Necrotising fasciitis of the neck: Unusual presentation with aggressive management – case report with review of literature

Abstract

Tonsillitis and peri-tonsillar abscess are common conditions which account for a large proportion of hospital admissions. They may present in a similar way to supraglottitis and retropharyngeal collection. With adequate antibiotic coverage, admissions for tonsillitis have decreased compared to cases admitting with complications. This report shows an unusual presentation of necrotising fasciitis in the neck of a 71-year-old male who presented initially with tonsillitis and later developed into supraglottitis with retro- and parapharyngeal abscess complicated by necrotising fasciitis extending into pleural cavity. The patient required a prolonged stay in the Intensive Care Unit, with airway support including tracheostomy, and underwent repeated surgical drainage followed by sequential debridement (10 times). Radiological investigation and nasopharyngolaryngoscopy plays an important role in contributing to early diagnosis. Agressive debridements and necrotic tissue removal with antibiotic cover are mainstay of treatment.

Keywords

• Necrotising fasciitis
• retro- and parapharyngeal abscess
• debridement