Craniocervical necrotizing fasciitis.

Craniocervical necrotizing fasciitis (CCNF) is a severe, progressive bacterial infection of the cervical fascia. The most significant manifestations of this disease are extensive fascial necrosis with widespread undermining of the surrounding tissues and extreme systemic toxicity. We are adding three cases to the 29 previously reported cases of CCNF. We will discuss the regional anatomy, focusing on the relationship of the cervical fascial planes to vital structures. Available data suggest that CCNF is a synergistic infection produced in most instances by a combination of facultative anaerobic and obligate anaerobic organisms. Although antimicrobial therapy should provide broad-spectrum activity against mixed flora, treatment also includes aggressive excision and debridement of involved fascia, subcutaneous tissue, and necrotic skin.