Bilateral Dysfunction of Superior Laryngeal Nerves as a consequence of Cervical Necrotising Fasciitis: A case report

Abstract

Background. Cervical necrotizing fasciitis is an infectious disease with serious complications and grave prognosis. We report a case of the cervical necrotizing fasciitis with consequent bilateral dysfunction of superior laryngeal nerves and describe the characteristics of this exceptional complication.Case report. A 71-year-old female patient, surgically treated for cervical necrotizing fasciitis, suffered from severe dysphagia after surgery. Radiographic and fiberendoscopic evaluation showed aspiration and hyposensibility of glottis and supraglottis. Apart from inadequate laryngeal elevation, we explain the dysphagia also by the sensory deficit of the supraglottic mucosa with consequent lack of vocal folds adduction during swallowing. The sensory deficit was attributed to the toxic neuritis-mediated dysfunction of both internal branches of superior laryngeal nerves. The healing of both cervical necrotizing fasciitis and toxic neuritis led to the restoration of sensory function and the swallowing.Conclusions. Although only occasionally reported in the literature, the patients with cervical necrotizing fasciitis are prone to toxic neuritis-mediated neurologic deficits of cranial nerves. They are considered to be another complication of this entity.

Keywords

• Cervical necrotizing fasciitis
• dysphagia
• toxic neuritis
• cranial nerve dysfunction
• superior laryngeal nerve