[Therapeutic management of necrotizing neck infections].
BACKGROUND
Necrotizing neck infections are uncommon soft-tissue infections, usually caused by virulent, toxin producing bacteria. Necrotizing fasciitis represents a special form of necrotizing soft tissue infection with a mortality rate of up to 76% even though aggressive therapy is recommended.


METHODS
In the last 2 years we treated four patients with severe necrotizing neck infections and five suffering from necrotizing fasciitis.


RESULTS
Microbiological analysis revealed mixed infections with Candida albicans, Streptococcus pyogenes, Fusobacterium, Proprioni bacteria and Staphylococcus. The surgical management was not only restricted to drainage, but also included functional neck dissection in order minimize the spread of the disease. Eight of our patients recovered completely, but one died due to toxic shock as consequence of a delayed in therapy.


CONCLUSIONS
Complete recovery of patients suffering from necrotizing fasciitis depends on early and aggressive surgical therapy including neck dissection and drainage as well as an interdisciplinary strategy of conservative therapy. Hyperbaric oxygen should be considered as a treatment adjunct in patients with necrotizing fasciitis if surgery and antibiotic treatment fail.
Rudack
C
C
HNO-Klinik, Universitätsklinikum Muenster. rudack@uni-muenster.de
Eikenbusch
G
G
Stoll
W
W
Hermann
W
W
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009334:Neck Muscles / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D012772:Shock, Septic / Q000401:mortality; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014068:Tonsillectomy; D014069:Tonsillitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents