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Necrotizing fasciitis of the face
M L Shindo1, V P Nalbone, W R Dougherty
1Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, USA.
Abstract:
Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection with high morbidity and mortality rates. Its occurrence in the head and neck region is uncommon, the majority of reported cases being limited to involvement of the neck, usually from infections of dental or pharyngeal origin. Involvement of the face from NF is rare; only 35 such cases have been reported in the literature since 1960. It is not only associated with a high mortality but can also result in severe disfigurement of the face, posing challenging reconstructive problems. Successful management of facial NF requires early diagnosis, prompt institution of broad spectrum antibiotics, aggressive surgical debridement to control the infection, and reconstruction of the resultant soft tissue defects. This report describes four additional cases of facial necrotizing fasciitis. One of the four patients died as a result of sepsis and multi-organ system failure. Two of the three surviving patients had significant facial disfigurement. A comprehensive review of the facial NF cases reported in the literature is also provided. Based on our experience with facial NF and the results of all previous case reports, the clinical manifestations, pathogenesis, and management of this disease are discussed.
Insights
Facial necrotizing fasciitis (NF) is a rare, aggressive infection causing high mortality and disfigurement. Early diagnosis, antibiotics, and surgery are crucial for managing this severe soft tissue condition.
Area of Science:
- Infectious Diseases
- Plastic Surgery
- Head and Neck Surgery
Background:
- Necrotizing fasciitis (NF) is a severe, rapidly progressing soft tissue infection.
- Facial NF is rare, with limited reported cases, often stemming from dental or pharyngeal infections.
Observation:
- This report details four new cases of facial necrotizing fasciitis.
- One patient succumbed to sepsis and multi-organ failure; two survivors experienced significant facial disfigurement.
Findings:
- Facial NF presents a high mortality risk and can lead to severe cosmetic deformities.
- Successful management hinges on early diagnosis, broad-spectrum antibiotics, and aggressive surgical debridement.
Implications:
- Prompt intervention is vital for improving outcomes in facial NF.
- Reconstruction of facial defects presents significant challenges.
- Further research into the pathogenesis and optimal treatment strategies for facial NF is warranted.