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Yuka Sumi, MD; Hiroshi Ogura, MD; Yasushi Nakamori, MD; Isao Ukai, MD; Osamu Tasaki, MD; Yasuyuki Kuwagata, MD; Takeshi Shimazu, MD; Hiroshi Tanaka, MD; Hisashi Sugimoto, MD

Arch Otolaryngol Head Neck Surg. 2008;134(7):750-756.

Objective  To evaluate the clinical utility of catheter drainage for cervical necrotizing fasciitis (CNF) with and without descending necrotizing mediastinitis (DNM).

Design  Retrospective analysis.

Setting  Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine.

Patients  Thirty-two patients with clinically and radiographically diagnosed CNF with and without DNM were included.

Interventions  Catheters were introduced into the infected space through the patients' necks under sonographic and x-ray fluoroscopic guidance.

Main Outcome Measures  Treatments, clinical course, complications, and mortality were evaluated.

Results  Catheter drainage was successfully performed in all patients. The CNF was due to pharyngeal infection in 14 patients (44%) and dental infection in 14 other patients (44%). Mediastinal extension occurred in 14 patients (44%). Overall mortality was 3.1%; only 1 patient with DNM died due to Clostridium sepsis. Both pharyngeal origin and diabetes mellitus were significantly associated with the development of DNM. More intensive treatment is necessary for patients with CNF with DNM than for patients with CNF without DNM.

Conclusion  Percutaneous catheter drainage may be used as an effective treatment for CNF with and without DNM.

Author Affiliations: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine (Drs Sumi, Ogura, Ukai, Tasaki, Kuwagata, Shimazu, Tanaka, and Sugimoto), and Critical Care and Trauma Center, Osaka Prefectural Hospital Organization, Osaka General Medical Center (Dr Nakamori) Osaka, Japan. Dr Sumi is now with the Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.