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Techniques for early diagnosis and management of cervicofacial necrotising fasciitis

  • J W Lee (a1), S B Immerman (a1) and L G T Morris (a1)
  • DOI:
  • Published online: 19 March 2010

Cervicofacial necrotising fasciitis carries high rates of morbidity and mortality, and is not often initially suspected due to its rarity and misleadingly innocuous presentation. We propose an algorithm for the timely diagnosis and management of cervicofacial necrotising fasciitis.


Retrospective review of seven patients ultimately diagnosed with cervicofacial necrotising fasciitis.


In these seven patients, common presenting symptoms included sore throat, fever and neck pain. On initial examination and imaging, only three had obvious findings. One patient's diagnosis was facilitated via a bedside cut-down procedure. Six patients underwent surgical debridement. Four required tracheotomy, and five wounds closed via secondary intention. There were two deaths.


The severity of cervical necrotising fasciitis and its rapid spread necessitate early diagnosis and timely surgical management. The presentation often appears benign. A high index of clinical suspicion should be maintained in cases of neck cellulitis with nonspecific clinical findings, especially in diabetic or otherwise immunocompromised patients. A normal computed tomography scan does not rule out necrotising fasciitis. A cut-down procedure may be critical to early diagnosis in some cases.

Corresponding author
Address for correspondence: Dr Luc G T Morris, Head and Neck Surgery Service, Department of Otolaryngology, New York University Medical Center, 550 First Avenue, NBV 5E5, New York, NY 10016, USA. Fax: +1 212 263 8257 E-mail:
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3C Lin , FL Yeh , JT Lin , H Ma , CH Hwang , BH Shen Necrotizing fasciitis of the head and neck: an analysis of 47 cases. Plast Reconstr Surg 2001;107:1684–93

4T DeBacker , M Bossuyt , J Schoenaers . Management of necrotizing fasciitis in the neck. J Craniomaxillofac Surg 1997;24:366–71

5L Krenk , HU Nielson , ME Christensen . Necrotizing fasciitis of the head and neck region: an analysis of standard treatment effectiveness. Eur Arch Otorhinolaryngol 2007;264:917–22

6CE Flanagan , OO Daramola , RH Maisel , C Adkinson , RM Odland . Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing fasciitis. Otolaryngol Head Neck Surg 2009;140:730–4

7A Islam , M Oko . Cervical necrotising fasciitis and descending mediastinitis secondary to unilateral tonsillitis: a case report. J Med Case Reports 2008;2:368

9B Hohlweg-Majert , N Weyer , MC Metzger , R Schön . Cervicofacial necrotizing fasciitis. Diabetes Res Clin Pract 2006;72:206–8

10M Berlucchi , C Galtelli , N Nassif , MP Bondioni , P Nicolai . Cervical necrotizing fasciitis with mediastinitis: a rare occurrence in the pediatric age. Am J Otolaryngol 2007;28:1821

11MM Chidzonga . Necrotizing fasciitis of the cervical region in an AIDS patient: report of a case. J Oral Maxillofac Surg 2005;63:855–9

13E Daniel , CS Whang , JT Cohen . Radiology quiz case 2. Cervical necrotizing fasciitis (CNF), odontogenic origin. Arch Otolaryngol Head Neck Surg 2004;130:480–3

15L Whitesides , C Cotto-Cumba , RA Myers . Cervical necrotizing fasciitis of odontogenic origin: a case report and review of 12 cases. J Oral Maxillofac Surg 2000;58:144–51

16N Skitarelic , R Mladina , M Morovic . Cervical necrotizing fasciitis: sources and outcomes. Infection 2003;31:3944

18M Cainzos , FJ Gonzales-Rodriguez . Necrotizing soft tissue infections. Curr Opin Crit Care 2007;13:433–9

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