Adekanye Abiola Grace, Umana A N, Offiong M E, Mgbe R B, Owughalu B C, Inyama M, Omang H M
Department of Otorhinolaryngology Head and Neck Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria.
Department of Haematology, University of Calabar Teaching Hospital, Calabar, Nigeria.
Eur Arch Otorhinolaryngol. 2016 Sep;273(9):2779-84. doi: 10.1007/s00405-015-3841-0. Epub 2015 Dec 1.
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.
头颈部坏死性筋膜炎是一种罕见且可能致命的疾病。它是一种细菌感染，其特征是沿筋膜平面和皮下组织扩散，导致组织坏死并可能致死。它通常起源于牙齿或咽部。影响治疗成功的因素包括早期诊断、适当的抗生素和手术清创。我们的研究显示有8例患者，5例男性和3例女性，平均年龄49.25岁（范围20 - 71岁）。临床表现为颈部疼痛性肿胀迅速进展、发热、吞咽困难和牙关紧闭。病因各不相同，包括特发性、咽部/扁桃体感染、创伤和鼻腔恶性肿瘤。存在各种合并症（糖尿病、HIV感染、高血压和充血性心力衰竭）。所有患者均接受了早期积极的药物治疗。由于患者经济状况不佳，最早的手术时间是入院后12小时。3例患者出现了该病的并发症，不适合在全身麻醉下进行广泛清创。对他们进行了有限且合理的床边清创。死亡率为50%，死因包括多器官衰竭、HIV脑病、吸入性肺炎和败血症。死亡患者的住院时间为1至16天，存活患者为4至34天。我们的研究提高了人们的认识，并概述了在资源匮乏地区头颈部坏死性筋膜炎的管理挑战。
