Marioni Gino, Bottin Raffaele, Tregnaghi Alberto, Boninsegna Marco, Staffieri Alberto
Department of Otolaryngology-Head and Neck Surgery, University of Padua, Padua, Italy.
Acta Otolaryngol. 2003 Aug;123(6):737-40. doi: 10.1080/00016480310000430.
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.
坏死性筋膜炎是一种潜在致命的软组织感染，主要累及腹壁、会阴和四肢。它在头颈部是一种不常见的临床病症，对英文文献的详尽回顾发现了约160例相关报道。牙源性病变、创伤后或医源性皮肤或黏膜损伤以及咽旁或扁桃体周围感染是最常描述的病因。我们在此报告首例因腮腺脓肿导致的颅颈交界区坏死性筋膜炎（CCNF）病例。该患者通过静脉注射广谱抗生素治疗及积极的手术方法（腮腺脓肿引流及颈部探查，伴坏死组织引流和清创）成功治愈。CCNF的有效管理取决于及时诊断。应立即开始静脉注射广谱抗生素治疗。一旦获得培养结果，抗生素覆盖范围可缩小。积极的手术干预是必要的，包括广泛切开、充分探查深部颈部间隙以及对坏死组织进行清创，直至遇到健康的出血组织。
