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An algorithm for early diagnosis of cervicofacial necrotising fasciitis

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Abstract

Cervicofacial necrotising fasciitis (CNF) is a potentially fatal infection which can occasionally present in the head and neck. An early diagnosis and aggressive treatment is imperative for minimising the associated mortality and morbidity. The early clinical features are usually non-specific which makes it difficult to differentiate it from other less serious infections. Necrosis of the skin is a late feature. Although it is more common in the immunocompromised, it can also affect normal individuals. We discuss our experience of five patients with CNF, review of literature and algorithm for early diagnosis of CNF. With experience, we were able to diagnose the subsequent cases early and minimise the mortality and morbidity. In conclusion, the incidence of CNF has increased in the last decade partly due to an increased clinical awareness. Early intervention is essential to minimise the mortality and morbidity. It should be managed by a team of at least otolaryngologists, intensivist, microbiologist and plastic surgeons; cardiothoracic surgeons may be required. Treatment involves early aggressive surgical debridement/fasciotomy, intravenous antibiotics and general metabolic support in the intensive care unit.

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Acknowledgments

The authors gratefully acknowledge Mrs. Sue Warburton for her kind assistance with medical records.

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Authors and Affiliations

  1. Department of Otolaryngology, Royal Bolton Hospital, Royal Bolton Hospital NHS Foundation Trust, Minerva Road, Bolton, BL4 0JR, UK

    Vikas Malik, Chaitanya Gadepalli, Shailesh Agrawal & Christopher Lobo

  2. Department of Ophthalmology, Royal Bolton Hospital, Royal Bolton Hospital NHS Foundation Trust, Minerva Road, Bolton, BL4 0JR, UK

    Claire Inkster

  3. 22 Marsham Road, Westhoughton, Bolton, BL5 2GX, UK

    Vikas Malik

Authors
  1. Vikas Malik
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  2. Chaitanya Gadepalli
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  3. Shailesh Agrawal
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  4. Claire Inkster
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  5. Christopher Lobo
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Corresponding author

Correspondence to Vikas Malik.

Appendix: algorithm for management of CNF

Appendix: algorithm for management of CNF

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Malik, V., Gadepalli, C., Agrawal, S. et al. An algorithm for early diagnosis of cervicofacial necrotising fasciitis. Eur Arch Otorhinolaryngol 267, 1169–1177 (2010). https://doi.org/10.1007/s00405-010-1248-5

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  • DOI: https://doi.org/10.1007/s00405-010-1248-5

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