Cervical necrotizing fasciitis: systematic review and analysis of 1235 reported cases from the literature

Dakshika A. Gunaratne, Evan A. Tseros, Zubair Hasan, Akshay S. Kudpaje, Anand Suruliraj, Mark C. Smith, Faruque Riffat, Carsten E. Palme

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Background: Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. Methods: A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm “(cervical OR neck) AND necrotizing fasciitis.” Results: There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. Conclusion: Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.

LanguageEnglish
Pages2094-2102
Number of pages9
JournalHead and Neck
Volume40
Issue number9
DOIs
Publication statusPublished - 1 Sep 2018

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Necrotizing Fasciitis
Mortality
Prevotella
Morbidity
Mediastinitis
Soft Tissue Infections
Debridement
Streptococcus
Staphylococcus
PubMed
MEDLINE
Length of Stay
Neck
Databases
Physicians

Keywords

  • cervical necrotizing fasciitis
  • head and neck
  • mortality
  • necrotizing fasciitis
  • sequelae

Cite this

Gunaratne, D. A., Tseros, E. A., Hasan, Z., Kudpaje, A. S., Suruliraj, A., Smith, M. C., ... Palme, C. E. (2018). Cervical necrotizing fasciitis: systematic review and analysis of 1235 reported cases from the literature. Head and Neck, 40(9), 2094-2102. https://doi.org/10.1002/hed.25184
Gunaratne, Dakshika A. ; Tseros, Evan A. ; Hasan, Zubair ; Kudpaje, Akshay S. ; Suruliraj, Anand ; Smith, Mark C. ; Riffat, Faruque ; Palme, Carsten E. / Cervical necrotizing fasciitis : systematic review and analysis of 1235 reported cases from the literature. In: Head and Neck. 2018 ; Vol. 40, No. 9. pp. 2094-2102.
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abstract = "Background: Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. Methods: A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm “(cervical OR neck) AND necrotizing fasciitis.” Results: There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23{\%} men). Etiology was odontogenic (47.04{\%}), pharyngolaryngeal (28.34{\%}), or tonsillar/peritonsillar (6.07{\%}). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22{\%}), staphylococci (18.09{\%}), and prevotella (10.87{\%}). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56{\%} of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36{\%}. Conclusion: Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.",
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Gunaratne, DA, Tseros, EA, Hasan, Z, Kudpaje, AS, Suruliraj, A, Smith, MC, Riffat, F & Palme, CE 2018, 'Cervical necrotizing fasciitis: systematic review and analysis of 1235 reported cases from the literature', Head and Neck, vol. 40, no. 9, pp. 2094-2102. https://doi.org/10.1002/hed.25184

Cervical necrotizing fasciitis : systematic review and analysis of 1235 reported cases from the literature. / Gunaratne, Dakshika A.; Tseros, Evan A.; Hasan, Zubair; Kudpaje, Akshay S.; Suruliraj, Anand; Smith, Mark C.; Riffat, Faruque; Palme, Carsten E.

In: Head and Neck, Vol. 40, No. 9, 01.09.2018, p. 2094-2102.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Cervical necrotizing fasciitis

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AU - Gunaratne, Dakshika A.

AU - Tseros, Evan A.

AU - Hasan, Zubair

AU - Kudpaje, Akshay S.

AU - Suruliraj, Anand

AU - Smith, Mark C.

AU - Riffat, Faruque

AU - Palme, Carsten E.

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N2 - Background: Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. Methods: A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm “(cervical OR neck) AND necrotizing fasciitis.” Results: There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. Conclusion: Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.

AB - Background: Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality. Methods: A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm “(cervical OR neck) AND necrotizing fasciitis.” Results: There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%. Conclusion: Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.

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Gunaratne DA, Tseros EA, Hasan Z, Kudpaje AS, Suruliraj A, Smith MC et al. Cervical necrotizing fasciitis: systematic review and analysis of 1235 reported cases from the literature. Head and Neck. 2018 Sep 1;40(9):2094-2102. https://doi.org/10.1002/hed.25184