AtlasInfectionsCervicofacial Necrotising Fasciitis

Maxillofacial Infections

Cervicofacial Necrotising Fasciitis

aka NF · Flesh-eating Infection

Rapidly progressive polymicrobial infection of subcutaneous tissue and fascia with high mortality; requires emergent surgical debridement and broad-spectrum antibiotics.

Rx
Emergent debridement + IV abx
Abx
Pip-tazo + clinda + vanco
Mortality
20–40%

§ figuresFigures (3)

Fig. 1The start of Necrotizing Fasciitis in Joe Doetsch.

“Beginning of Necrotizing Fasciitis 01” · Doetsch · CC BY-SA 4.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Cervicofacial Necrotising Fasciitis figures pending faculty review.

§ overviewOverview

Life-threatening soft-tissue infection producing widespread fascial necrosis, often with relative sparing of underlying muscle and overlying skin early in the disease.

§ icdICD Classification

M72.6

§ riskRisk Factors

  • 01Odontogenic infection
  • 02Diabetes
  • 03Immunosuppression, alcoholism
  • 04IV drug use
  • 05Recent surgery/trauma

§ clinicalClinical Features

  • 01Rapidly spreading painful cellulitis disproportionate to skin findings
  • 02Skin: erythema → dusky discolouration → haemorrhagic bullae → necrosis
  • 03Crepitus (gas)
  • 04Systemic toxicity: fever, tachycardia, hypotension, altered mentation (SIRS/sepsis)

§ differentialDifferential Diagnosis

  • 01Ludwig angina
  • 02Cellulitis
  • 03Erysipelas
  • 04Cervicofacial actinomycosis

§ investigationsInvestigations

  • 01Do NOT delay surgery for imaging in obvious cases
  • 02LRINEC score
  • 03CT/MRI: gas in fascial planes, fascial thickening
  • 04Blood cultures, wound cultures
  • 05Frozen section: fascial necrosis

§ labsLaboratory Findings

  • 01Leucocytosis or leucopenia
  • 02Elevated CRP, lactate, creatinine
  • 03Hyponatraemia (< 135)
  • 04Coagulopathy

§ classificationClassification

  • 01Type I: polymicrobial (aerobic + anaerobic) — most head-neck NF
  • 02Type II: monomicrobial Group A Streptococcus ± S. aureus
  • 03Type III: Vibrio, Aeromonas
  • 04Type IV: fungal (immunocompromised)

§ treatmentTreatment

  • 01Immediate aggressive surgical debridement — the mainstay; repeat every 24 h until clean
  • 02Empirical broad-spectrum: piperacillin–tazobactam + clindamycin + vancomycin/linezolid
  • 03Clindamycin suppresses exotoxin production
  • 04IVIG for streptococcal toxic shock
  • 05ICU support: fluids, vasopressors, ventilation
  • 06Hyperbaric oxygen adjunctive
  • 07Reconstruction after infection controlled

§ complicationsComplications

  • 01Descending mediastinitis
  • 02Sepsis, MODS
  • 03Airway compromise
  • 04Death

§ prognosisPrognosis

Mortality 20–40% (higher with mediastinitis, delayed surgery, comorbidity).

§ examKey Examination Points

  • 01Pain out of proportion + rapid spread → suspect NF
  • 02Skin appearance underestimates fascial destruction

§ revisionQuick Revision Summary

  • 01Polymicrobial · early aggressive debridement · clindamycin + β-lactam · high mortality

§ vivaBDS Viva Questions

  • 01Types of NF?
  • 02LRINEC score?
  • 03Why clindamycin?

§ mcqsMCQs — Assessment (3)

Question 1

Definitive treatment:

Question 2

Clindamycin adjunct role:

Question 3

Most feared complication of cervicofacial NF:

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

  • L1 · Classification — 1
  • L4 · Research — 1
  • L6 · Textbook — 3

2 linked sources were published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

Open PubMed

Current Classification

Reference #1L1 · ClassificationWHO / Classification Verified
WHO Classification of Tumours Online — Head and Neck

IARC / WHO. IARC · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

DOI: Identifier not availablePMID: Identifier not available
View source

Key Research

Reference #2L4 · ResearchOriginal ResearchRecent Verified
Navigating the Airway Maze: Challenges and Strategies in Deep Neck Space Infections

R MN, R H, M V et al.. Cureus · 2024 · 16(10):e72337

Review of airway assessment and management strategies in deep neck space infection.

DOI: 10.7759/cureus.72337PMID: 39583498
PubMedDOIFull text

Histopathology References

Reference #5L6 · TextbookHistopathology References Unverified
Surgical Pathology of the Head and Neck3rd Edition

Barnes L. CRC Press · 2008

Detailed histopathological reference for head and neck diagnostic criteria.

DOI: Identifier not availablePMID: Identifier not available

Textbook References

Reference #3L6 · TextbookTextbooksRecent Verified
Oral and Maxillofacial Pathology5th Edition

Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024

Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.

DOI: Identifier not availablePMID: Identifier not available
View source
Reference #4L6 · TextbookTextbooks Unverified
Shafer's Textbook of Oral Pathology9th Edition

Rajendran R, Sivapathasundharam B. Elsevier · 2020

Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.

DOI: Identifier not availablePMID: Identifier not available

Additional sources cited on this page

  1. Stevens DL. Clin Infect Dis 2014

Browse the full evidence library →

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.