Objective Recognition and Approach for Necrotizing Fasciitis in a Standard of Care (2024 AMW)

Provide a practical and concise evaluation of diagnosis and approaches for head and neck necrotizing fasciitis. It highlights the importance of this devastating disease. Despite the improvements in diagnostic tests and the availability of modern antibiotic therapy, those infections continue to cause significant morbidity and mortality rates, especially when there is no early treatment. It occurs with considerable frequency, and its severity and extent may be underestimated, making this entity diagnostic challenge to emergency physicians, otolaryngologists, and head and neck surgeons because clinical signs and symptoms often overlap with those of other familiar clinical pictures. However, a rapid spread in a multilayer involvement of skin, subcutaneous fat, and muscle extending through fascial layers. It is potentially fatal and requires aggressive diagnostic and therapeutic management to avoid life-threatening complications, such as airway obstruction, jugular vein thrombosis, disseminated intravascular coagulation empyema, mediastinitis, aspiration pneumonia or thrombosis/aneurysm of the carotid artery. Usually, it is polymicrobial and can occur from previous uncontrolled infections such as tonsillitis, dental infections, surgery, or trauma to the head and neck lymphadenitis after an upper airway infection. The clinical manifestations are diverse and depend on the affected cervical area. Moreover, inappropriate antibiotics may change the clinical presentation of conditions, making them elusive. Patients may be mildly symptomatic and present with symptoms of fever and pain or experience more severe or life-threatening symptoms such as dyspnea, airway obstruction, and septic shock. In the head and neck area, due to several important vascular and nerve structures and proximity to the thorax and mediastine, prompt diagnosis and treatment. Attendees will face a practical strategy for early recognition of the disease for immediate treatment. We will present early diagnosis, evaluation of risk factors, and treatment.