Review Article

Facial Necrotizing Fasciitis in Adults. A Systematic Review

Diego Abelardo Alvarez Hernández*, Alberto Manuel González Chávez and Alexia S Rivera

Published: 26 April, 2017 | Volume 1 - Issue 1 | Pages: 020-031

Introduction: Necrotizing Fasciitis (NF) is a rapidly progressing, severe suppurative infection of the superficial fascia and the sorrounding tissues that may lead to necrosis, septic shock and death if left untreated. Facial NF is rarely seen and symptoms may be non-specific at the onset and depend on the origin site and the stage of the disease, making it difficult for diagnosis.

Materials and Methods: A systematic review was done following the PRISMA guidance. PubMed database was searched for case reports published between January 2007 and March 2017. Full text articles were obtained and assesed for relevance. Data extraction was performed as an iterative process.

Results: A total of 24 articles, describing 29 adult patients with facial NF were included. Facial NF was more common in males. Skin trauma was the most frequent mechanism of lesion and diabetes mellitus was the most common associated systemic disorder. Periorbital area was the most affected area. In order of appereance, swelling and pain were the most common initial clinical manifestations. Group A Streptococcus was the most frequent microorganism isolated. Advanced airway management was needed in more than 50% of the cases and surgical management was done in 90% of the cases.

Conclusions: Practitioners should be aware of its existance, epidemiology, etiology, risk factors and initial clinical manifestations to develop a high index of suspicion, to order studies that may discard or confirm the diagnosis, and to offer prompt treatment to preserve patient’s life and reduce the disfigurement and disability that it may cause.

Read Full Article HTML DOI: 10.29328/journal.hor.1001005 Cite this Article Read Full Article PDF


Adults; Facial; Necrotizing fasciitis


  1. Gurdal C, Bilkan H, Sarac O, Seven E, Yenidunya MO, et al. Periorbital Necrotizing Fasciitis Caused by Community-Associated Methicillin-Resistant Staphylococcus Aureus Periorbital Necrotizing Fasciitis. Orbit. 2010; 29: 348-350. Ref.: https://goo.gl/1OQJx4
  2. Ord R, Coletti D. Cervico-facial necrotizing fasciitis. Oral Dis. 2009; 15: 133-141. Ref.: https://goo.gl/u3cWYR
  3. O’Loughlin RE, Roberson A, Cieslak PR, Lynfield R, Gershman K, et al. The epidemiology of invasive group A streptococcal infection and potential implications: United States, 2000 -2004. Clin Infect Dis. 2007; 45: 853-862. Ref.: https://goo.gl/uHU6cY
  4. Dhaif G, Al-Saati A, Bassim M, Cabs A. Management Dilemma of cervicofacial Necrotizing fasciitis. J Bahrain Med Soc. 2009; 21: 223-227.
  5. Zundel S, Lemarechal A, Kaiser P, Szavay P. Diagnosis and Treatment of Pediatric Necrotizing Fasciitis: A Systematic Review of the Literature. Eur J Pediatr Surg. 2017; 27: 127-137. Ref.: https://goo.gl/WRxtOC
  6. Ulu S, Ulu SM, Oz G, Kacar, Emre, et al. Paralysis of cranial nerve and striking prognosis of cervical necrotizing fasciitis. J Craniofac Surg. 2012; 23: 1812-1814. Ref.: https://goo.gl/olQZpt
  7. Eltayeb AS, Ahmad AG, Elbeshir EI. A case of labio-facial necrotizing fasciitis complicating acne. BMC Res Notes. 2016; 9: 232. Ref.: https://goo.gl/fkzT1m
  8. Ormenisan A, Morariu SH, Cotoi OS, Vartolomei MD, Grigoraş RI, et al. Necrotizing fasciitis in oro-maxillo-facial area after radiotherapy for squamous cell carcinoma of the soft palate. Rom J Morphol Embryol. 2015; 56: 847-850. Ref.: https://goo.gl/YOmnux
  9. Choi HJ. Cervical Necrotizing Fasciitis Resulting in Acupuncture and Herbal Injection for Submental Lipoplasty. J Craniofac Surg. 2014; 25: 507-509. Ref.: https://goo.gl/u6cAYN
  10. Casey K, Cudjoe P, Green III JM, Valerio IL. A Recent Case of Periorbital Necrotizing Fasciitis-Presentation of Definitive Reconstruction Within an In-Theater Combat Hospital Setting. J Oral Maxillofac Surg. 2014; 72: 1320-1324. Ref.: https://goo.gl/LbgDjy
  11. Nagamoto E, Fujisawa A, Yoshino Y, Yoshitsugu K, Odo M, et al. A Case of Paecilomyces lilacinus Infection Occuring in Necrotizing Fasciitis-associated Skin Ulcers on the Face and Surrounding a Tracheotomy Stoma. Med Mycol J. 2014; 55: 21-27. Ref.: https://goo.gl/OG4cim
  12. Lee JH, Choi HC, Kim C, Sohn JH, Kim HC. Fulminant Cerebral Infraction of Anterior and Posterior Cerebral Circulation after Ascending Type of Facial Necrotizing Fasciitis. J Stroke Cerebrovasc Dis. 2014; 23: 173-175. Ref.: https://goo.gl/x1jNNz
  13. Richir MC, Schreurs HH. Facial Necrotizing Fasciitis. Surg Infect (Larchmt). 2013; 14: 428-429. Ref.: https://goo.gl/A74QPt
  14. Bucak A, Ulu S, Kokulu S, Oz G, Solak O, et al. Facial paralysis and mediastinitis due to odontogenic infection and poor prognosis. J Craniofac Surg. 2013; 24: 1953-1956. Ref.: https://goo.gl/7NZowG
  15. Yadav S, Verma A, Sachdeva A. Facial necrotizing fasciitis from an odontogenic infection. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 113: 1-4. Ref.: https://goo.gl/5FkFtw
  16. Murray M, Dean J, Finn R. Cervicofacial necrotizing fasciitis and steroids: case report and literature review. J Oral Maxillofac Surg. 2012; 70: 340-344. Ref.: https://goo.gl/7nRwrf
  17. Park E, Hirsch EM, Steinberg JP, Olsson AB. Ascending necrotizing fasciitis of the face following odontogenic infection. J Craniofac Surg. 2012; 23: 211-214. Ref.: https://goo.gl/YsK688
  18. Bilodeau E, Parashar VP, Yeung A, Potluri A. Acute cervicofacial necrotizing fasciitis: Three clinical cases and a review of the current literatura. Gen Dent. 2011; 60: 70-74. Ref.: https://goo.gl/3VuJiZ
  19. Lee JT, Hsiao HT, Tzeng SG. Facial necrotizing fasciitis secondary to accidental bite of the upper lip. J Emerg Med. 2011; 41: 5-8. Ref.: https://goo.gl/MVZsU2
  20. Medeiros Junior R, Melo-Ada R, Oliveira HF, Cardoso SM, Lago CA. Cervical-thoracic facial necrotizing fasciitis of odontogenic origin. Braz J Otorhinolaryngol. 2011; 77: 805. Ref.: https://goo.gl/o6B38l
  21. Lim VS, Amrith S. Necrotising fasciitis of the eyelid with toxic shock due to Pseudomonas aeruginosa. Singapore Med J. 2010; 51: 51-53. Ref.: https://goo.gl/FDNScm
  22. Pepe I, Lo-Russo L, Cannone V, Giammanco A, Sorrentino F, et al. Necrotizing fasciitis of the face: a life-threatening condition. Aging Clin Exp Res. 2009; 21: 358-362. Ref.: https://goo.gl/AMmVoX
  23. Rath S, Kar S, Sahu SK, Sharma S. Fungal periorbital necrotizing fasciitis in an immunocompetent adult. Opthal Plast Reconstr Surg. 2009; 25: 334-335. Ref.: https://goo.gl/ih1ooO
  24. Aakalu VK, Sajja K, Cook JL, Amjad ZA. Group A Streptococcal Necrotizing Fasciitis of the Eyelids and Face Managed With Debridement and Adjunctive Intravenous Immunoglobulin. Opthal Plast Reconstr Surg. 2009; 25: 332-334. Ref.: https://goo.gl/ANflF9
  25. Bilbault P, Castelain V, Schenck-Dhif M, Schneider F, Charpiot A. Life-threatening cervical necrotizing fasciitis after a common dental extraction. Am J Emerg Med. 2008; 26: 5-7. Ref.: https://goo.gl/9dgCoV
  26. Akcay EK, Cagil N, Ylek F, Anayol MA, Cetin H, et al. Necrotizing fasciitis of eyelid secondary to parotitis. Eur J Opthalmol. 2008; 18: 128-130. Ref.: https://goo.gl/0kAiYl
  27. Hohlweg-Majert B. Necrotizing fasciitis. Opthalmology. 2007; 114: 1422. Ref.: https://goo.gl/eLvfKs
  28. Raja V, Job R, Hubbard A, Moriarty B. Periorbital necrotising fasciitis: delay in diagnosis results in loss of lower eyelid. Int Ophtalmol. 2008; 28: 67-69. Ref.: https://goo.gl/xDswXw
  29. Meleney FL. Hemolytic Streptococcus gangrene. Arch Surg 1924; 9: 317-364. Ref.: https://goo.gl/XzYijD
  30. Flynn TR, Shanti RM, Levi MH, Adamo AK, Kraut RA, et al. Severe odontogenic infection, part 1: prospective report. J Oral Maxillofac Surg. 2006; 64: 1093-1103. Ref.: https://goo.gl/SrGAWu
  31. Bono G, Argo A, Zerbo S, Valentina T, Procaccianti P. Cervical necrotizing fasciitis and descending necrotizing mediastinitis in a patient affected by neglected peritonsillar abscess: a case of medical negligence. J Forensic Leg Med. 2008; 15: 391-394. Ref.: https://goo.gl/UdGRP2
  32. Seal DV. Necrotizing fasciitis. Curr Opin Infect Dis 2001; 14: 127-132. Ref.: https://goo.gl/jVL4gE
  33. Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infection: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003; 24: 111-117. Ref.: https://goo.gl/uf64wA
  34. Lee TC, Carrick MM, Scott BG, Hodges JC, Pham HQ. Incidence and clinical characteristics of methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a large urban hospital. Am J Surg. 2007; 194: 809-812. Ref.: https://goo.gl/0KtR5X
  35. Santos-Gorjón P, Blanco-Pérez P, Morales-Martín AC, del Pozo de Diosb JC, Estévez Alonsob S, et al. Deep neck infection. Review of 286 cases. Acta Otorrinolaringol Esp. 2012; 63: 31-41. Ref.: https://goo.gl/lp8X2n
  36. Stevens DL, Bisno AL, Chambers HF, Dale Everett E, Dellinger P, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections. Clin Infect Dis. 2014; 59: 10-52. Ref.: https://goo.gl/t5CGYi
  37. Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, et al. Current Concepts in the Management of Necrotizing Fasciitis. Front Surg. 2014; 1: 36. Ref.: https://goo.gl/eulv5a


Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?