Paediatric necrotizing fasciitis complicating third molar extraction: report of a case

A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018

BACKGROUND

Necrotising fasciitis is a rapidly progressing soft-tissue infection with a low incidence that carries a relevant risk of morbidity and mortality. Although necrotising fasciitis is often fatal in adults, its case fatality rate seems to be lower in children. A highly variable clinical presentation makes the diagnosis challenging, which often results in misdiagnosis and time-delay to therapy.

METHODS

We conducted a protocol-based systematic review to identify specific features of necrotising fasciitis in children aged one month to 17 years. We searched 'PubMed', 'Web of Science' and 'SCOPUS' for relevant literature. Primary outcomes were incidence and case fatality rates in population-based studies, and skin symptoms on presentation. We also assessed signs of systemic illness, causative organisms, predisposing factors, and reconstructive procedures as secondary outcomes.

RESULTS

We included five studies reporting incidence and case fatality rates, two case-control studies, and 298 cases from 195 reports. Incidence rates varied between 0.022 and 0.843 per 100,000 children per year with a case-fatality rate ranging from 0% to 14.3%. The most frequent skin symptoms were erythema (58.7%; 175/298) and swelling (48%; 143/298), whereas all other symptoms occurred in less than 50% of cases. The majority of cases had fever (76.7%; 188/245), but other signs of systemic illness were present in less than half of the cohort. Group-A streptococci accounted for 44.8% (132/298) followed by Gram-negative rods in 29.8% (88/295), while polymicrobial infections occurred in 17.3% (51/295). Extremities were affected in 45.6% (136/298), of which 73.5% (100/136) occurred in the lower extremities. Skin grafts were necessary in 51.6% (84/162) of the pooled cases, while flaps were seldom used (10.5%; 17/162). The vast majority of included reports originate from developed countries.

CONCLUSIONS

Clinical suspicion remains the key to diagnose necrotising fasciitis. A combination of swelling, pain, erythema, and a systemic inflammatory response syndrome might indicate necrotising fasciitis. Incidence and case-fatality rates in children are much smaller than in adults, although there seems to be a relevant risk of morbidity indicated by the high percentage of skin grafts. Systematic multi-institutional research efforts are necessary to improve early diagnosis on necrotising fasciits.

Cervicofacial Necrotizing Fasciitis in Patients with No Underlying Medical Conditions: A Review of Four Cases Seen in Twelve Months at a Nigerian Tertiary Hospital

Necrotizing fasciitis of the head and neck is a rare but rapidly progressive infection involving the skin, subcutaneous tissue, and fascia. We report 4 cases of cervicofacial necrotizing fasciitis with similar patterns of presentation. All the 4 cases presented with an odontogenic source and no underlying medical condition. All the patients had tooth extraction and serial wound debridement. Three of these patients recovered well, and healing of the wound occurred by secondary intention. One patient had a resultant neck defect, which was repaired with a supraclavicular island flap after the infection had subsided. We advocate the importance of early detection of necrotizing fasciitis with or without an underlying medical condition and an aggressive medical and surgical intervention. Additionally, eradication of the source of infection is highly indicated to reduce the mortality of this disease.

Extensive cervical necrotizing fasciitis of odontogenic origin

Necrotizing fasciitis (NF) is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of necrotizing fasciitis from odontogenic origin in a patient with uncontrolled diabetes mellitus. The initial diagnosis was based on clinical information, in which multiple necrosis areas in cervical and thoracic regions were observed. Wide antibiotic therapy was applied, followed by surgical drain age and debridement. Culture was positive for methicillin-resistant Staphylococcus aureus. Although the treatment is established, the patient dies after sepsis and failure of vital organs. Clearly, the morbidity associated to this infection, even in diabetic patients, can be minimized if an early diagnosis and effective debridement are done.

Cervical necrotizing fasciitis caused by dental infection: A review and case report

Necrotizing fasciitis of the head and neck is an uncommon, potentially fatal , soft tissue infection characterized by extensive necrosis and gas formation in the subcutaneous tissue and fascia. The purpose of this report is to heighten the awareness of this infection. The article also outlines an appropriate management strategy for use in the treatment of these patients and reviews the literature along with a report of a case which was successfully managed.

Craniocervical necrotising fasciitis--an interesting case with review of the literature

Craniocervical necrotising fasciitis (CCNF) is an aggressive and potentially fatal infection associated with high morbidity and mortality if early intervention is not implemented. Patients are often unwell at presentation, the clinical picture is often unclear thus presenting with diagnostic difficulty. We report a case of CCNF presenting at an advanced stage and discuss the condition including its management and associated complications.

Cervicofacial necrotizing fasciitis

Cervical necrotizing fasciitis is a fast spreading acute soft tissue inflammation. Death can occur within 12-24 h. Early identification and treatment is needed. We report the case of a 75 year old woman with diabetes and high cholesterol, adipositas who developed cervical necrotizing fasciitis of odotongenic origin with massive subcutaneous air collection and first sign of septicaemia. Surgical treatment with debridement and drainage in combination with intravenous broadbased antibiotics as well as daily irrigation of the wound with iodine solution (Betaisodona) and metronidazol (local antibiotic treatment) was performed. The patient recovered completely. Surgical debridement combined with broad-spectrum of antibiotics showed satisfying result for the management of cervical necrotizing fasciitis of dentogenous origin.