title: Cervical necrotizing fasciitis: management challenges in poor resource environment.
abstract: Necrotizing fasciitis of the head and neck is a rare and potentially fatal disease. It is a bacterial infection characterized by spreading along fascia planes and subcutaneous tissue resulting in tissue necrosis and likely death. It is commonly of dental or pharyngeal origin. Factors affecting the success of the treatment are early diagnosis, appropriate antibiotics and surgical debridement. Our study showed eight patients, five males and three females with mean age of 49.25 years (range 20-71 years). Clinical presentations were a rapidly progressing painful neck swelling, fever, dysphagia and trismus. The aetiology varied from idiopathic, pharyngeal/tonsillar infection, trauma and nasal malignancy. There were associated variable comorbidities (diabetes mellitus, HIV infection, hypertension and congestive cardiac failure). All the patients received early and aggressive medical treatment. The earliest time of surgery was 12 h after admission because of the poor financial status of patients. Three cases came in with complications of the disease and were not fit for extensive debridement under general anaesthesia. For them limited and reasonable bed side debridement was done. Mortality was 50 % from multiple organ failure, HIV encephalopathy, aspiration pneumonitis and septicemia. The duration of hospital stay for the patients that died ranged from 1 to 16 days and 4 to 34 days for the survivor. Our study heightens awareness and outlines the management challenges of necrotizing fasciitis of the head and neck in a poor resource setting.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria. abiolaadekanye@yahoo.com.
authors.forename: Abiola Grace
authors.initials: AG
authors.lastname: Adekanye
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria.
authors.forename: A N
authors.initials: AN
authors.lastname: Umana
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria.
authors.forename: M E
authors.initials: ME
authors.lastname: Offiong
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria.
authors.forename: R B
authors.initials: RB
authors.lastname: Mgbe
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria.
authors.forename: B C
authors.initials: BC
authors.lastname: Owughalu
authors.affiliation: Department of Haematology, University of Calabar Teaching Hospital, Calabar, Nigeria.
authors.forename: M
authors.initials: M
authors.lastname: Inyama
authors.affiliation: Department of Microbiology, University of Calabar Teaching Hospital, Calabar, Nigeria.
authors.forename: H M
authors.initials: HM
authors.lastname: Omang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods*; D019468:Disease Management; D019115:Fasciitis, Necrotizing / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009333:Neck; D009549:Nigeria / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cervical necrotizing fasciitis; High mortality; Poor resource setting