title: Craniocervical necrotizing fasciitis secondary to parotid gland abscess.
abstract: Necrotizing fasciitis is a potentially fatal soft-tissue infection that predominantly affects the abdominal wall, perineum and extremities. It is an uncommon clinical entity in the head and neck region and an exhaustive review of the English language literature disclosed reports on approximately 160 cases. Dental pathology, post-traumatic or iatrogenic skin or mucosa injuries and parapharyngeal or peritonsillar infections were the most frequently described origins. We describe herein the first case of craniocervical necrotizing fasciitis (CCNF) due to a parotid gland abscess. The patient was successfully treated with i.v. broad-spectrum antibiotic therapy and an aggressive surgical approach (drainage of the parotid abscess and exploration of the neck, with drainage and debridement of necrotic tissue). Effective management of CCNF depends on a prompt diagnosis. Intravenous broad-spectrum antibiotic therapy should be instituted immediately. Antibiotic coverage can be narrowed once the culture results are obtained. Aggressive surgical intervention is necessary, involving wide incision, adequate exploration of deep neck spaces and debridement of necrotic tissue until healthy bleeding tissue is encountered.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Padua, Padua, Italy. g_marioni@virgilio.it
authors.forename: Gino
authors.initials: G
authors.lastname: Marioni
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bottin
authors.forename: Alberto
authors.initials: A
authors.lastname: Tregnaghi
authors.forename: Marco
authors.initials: M
authors.lastname: Boninsegna
authors.forename: Alberto
authors.initials: A
authors.lastname: Staffieri
mesh_terms: D000038:Abscess / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement / Q000379:methods; D004322:Drainage / Q000379:methods; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006257:Head; D006801:Humans; D009333:Neck; D010309:Parotitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013212:Staphylococcus epidermidis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents