Treatment of Cervical Necrotizing Fasciitis with Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy has significantly improved the management of necrotizing fasciitis of the extremities and trunk. Its role in cervical necrotizing fasciitis has not been fully evaluated. Historically, necrotizing fasciitis has been associated with considerable morbidity and mortality. This report discusses our experience with cervical necrotizing fasciitis in six patients treated from 1986 to 1993 who received hyperbaric oxygen therapy. All patients survived. In all cases infection was of probable odontogenic origin. Most patients in whom necrotizing fasciitis develops have identifiable risk factors; however, two patients in this series were previously healthy, and there was no relationship between hospital course and identified risk factors. Clinical presentation and microbiology are reviewed together with the rationale for hyperbaric oxygen therapy as an adjunct to broad-spectrum antibiotics and aggressive early surgical debridement.