ABSTRACT
BACKGROUND AND OBJECTIVES: To clarify the presenting signs and symptoms, clinical course, pathologic organisms, and management of cervical necrotizing fasciitis. SUBJECTS AND METHOD: We retrospectively reviewed the inpatient charts treated at our ENT department for cervical necrotizing fasciitis. Seven such patients were identified as having been treated from January 2002 to December 2004. RESULTS: During the 36-months period, 7 adults consisting of 5 males and 2 females with cervical necrotizing fasciitis were diagnosed and treated. The mean age was 45 years ranging from 25 to 59 years. All patients had infections in more than five fascial spaces. The most commonly involved sites of infection were the superficial neck space (100%), followed by submandibular (85.7%), and parapharyngeal and submental space (57.1%). The most commonly known associated preceding illness were tonsillitis and dental abscess (28.5%). Painful neck swelling and difficulty in moving the neck were the most frequent symptoms and signs. The most common pathogen was Streptococcus species (4/7), followed by Staphylococcus epidermidis and Klebsiella pneumoniae (1/6). The mean duration of hospitalization was 17.2 days (range, 8-24). Leukocytosis (WBC>10000/mm3) was found in all patients. All patients received parenteral antibiotics and surgical drainage after admission. Six patients recovered and one patient died after surgical drainage. Tacheotomy was performed on five patients. CONCLUSION: Cervical necrotizing facilitis is an uncommon but often fatal bacterial infection of the skin, subcutaneous fat, superficial fascia, and deep fascia. It is characterized by marked tissue edema, rapid spread of inflammation, and signs of systemic toxicity. High index of suspicion, prompt aggressive surgery, appropriate antibiotics, and supportive care are the mainstays of management.
Subject(s)
Adult , Female , Humans , Male , Abscess , Anti-Bacterial Agents , Bacterial Infections , Drainage , Edema , Fascia , Fasciitis, Necrotizing , Hospitalization , Inflammation , Inpatients , Klebsiella pneumoniae , Leukocytosis , Neck , Palatine Tonsil , Retrospective Studies , Skin , Staphylococcus epidermidis , Streptococcus , Subcutaneous Fat , Subcutaneous Tissue , TonsillitisABSTRACT
BACKGROUND AND OBJECTIVES: The objective of this study was to clarify the presenting signs and symptoms, clinical course, pathologic organisms, and management of deep neck infections in children. SUBJECTS AND METHOD: We retrospectively reviewed the in-patient charts of children treated at our ENT department for deep neck infections. Thirty-six such patients were identified as having been treated from January 2000 to December 2003. RESULTS: During the 4-year period, 36 children with deep neck space infection were diagnosed and treated, including 20 (56%) boys and 16 (44%) girls. The ages ranged from 11 months to 15 years, with the mean of 6.9+/-4.5 years. The most common site of infection was the peritonsillar space (41.7%), followed by the parapharyngeal (27.8%) and submandibular (16.6%) space. Six (16.6%) children had infections in more than one fascial space. The most commonly known associated preceding illness was viral upper respiratory infection (53%). Neck swelling, fever, and dysphagia were the most frequent symptoms. The most common pathogens were Streptococcus pyogens (3/10) and Staphylococcus aureus (2/10). The mean duration of hospitalization was 7.7 days (range, 2-15). Leukocytosis (WBC>15000/mm3) was found in 13 (36%) patients. All patients received parenteral antibiotics after admission. Thirteen (36%) children recovered from the infection with conservative treatment and twenty-three (64%) children received surgical drainage. No complication and tracheotomy occurred. CONCLUSION: Deep neck space infections in children are rapidly progressive and usually present with neck swelling and fever. Peritonsillar space and Streptococcus pyogens infections were most common anatomic sites and pathogen in deep neck infection of children, respectively.