[Cervico-facial necrotizing fasciitis].
Cervical fasciitis is a life-threatening condition often due to a benign pharyngeal or dental infection, leading to extensive necrosis, spreading along the fascia of the neck and possibly to the mediastinum. It represents one of the most severe ENT emergencies which requires immediate treatment by a multidisciplinary team. Facing any banal infection of the head and neck, great attention should be paid to any functional or general symptoms and signs of severe sepsis. Patient should be urgently referred to a tertiary center where a CT scan should immediately be done, followed by surgical drainage of the any cervical or thoracic abscesses. Intensive medical care is then needed to treat the frequently encountered cardio-hemodynamic failures or secondary pulmonary or mediastinal infections. The extreme severity of the condition is attested by a mortality rate averaging 5-10%, pneumopathy developing in 1/3 of the patients, hemodynamic failure or mediastinitis in half of the patients, mean duration of mechanical ventilation of 10 days, intubation of 13 days, tracheostomy of 31 days, intensive care unit of 17 days and hospitalization of 26 days. Functional and esthetic sequellae were observed in half of the patients. No predisposing factors could be identified except possibly inadequate initial medical treatment and self-medication by non steroidal antiinflammatory drugs.
Service d'oto-rhino-laryngologie, hôpital Lariboisière, AP-HP, 75009 Paris, France. patrice.tran-ba-huy@lrb.aphp.fr
Patrice Tran Ba
PT
Huy
D002481:Cellulitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D004632:Emergency Medical Services / Q000379:methods; D005145:Face; D019115:Fasciitis, Necrotizing / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D006801:Humans; D009333:Neck; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology; D014057:Tomography, X-Ray Computed