European Archives of Oto-Rhino-Laryngology

, Volume 267, Issue 8, pp 1169–1177 | Cite as

An algorithm for early diagnosis of cervicofacial necrotising fasciitis

  • Vikas Malik
  • Chaitanya Gadepalli
  • Shailesh Agrawal
  • Claire Inkster
  • Christopher Lobo
Review Article


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.


Necrotising fasciitis Head and neck Cervicofacial 



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

Conflict of interest statement



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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Vikas Malik
    • 1
    • 3
  • Chaitanya Gadepalli
    • 1
  • Shailesh Agrawal
    • 1
  • Claire Inkster
    • 2
  • Christopher Lobo
    • 1
  1. 1.Department of OtolaryngologyRoyal Bolton Hospital, Royal Bolton Hospital NHS Foundation TrustBoltonUK
  2. 2.Department of OphthalmologyRoyal Bolton Hospital, Royal Bolton Hospital NHS Foundation TrustBoltonUK
  3. 3.BoltonUK

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