Improvement in mortality with hyperbaric oxygen therapy in cervical necrotising fasciitis: a systematic review of the literature

Tseros, Evan A.; Reddy, Rithvik; Ho, Jocelyn; Gunaratne, Dakshika A.; Venkatesha, V.; Riffat, Faruque

doi:10.21037/ajo-23-5

Cited by 1 publication

(1 citation statement)

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“…Moreover, other treatment options described in necrotising fasciitis include hyperbaric oxygen, intravenous immunoglobulin (IVIG) and sterile maggots ( 19 ). Hyperbaric oxygen has been utilised as a potential treatment due to its ability to inhibit anaerobic infection however there is no agreed consensus on its use ( 20 - 23 ); Tseros et al performed a systematic review suggesting a significant reduction in mortality in those receiving hyperbaric oxygen as an adjunctive treatment in cervical necrotising fasciitis though higher quality randomised data is needed ( 23 ). IVIG and hydrocortisone immunosuppressive therapy were utilised by Koch et al ( 24 ) due to its suppression of streptococcal superantigen induced T cell proliferation and cytokine production ( 25 , 26 ); though this has only been shown to be beneficial in necrotising fasciitis of staphylococcal or streptococcal origin ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

A parotid abscess out of control resulting in craniocervical necrotising fasciitis in the context of diabetes mellitus—a case report and review of the literature

Rajmohan,

Gao,

Rajmohan

et al. 2024

Gland Surg

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Background Necrotising fasciitis is an aggressive life-threatening infective process rarely making an appearance in the head and neck region and its development secondary to parotid abscess is exceptionally rare and scarcely reported in the literature. This case report serves to guide otolaryngologists with respect to its recognition and offers an alternative approach to craniocervical necrotising fasciitis with multiple neck explorations, use of antimicrobial impregnated packing enabling delayed reconstruction with lower morbidity. Case Description A 76-year-old female with a body mass index of 36.2 kg/m 2 and a 30-year history of poorly controlled type 2 diabetes mellitus (HbA1c 91 mmol/moL), presented to the outpatient otolaryngology clinic with right sided parotid mass with minimal erythema, hyperglycaemia (19.2 mmol/L) and no cranial neuropathies. However, the aggressive nature of the parotid abscess triggered by group A streptococcus and Staphylococcus epidermidis led to sepsis and extensive non-odontogenic necrotising fasciitis involving the lateral neck mandating multiple surgical debridement and neck explorations, prolonged intravenous antibiotics with interval definitive reconstruction. A cervicofacial rotational sternocleidomastoid flap was utilised to conceal the defect with patient experiencing a remarkable recovery. The patient’s immunosuppressive state from poorly controlled diabetes mellitus and multi-lineage cytopenia is likely to have contributed to a prolonged recovery. Conclusions This case report highlights the significance of repeat explorations and the need to give time for tissue healing as it unlocks options for reconstruction and reduce overall patient morbidity. Bismuth iodoform paraffin paste packing is a valuable tool with this case demonstrating its use an antiseptic and haemostatic agent in necrotising fasciitis and its ability to create an atmosphere to enable tissue healing minimising need for large-scale reconstructions. The absence of crepitus should not discourage the treating clinician from suspecting necrotising fasciitis of the neck. To limit successive cases, early prevention through aggressive control of predisposing systemic conditions including diabetes mellitus is needed. Moreover, when aggressive infections arise, the clinician should investigate for contributing systemic conditions.

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