Challenges in the management of cervicofacial necrotizing fasciitis in a developing economy: our experience

Abstract

Background: Necrotizing fascitis is uncommon but a life threatening cervico-facial infection, which is characterized by aggressive spread of inflammation and necrosis of the tissues. In our environment clinical presentation is often late and patient's management at this stage is very challenging. We present the challenges in the management of this lesion as experience in our centres.

Methods: We carried out clinical evaluation on the management and treatment options amongst the 11 patients that presented with cervicofacial necrotizing fascitis at two tertiary hospitals in South east, Nigeria over a 3-year period from 2012 to 2015. The focus was on the management challenges which include diagnosis, lack of modern facilities and treatment options, associated co- morbidities such as retroviral disease and diabetes mellitus, financial constraint and incessant industrial action by the medical and allied workforce.

Result: There were 7 males (63.6%) and 4 females (36.7%) giving a male-to-female ratio of 1.8: 1 aged between 27 – 78 years with a mean of 57.4 ± 17.9 years. All presented as emergency and were hospitalized. Six (54.5%) were treated successfully with mortality rate of 9.1% (one patient) recorded. Four (36.4%) were lost to follow up., two of which were referred as a result of industrial action while the other 2 were discharged against medical advice.

Conclusion: Patients often presents late and with limited options of treatment in a depressed economy treatment is often very challenging. Since poor oral hygiene is a modifiable risk factor, emphasis on oral health care should be a preventable measure.

Keywords: Cervicofacial, Necrotizing fasciitis, Challenges, Management, Developing economy