Outcomes of necrotizing fasciitis in the head and neck region in the United Kingdom-a case series and literature review

Abstract

Introduction: Necrotising fasciitis (NF) is a relatively rare but aggressive infection with high mortality and morbidity if not treated early. Presentation can be vague which can contribute to the treatment delays and poorer patients’ outcomes. The aim of this paper was to reflect on incidence, causation, management and mortality of head and neck (HN) NF cases in the UK by conducting a literature review and present a case series. Method: The literature search was undertaken using PubMed, CINAHL, EMBASE and Medline for HN NF in accordance to PRISMA. Our case series were collected from patients treated between 2010 and 2020 in two hospitals; in East London and Merseyside regions. The data parameters include patients’ demographics, co-morbidities, radiographic investigations, management, microbiology, length of stay and mortality. Results: A total of fifty-one cases were included. Only 59.5% of cases reported of underlying health condition. The main origin of infection was odontogenic (29.4%) and traumatic (27.5%). Before their acute presentation of NF, 41.2% had sought medical treatment either from primary care or emergency services. All patients received IV antibiotics of varying types and 90.2% had surgical debridement. Overall, the mortality rate was 17.6%; cases of traumatic origin had a higher mortality (35.7%). Conclusion: There is a need for awareness for early detection of clinical diagnosis of H&N NF in primary care and emergency services. Prompt referral to the specialist services is crucial to allow early management and improve patients’ outcomes particularly in patients with a history of H&N trauma.

Keywords

• Necrotising
• Fasciitis
• Odontogenic
• Infection
• Cervical