RETROSPECTIVE ANALYSIS OF CLINICAL PRESENTATIONS AND MANAGEMENT OUTCOMES OF PATIENTS MANAGED FOR CERVICOFACIAL NECROTIZING FASCIITIS AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN.

Abstract

Background: Cervicofacial necrotizing fasciitis is a rare, rapidly progressive and fatal polymicrobial necrotizing infection of the fascial and subcutaneous tissue of the head and neck resulting from the vascular thrombosis and ischemia within the fascial plane.

Aim: The aim of this study was to evaluate the clinical presentations and management outcomes of patients managed for cervicofacial necrotizing fasciitis at the University College Hospital, Ibadan.

Methods: The data of patients managed for cervicofacial necrotizing fasciitis between January 2018 and December 2023 were extracted from case notes obtained from the medical records. All patients were admitted and those with comorbidities were co-managed with the physicians. Antibiotics were administered empirically after samples for microbiology culture and sensitivity were taken. Patients had extraction of offending teeth, serial debridement and honey dressing until no visible sign of infection and wounds epithelized. SPSS was used for data analysis.

Results: During this period, seventeen patients with cervicofacial necrotizing fasciitis were managed. The male to female ratio was 1.8:1 with mean age of 57.65 (+17.674) years. Most (88.2%) of the patients were of low socio-economic status. Anaemia was the commonest underlying systemic condition while about half (47.1%) of the patients were diagnosed with diabetes mellitus. The only identified aetiology was odontogenic infection among all patients. Seventyfive percent of patients with diabetes presented with features of sepsis. The Chi-test test showed statistical significance association between the diagnosis of diabetes mellitus and sepsis at presentation (P-value=0.030) . Submandibulocervical region was the commonest affected site and average hospital stay was 13.59 (+8.382) days. The major complication encountered was scar formation with no mortality recorded.

Conclusion: Cervicofacial necrotizing fasciitis is a rare but debilitating disease which is usually associated with poverty and presence of comorbidities. Its non-specific symptoms make late presentations common. Hence, the need for high index of suspicion for prompt management.