Objectives: To analyze the occurrence and course in aggressive management of the head and neck necrotizing fasciitis.

Methods: A prospective cohort study of the patients with necrotizing fasciitis (NF) of the head and neck. A NF was divided in two broad categories: NF of the neck with/without mediastinits and NF of the face. The NF of the neck was further subdivided according to the facial plane involved (superficial and deep).

Results: From 1992 to 2006 thirty-four patients with NF were treated in our department. Among those patients 5 patients presented with facial NF. The most severe complication in these groups was a skin necrosis which was a uniformal finding. Twenty-nine patients had a NF of the neck, 16 (55%) of them presenting with mediastinits. The common feature of the patients with mediastinits was pretracheal fascia NF.

From 34 patients with NF only one died from uncontrolled infection. Fifteen patients (44%) had no significant comorbidity. All patients were treated with aggressive surgical necrectomy, mediastinal drainage with or without thoracotomy/sternotomy.

Conclusion: NF was considered a disease with high mortality. We proved that it is not necessarily through, if infection is managed surgically, early in course of the disease and with multidisciplinary approach.

Conflict of interest: None declared.