Analysis of cervicofacial necrotising fasciitis at Tygerberg oral health centre
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Date
2025
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University of the Western Cape
Abstract
Cervicofacial necrotising fasciitis (CFNF) is an uncommon, and potentially fatal infection characterized by rapid destruction of involved structures, often originating from odontogenic infections or trauma. Despite its high morbidity and mortality, particularly in immunocompromised patients, there is limited literature on CFNF, especially relating to the Western Cape, South Africa. This study aims to analyse the clinicopathological features, treatment strategies, and outcomes of CFNF cases treated at Tygerberg Oral Health Centre between 2010 and 2023. This retrospective, descriptive case-series study examined clinical records of patients diagnosed with CFNF at Tygerberg Academic Hospital, analysing the demographics, comorbidities, clinical presentation, microbiological findings, imaging results, treatment modalities, and patient outcomes. The study sample included 22 patients, with a male predominance (59.1%) and a mean age of 46.04 years. Diabetes mellitus (32%) and HIV/AIDS (23%) were the most prevalent comorbidities while odontogenic infections accounted for the majority of CFNF cases (54.5%). Common clinical signs documented were swelling, pain, erythema, and trismus, with some patients exhibiting airway distress. Streptococcus species, particularly Streptococcus constellatus (36%), were the most frequently cultured organisms, followed by Staphylococcus aureus (27%).
Treatment primarily involved surgical debridement, with 68.2% of patients undergoing multiple procedures. Skin grafting was required for 63.6% of patients post-debridement. A significant proportion of patients, particularly those with diabetes, experienced increased morbidity. The overall mortality rate was 13.6%, with all fatalities occurring in patients with diabetes mellitus (p=0.03). The average length of hospital stay was 15.77 days. Patients who presented with mediastinal involvement required prolonged hospitalization.
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Keywords
Cervicofacial necrotising fasciitis, Odontogenic infection, Diabetes mellitus, HIV/AIDS, Surgical debridement, Skin grafting
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