Bloching M, Gudziol S, Gajda M, Berghaus A
Klinik für Hals-, Nasen-, Ohrenkrankheiten, Gesichts- und Hals-chirurgie der Martin-Luther-Universität Halle-Wittenberg.
Laryngorhinootologie. 2000 Dec;79(12):774-9. doi: 10.1055/s-2000-9139.
Necrotizing fasciitis of the head and neck is a rare occurrence. It spreads rapidly along fascial planes causing extensive necrosis; it often results in gangrene of the overlying skin. Mostly involved are immunodeficient patients with banal infections of the upper aerodigestive tract, small traumas, but also after surgical procedures. The "Federal Health Agency" of the Federal Republic of Germany estimates a number of 40 cases a year in Germany for all regions of the body. The mortality is about 20%-50% dependent on the localisation of this soft tissue infection.
Four cases of necrotizing fasciitis of the head and neck region, which were treated at the ENT-Department of the Martin Luther University Halle-Wittenberg since 1995, were described.
Despite aggressive surgical debridement and intensive care medicine two patients died because of streptococcus-associated-toxic-shock-syndrome. In all patients we found a diabetes mellitus as a known risk factor for this necrotizing soft tissue disease. In two of four patients with cervical involvement mediastinitis was diagnosed as a complication. The CT-scan showed this mediastinal spread only in one case.
Only rapid diagnosis and surgical treatment with radical debridement can influence the disease positively. Thoracal CT-scan is necessary in all cases of cervical necrotizing fasciitis because of the high risk of mediastinal involvement. A strong complication is a streptococcus-associated-toxic-shock-syndrome, which should be prevented because it is often associated with a lethal outcome. Penicillin G and clindamycin are advocated for antibiotic treatment.
头颈部坏死性筋膜炎较为罕见。它沿筋膜平面迅速蔓延，导致广泛坏死，常致使覆盖皮肤发生坏疽。主要累及免疫功能低下的患者，这些患者常伴有上呼吸道和消化道的普通感染、轻微创伤，也可发生于外科手术后。德意志联邦共和国的“联邦卫生局”估计，德国全身每年约有40例该病病例。其死亡率约为20% - 50%，取决于这种软组织感染的部位。
描述了自1995年以来在马丁路德大学哈雷 - 维滕贝格耳鼻喉科接受治疗的4例头颈部坏死性筋膜炎病例。
尽管进行了积极的手术清创和重症监护治疗，仍有2例患者因链球菌相关性中毒性休克综合征死亡。在所有患者中，我们发现糖尿病是这种坏死性软组织疾病的已知危险因素。4例颈部受累患者中有2例被诊断并发纵隔炎。CT扫描仅在1例中显示有纵隔扩散。
只有快速诊断并进行彻底清创的手术治疗才能对疾病产生积极影响。由于纵隔受累风险高，所有颈部坏死性筋膜炎病例均需进行胸部CT扫描。一种严重的并发症是链球菌相关性中毒性休克综合征，因其常与致命结局相关，故应予以预防。抗生素治疗推荐使用青霉素G和克林霉素。
