Cervical necrotizing fascitis: considerations for early management

Abstract

Cervical necrotizing fasciitis (CNF) is an infection that affects the cervical fascia and subcutaneous tissue. It is characterized by a rapid dissemination trough the fascial pla­nes, with a high rate of mortality. Even tough imaging results a fundamental diagnostic tool, it is still made by clinic signs with rapid progression of symptoms in few hours. Here, we identify worse prognostic factors in the precocious diagnosis of CNF, from five cases presented in our center. A descriptive case-series study was performed in patients with CNF in the last ten years in the Otolaryngology Department of Barros Luco Trudeau Hospital. Five patients were identified, between the clinical and laboratory parameters. A disproportional pain and rapid deterioration of the laboratory exams were the most highlighted features. In the cases with suggestive signs of CFN in the CT scan, allowed an aggressive surgical management, while in those that had no suggestive images the diagnosis was delayed and therefore their management ended in a fatal outcome. CFN constitutes a severe picture in wich clinical suspicion and a prompt initiation of treatment are fundamental in its prognosis.