Zusammenfassung
Hintergrund
Bei nekrotisierenden Weichteilinfektionen des Halses geht man ursächlich von toxinbildenden virulenten Bakterien aus. Die Mortalität einer Sonderform, der nekrotisierenden Fasziitis, wird in der Literatur mit bis zu 76% angegeben.
Patienten und Methode
Von 2000 bis 2001 wurden 4 Patienten mit schweren nekrotisierenden Halsweichteilinfektionen und 5 Patienten mit einer nekrotisierenden Fasziitis behandelt.
Ergebnisse
Das Keimspektrum reichte von Mischinfektionen mit Candida albicans, Streptococcus pyogenes, Fusobacterium, Propionibakterien bis hin zu Staphylokokken. Nach frühzeitiger operativer Intervention mit ausgedehnter Drainage der verschiedenen Halslogenund funktioneller Neck Dissection zur Begrenzung der Ausbreitung des Prozesses wurde in 8/9 Fällen eine vollständige Heilung erzielt. Ein Patient verstarb an einem septischen Schock, weil die Therapie zu spät eingeleitet wurde.
Schlussfolgerung
Entscheidend ist nach unserer Ansicht die frühzeitige und konsequente chirurgische Therapie mit Drainage aller Abszesshöhlen funktioneller Neck Dissection sowie interdisziplinärem Vorgehen inklusive der resistogrammgerechten Antibiose und hyperbarer Sauerstofftherapie als Ergänzung.
Abstract
Background
Necrotizing neck infections are uncommon soft-tissue infections, usually caused by virulent, toxin producing bacteria. Necrotizing fasciitis represents a special form of necrotizing soft tissue infection with a mortality rate of up to 76% even though aggressive therapy is recommended.
Patients and methods
In the last 2 years we treated four patients with severe necrotizing neck infections and five suffering from necrotizing fasciitis.
Results
Microbiological analysis revealed mixed infections with Candida albicans, Streptococcus pyogenes, Fusobacterium, Proprioni bacteria and Staphylococcus. The surgical management was not only restricted to drainage, but also included functional neck dissection in order minimize the spread of the disease. Eight of our patients recovered completely, but one died due to toxic shock as consequence of a delayed in therapy.
Conclusion
Complete recovery of patients suffering from necrotizing fasciitis depends on early and aggressive surgical therapy including neck dissection and drainage as well as an interdisciplinary strategy of conservative therapy. Hyperbaric oxygen should be considered as a treatment adjunct in patients with necrotizing fasciitis if surgery and antibiotic treatment fail.
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Rudack, C., Eikenbusch, G., Stoll, W. et al. Therapeutisches Management nekrotisierender Weichteilinfektionen des Halses. HNO 51, 986–992 (2003). https://doi.org/10.1007/s00106-003-0854-6
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DOI: https://doi.org/10.1007/s00106-003-0854-6