Background and objectives: Necrotizing fasciitis is a severe and very aggressive form of head and neck infection, which represents a real danger for the patient’s life. In this study, we evaluated the cases of necrotizing fasciitis treated in our department.
Methods: This is a retrospective cross-sectional study, in which we used data from patients treated in the department of Oral and Maxillofacial Surgery of the University of Medicine and Pharmacy, Cluj-Napoca between January 1996 and December 2012. The inclusion criteria were infections of the head and neck confirmed by the intraoperative detection of necrotic areas in the cervical fascia. We analyzed the origin, the extent and the aspect of the affected tissues in the patients included in the study, the bacterial flora and the type of treatment applied in each case.
Results: We identified 69 patients with necrotizing fasciitis; odontogenic infections being the most frequent origin of this pathology (79.71%). Comorbidities were present in 37.68% of the cases; diabetes mellitus was the most frequent. The subcutaneous and deep laterocervical fascial layers were affected in 69.57% of the cases. We identified necrotic areas and small amounts of purulent discharge in 66.67% of the cases and 13 patients with mediastinitis, 7 of which developed extrathoracic septic disseminations. A microbiological analysis was carried out in 53.62% of the cases and it revealed MSSA in 23.91% of the patients, followed by Escherichia coli (13.04%). In order to eliminate the necrotic areas, 2086 surgical procedures were required. The evolution was favourable in 64 cases; 5 patients died due to septic shock.
Conclusions: Necrotizing fasciitis occurs most commonly as a complication of odontogenic infections. The presence of common bacterial flora can cause the appearance of large areas of septic necrosis that can lead to the patient’s death in the absence of surgical and antibacterial therapy.