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I'm currently talking about head and neck emergencies that occur

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very rarely in your experience as an emergency department

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nor radiologist, but which are life threatening. Necrotizing

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Fasciitis is a very dangerous infection that can occur after

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dental infections, peri-tonsillar or pharyngeal abscesses,

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oosteoradionecrosis , insect bites, previous surgery,

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steroid neck injections, or skin popping by IV drug abusers.

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What you see here is this very aggressive air forming bacteria

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that is usually of a mixed flora that will aggressively

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invade the fascia of the neck.

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It will not respect the fascial boundaries of the

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deep cervical fascia, be it the superficial,

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middle or deep portions of the deep cervical fascia.

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And what you see is just this gross area of necrosis

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air in the neck bilaterally going through,

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and the patient is just absolutely miserable.

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And this has a very poor prognosis.

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The risk factors for the patients, here we

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have the risk factors of the infection,

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but the patients that it occurs in include

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those patients who are diabetics,

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those patients who have severe atherosclerosis

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with poor vascular supply to the neck anyway.

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Alcoholics, chronic renal failure,

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patients with malignancy who are unable

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to mount an effective immune response,

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the IV drug abusers who may be injecting in their

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neck, or individuals in a postpartum situation.

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So this is something that you want to recognize quickly.

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Quite often they have to do surgery to remove

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this necrotic tissue because, frankly,

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the antibiotics don't help all that much without some surgical

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intervention to decrease the overall

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load of the inflammatory process.

Necrotizing Fasciitis Summary

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