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Pediatric necrotizing soft tissue infections of the head and Neck: A case report and systematic review
Carlos Khalil1, Jenny Xiao1, Eduardo Gus2
1Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Insights
Pediatric necrotizing soft tissue infection (NSTI) of the head and neck is rare but life-threatening. Early recognition and aggressive management, including prompt surgical debridement, are crucial for improving outcomes in children.
Area of Science:
- Pediatric Infectious Diseases
- Head and Neck Surgery
- Critical Care Medicine
Background:
- Pediatric necrotizing soft tissue infection (NSTI) of the head and neck is a rare (0.08 per 100,000 children/year) yet life-threatening condition.
- Requires prompt diagnosis and aggressive management to prevent severe morbidity and mortality.
Purpose of the Study:
- To systematically review and synthesize current literature on pediatric head and neck NSTI.
- Identify key clinical features, common etiologies, and effective management strategies.
- Analyze patient outcomes, including mortality and length of hospital stay.
Main Methods:
- Systematic literature search of Medline, Embase, Cochrane Library, and Web of Science.
- Data extraction on patient demographics, clinical presentation, microbiology, treatment, and outcomes from 47 articles.
- Analysis of 56 identified cases of pediatric head and neck NSTI.
Main Results:
- The mean age of affected children was 5.2 years, with 61% being male.
- Common symptoms included erythema, edema, fever, and pain; Group A Streptococcus was the most frequent pathogen.
- Mean time to presentation was 3.2 days, with an average of 2.3 surgical debridements per patient; mortality rate was 5%.
Conclusions:
- Pediatric head and neck NSTI is a critical condition demanding early recognition and swift, aggressive intervention.
- Timely surgical debridement and a multidisciplinary approach are essential for optimizing patient outcomes.
- Further research into preventative strategies and standardized treatment protocols is warranted.
Introduction:
Pediatric necrotizing soft tissue infection (NSTI) of the head and neck is a rare (0.08 per 100,000 children per year) but life-threatening condition requiring prompt diagnosis and treatment. This systematic review aims to describe a case report and synthesize the current literature to identify key clinical features, management strategies, and outcomes of this rare condition.
Methods:
Medline (Ovid), Embase, the Cochrane library, and Web of Science were searched for articles that described pediatric patients who had NSTI of the head and neck. Data on patient factors, microbiology, treatment, and outcomes were extracted.
Results:
56 cases of pediatric NSTI of the head and neck were identified from 47 articles. Mean age of occurrence was 5.2 ± 5.3 years (61 % male). Mean time to presentation was 3.2 ± 4.4 days. Most common initial presenting symptoms included overlying skin erythema (n = 37/56, 66 %), edema (n = 36/56, 64 %), fever (n = 31/56, 55 %), pain (n = 19/56, 34 %), tachycardia (n = 16/56, 29 %), hypotension (n = 15/56, 27 %), and skin necrosis (n = 8/56, 14 %). Anatomical location of head and neck NSTI involvement was most commonly reported in cervicofacial (45/56, 80 %), craniocervical (8/56, 14 %), and thoracocervical (7/56, 13 %). Of known aetiologies, the most frequently reported were traumatic/iatrogenic (n = 11/56, 20 %) and odontogenic (n = 7/56, 13 %). In 41 % of cases the etiology of NSTI was unknown (23/56). Imaging was performed prior to the initial OR in 59 % of cases (n = 33/56) and computed tomography (CT) was the most common imaging modality (43 %, 24/56). Mean time to first surgical debridement was 1.3 ± 3.4 days. The most frequently identified microorganism was Group A Streptococcus (n = 13/56, 23 %), polymicrobial (n = 11, 20 %), Staphylococcus (n = 6/56, 11 %), and Pseudomonas (n = 6/56, 11 %). Almost one half (n = 19/41, 46 %) of the cases required more than one surgical debridement, and the overall average number of debridements was 2.3 ± 2.0. Mean length of hospital stay was 30 ± 25 days and overall mortality was 5 % (3/56).
Conclusion:
Pediatric NSTI of the head and neck is a rare, life-threatening condition requiring early recognition and aggressive management. Prompt diagnosis, timely surgical debridement, and a multidisciplinary approach are critical to improving outcomes in this vulnerable population.
