Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Necrotizing fasciitis (NF) in the head and neck is rare but highly aggressive, presenting unique diagnostic and management challenges due to complex anatomy and rapid progression risks. Early radiological identification and intervention are critical in reducing morbidity and mortality. This case series analyzes clinical and radiological features, triggers, and outcomes in patients with head and neck NF to inform diagnostic accuracy and treatment strategies.
Objective: To evaluate the clinical presentations, radiological features, and outcomes of head and neck necrotizing fasciitis (NF) cases, with a focus on assessing the role of initial imaging and the potential benefit of staged surgical reassessment in guiding early diagnosis and optimizing treatment outcomes.
Methods: We conducted a retrospective case series of six patients diagnosed with head and neck NF at a tertiary medical center between 2018 and 2022. Patient demographics, clinical presentations, imaging findings, culture results, and treatment regimens were extracted from medical records and radiological reviews. Imaging studies included CT, MRI, and ultrasound, with a focus on findings indicative of NF, such as gas formation, fascial thickening, and fluid collections. Data were analyzed using descriptive statistics.
Results: The average patient age was 53, with an equal distribution of males and females and minimal comorbidities. Dental procedures were identified as a primary trigger in 33% of cases. All patients initially presented with pain, 50% also showed erythema, and 66% exhibited necrosis.
Contrast-enhanced CT scans revealed free air in the neck tissues in 83% of cases, while fascial thickening, deep fat stranding, and lymphadenopathy were noted universally. Cultures were consistently polymicrobial, with 67% of cases involving both streptococci and anaerobes, and 17% showing MSSA. Management included prompt antibiotic therapy and surgical debridement upon diagnosis, with an average of two procedures per patient. Airway compromise presented in 66% of the patients, necessitating surgical intervention. The average hospital stay was 29 days. While no mortalities occurred, 50% of patients required respiratory rehabilitation post-discharge.
Conclusion: This case series underscores the importance of early radiological assessment in identifying key characteristics of head and neck NF, which poses unique diagnostic and management challenges. A high index of clinical suspicion, combined with prompt and comprehensive imaging, enhances diagnostic accuracy and informs treatment decisions. Furthermore, the findings suggest that incorporating staged surgical reassessment and collaborative multidisciplinary discussions into the management protocol could be beneficial, as timely evaluations may lead to necessary additional interventions, optimizing recovery and reducing complications.