Nekrotisierende Fasciitis im Kiefer-Gesichtsbereich

The clinical picture and treatment of a life threatening necrotizing fasciitis in a 53 and 75 year old patient is presented.In both patients a descending phlegmonous spread of infection sternally and ß-hemolytic pyogenic streptokokki were demonstrated in blood cultures. In the patient 53 years of age the necrotizing fasciitis was located in the area of the left eye lids. Intensive care was indicated due to septic complications and a beginning cardiac shock syndrom. CT and sonographic evaluation showed reactive swelling of the eyemuscles and phlemonous changes of the soft tissues in the head and neck from left temporal to parasternal region without signs of abscess formation. In the patient 75 years of age with the history of Diabetes mellitus the CT demonstrated extended necrosis and air filled cavities cervical to sternally. As origin of the infection a decaded lower right first molar was suspecetd. Due to the swelling the air way was compromised and endotraceal intubation was indicated in the septic patient.Following antibiotic therapy only a recoverey was noted in the 53 year old patient. Parameters of inflammation were normal after 6 days.In the 75 year old patient immediate surgical debridement and abscess drainage was performed in combination with a perioperative antibiotic therapy. Day post surgery the WBC decreased from 13,8 Tsd/µl to 9,5 Tsd/µl. Extubation was performed at postoperative day.In both patients a good recovery was noted. Conclusion: A surgical intervention and antibiotic treatment only demonstrated satisfying results in the treatment of necrotising fasciitis of the head and neck. Keywords: nekrotisierende Fasciitis