(A582) Necrotizing Fasciitis in the Head and Neck: Our Institutional Experience

Introduction: Necrotizing fasciitis of the head and neck is a rare, life-threatening condition characterized by rapidly progressive tissue necrosis due to poly-microbial infection. Often challenging to diagnose clinically, this case series examines five patients in an urban hospital to explore clinical presentations, co-morbidities, pathogens, and management strategies for this aggressive infection.

Methods: A retrospective chart review analyzed five cases of head and neck necrotizing fasciitis treated at Cooper University Hospital from 2015 to 2023. Patients were identified from surgical databases of three attending surgeons and included adults diagnosed based on clinical and imaging findings. Data collected included demographics (age, sex), social history (tobacco, alcohol, IV drug use), presenting symptoms, co-morbidities, laboratory findings (leukocytosis, neutrophilia), surgical interventions, microbiology of pathogens, and post-operative outcomes (survival, complications)

Results: The five patients presented with edema, pain, erythema, and crepitus, with etiologies including neck abscess, odontogenic infection, and IV drug use. Hypertension and diabetes mellitus were common comorbidities. All patients had elevated leukocytes and neutrophils but were afebrile. All received broad-spectrum antibiotics and underwent surgical debridement, with substance users requiring 2–3 debridements versus one in others. Most required repeat debridements, up to three. Cultures identified gram-positive cocci, predominantly group A streptococcus. Airway management included nasotracheal and endotracheal intubations, with no tracheostomies needed. No mortalities occurred.

Conclusions: Necrotizing fasciitis of the head and neck is rare but rapidly progressive, requiring prompt diagnosis and aggressive treatment to prevent further spread and mortality. This case series highlights surgical debridement as the cornerstone of management, emphasizing the need for extensive tissue removal for optimal outcomes.