안면부에 발생한 괴사성 근막염

Necrotizing fasciitis of the face

Necrotizing fasciitis is a rapidly progressing necrotizing process which affects subcutaneous tissue and fascia and is accompanied by severe systemic toxicity. Although necrotizing fasciitis can affect any part of the body including the back and neck, it is rather a rare entity in the head and neck. The rate of spread is remarkably rapid, with the tendency towards systemic toxicity related to delayed initiation of treatment. The infection process may be caused by any type of trauma. The infectious process usually begins 2 to 4 days after the initial insult. The skin becomes smooth, tense, and shiny: no sharp demarcation is seen between normal and affected skin. As the disease progresses, the pathognomonic sign of necrotizing fasciitis appears: a dusky discoloration of the skin as small purplish patches with ill-defined borders. An early exploration and drainage of all the involved fascial planes is important. We have had much difficulty in differentiating necrotizing fasciitis from other infections diseases. When infection is present in the oral & maxillofacial area, we thin abscess and cellulitis first of all. With failure of the lesion to respond to conventional treatment, we have to rule out the necrotizing fasciitis due to its alarming toxicity. Successful treatment of necrotizing fasciitis is bases on the early recognition of the infection process, aggressive surgical intervention systemic medical and supportive therapy, and intensive antibiotic therapy, with emphasis placed on early surgical care. The early exploration and drainage of al the involved fascial planes is critical. We experienced two cases of necrotizing fasciitis of the face. With early recognition of the infection process, aggressive fasciotomy and various medically supported therapy, we resolved the edema and exudate with offering the best chance for core. The patient was treated successfully.