Necrotizing fasciitis of the head and neck: role of CT in diagnosis and management.

PURPOSE

To determine the characteristic diagnostic features of necrotizing fasciitis and to evaluate the role of computed tomography (CT) in its management.

MATERIALS AND METHODS

Fourteen patients with surgically proved necrotizing fasciitis of the extracranial head and neck were examined with contrast material-enhanced CT. Clinical, radiologic, surgical, pathologic, and anatomic findings at admission and after initial treatment were analyzed retrospectively.

RESULTS

Constant CT features of necrotizing fasciitis were diffuse thickening and infiltration of the cutis and subcutis (cellulitis); diffuse enhancement and/or thickening of the superficial and deep cervical fasciae (fasciitis); enhancement and thickening of the platysma, sternocleidomastoid muscle, or strap muscles (myositis); and fluid collections in multiple neck compartments. Inconstant CT features included gas collections, mediastinitis, and pleural or pericardial effusions. All patients underwent extensive surgical debridement. Follow-up CT scans in 11 patients revealed clinically unsuspected progression of the inflammatory process in previously unaffected areas, a finding that warranted additional surgery in nine patients. Twelve patients survived, and two patients died of septic shock and aspiration pneumonia despite intensive surgical and medical treatment.

CONCLUSION

Early recognition of necrotizing fasciitis with CT enables appropriate surgical treatment. CT may also be a useful guide in further patient treatment after initial surgical debridement.