Greinwald J H, Wilson J F, Haggerty P G
Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, Portsmouth, Virginia.
Ann Otol Rhinol Laryngol. 1995 Feb;104(2):133-7. doi: 10.1177/000348949510400209.
Cervical necrotizing fasciitis is a devastating polymicrobial soft tissue infection characterized by gas formation and extensive necrosis of subcutaneous fat and fascia with extension to skin and muscle. Involvement of the head and neck is rare and is typically dental in origin. Despite broad-spectrum antibiotics, mortality rates for this disease remain high. We report a successfully treated case of necrotizing fasciitis arising from a peritonsillar abscess. Review of the literature reveals only 6 other cases, with 3 successful outcomes. Early diagnosis, broad-spectrum antibiotics, and aggressive surgical debridement are the cornerstones of therapy. The pathophysiology is typically a mixed aerobic and anaerobic infection. Supportive treatment options such as hyperbaric oxygen therapy and high-calorie supplemental nutrition may be of benefit. A comprehensive literature review of craniocervical necrotizing fasciitis is presented. Factors associated with poor outcomes include diabetes mellitus, mediastinitis, cardiovascular disease, and peritonsillar abscess.
颈部坏死性筋膜炎是一种毁灭性的多微生物软组织感染，其特征为气体形成以及皮下脂肪和筋膜的广泛坏死，并蔓延至皮肤和肌肉。头颈部受累罕见，通常源于牙科疾病。尽管使用了广谱抗生素，该疾病的死亡率仍然很高。我们报告了一例成功治疗的由扁桃体周围脓肿引起的坏死性筋膜炎病例。文献回顾显示仅有其他6例病例，其中3例治疗成功。早期诊断、广谱抗生素以及积极的手术清创是治疗的基石。病理生理学通常为需氧菌和厌氧菌混合感染。高压氧治疗和高热量补充营养等支持性治疗方法可能有益。本文对颅颈坏死性筋膜炎进行了全面的文献综述。与预后不良相关的因素包括糖尿病、纵隔炎、心血管疾病和扁桃体周围脓肿。
