft. Early presentation, prompt diagnosis, and aggressive surgical and medical care are key in achieving good outcomes of NF in resource-constrained developing nations.