Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Cervical necrotizing fasciitis (CNF) is a rapidly progressive soft tissue infection of the head and neck characterized by significant morbidity and mortality. Given the aggressive nature and rarity of the disease, management remains highly challenging and requires multidisciplinary medical and surgical intervention. The primary objective of this study was to characterize optimal treatment paradigms and clinical factors associated with successful outcomes and prognosis.
Methods: A retrospective analysis of adult patients treated for severe head and neck infections at a tertiary academic medical center between 2014 and 2024 was conducted. Patients were identified to have CNF based on clinical documentation, imaging, and pathology. Multivariate logistic regression was performed to identify predictors of complications in this cohort.
Results: 372 patients treated for severe head and neck infections were identified, with 35 patients undergoing surgical intervention for confirmed CNF. Of patients with CNF, the majority were male (N = 21, 60.0%) with a mean patient age of 52.7 years (range, 19-83 years). The most common comorbidity was diabetes mellitus (60.0%) and 51.4% of patients had a history of tobacco abuse. Mean Body Mass Index (BMI) was 32.4 ± 10.8. The mean Sequential Organ Failure Assessment (SOFA) score was 5.1 ± 2.5, mean Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was 6.2 ± 4.0, and 65.7% of patients had a Charlson Comorbidity Index (CCI) score of ≥ 2. The median time to surgery was 10 hours, with patients undergoing an average of 3.8 (range, 1-8) surgical interventions. Overall, 13 (37.1%) patients experienced complications as result of CNF, with descending mediastinitis (N = 8) as the most common. Tracheostomy was performed in 34.3% of patients; 14.3% required a gastrostomy tube, with 60.0% of patients remaining dependent at last follow up. Polymicrobial infections were most common (68.6%), with frequent identification of Streptococcus and Staphylococcusmicrobes. Among the 4 (11.4%) patients who died, no significant clinicopathologic differences were identified when compared to survivors. In a multivariable model, presence of tracheostomy was identified as a predictor of complications (aOR 10.05 [1.64-61.81, 95% CI]). Notably, the incidence of CNF in the cohort increased markedly since 2022, accounting for 54.3% [37.8-70.8%, 95% CI] of all cases from 2014 to 2024.
Conclusion: The rising frequency of CNF cases in recent years underscores the need for heightened clinical awareness and improved management strategies for this life-threatening condition. Despite historically high mortality rates reported in the literature, our study demonstrated an improved mortality rate of 11.4%, with the presence of tracheostomy identified as a factor in the development of CNF complications. Timely and aggressive medical and surgical intervention is critical to improve patient outcomes and survival in this population.