Greater Understanding Necessary in Treatment of Periorbital Facial Necrotizing Fasciitis, Review Argues

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A greater understanding of the signs, symptoms, and predisposing factors of facial necrotizing fasciitis (NF), particularly located in the periorbital region, is necessary in the early detection and treatment of the rare condition, according to a recent review published in the Journal of Personalized Medicine.

Study authors Pertea et al note that despite the low incidence of NF, a lack of prompt intervention bolsters the mortality rate from a typical 10% through 40% all the way to as high as 80%.

"Diagnosing NF at an early stage can be challenging due to the absence of specific symptoms, often resulting in missed diagnoses by health care practitioners," they wrote.

They also noted that due to the wide variety of specialities and physicians who may encounter NF in their practice, it is important for providers in several specialties to be cognizant of the possibility of a patient with NF, at any stage, presenting to their practice.

Following an individual case report, Pertea et al conducted a systematic review of NF literature. Through an initial PubMed database search including data from January 2018 to May 2023, 82 articles were extracted for review. In total, 47 records were extracted due to a lack of relevant data or adult-only cases, leaving 37 patient records to be analyzed. Authors sought to explore the literature of facial NF in the context of adult facial infections.

Relevant data, including year of literature publication, etiology of NF, associated pathologies, and presenting symptoms, were collected.

The predominant etiologies leading to the development of NF in patients included trauma (41%), odontogenic causes (27%), dermatological conditions (14%), and surgical procedures (10%), with more than a third (38%) of cases existing without an identifiable etiology.

Most commonly, facial NF was found in the periorbital region. In some instances, it was also identified in the cervical region, cheeks, chin, eyelids, submandibular area, temporal area, malar and mandibular areas, and glabellar area, among others.

Facial swelling and pain were reported as the most common signs and symptoms, with 100% of patients in the review identifying them as initial manifestations of their condition. Erythema, edema, fever, and purulent discharge were also common.

Patients were commonly treated via a multidisciplinary team, which included dermatologists, otolaryngologists, ophtalomologists, infectious disease specialists, intensive care units, and various surgical teams (reconstructive, plastic, general, and maxillofacial).

In each case of NF, surgical debridement was necessary, with 13 cases requiring a skin graft, 8 requiring the placement of skin flaps, and 3 requiring the initiation of negative-pressure wound therapy.

"Obtaining a precise and comprehensive patient history enables the identification of predisposing factors for this pathology," study authors wrote. "Early diagnosis (both clinical and imaging) can lead to prompt intervention, minimizing invasiveness and complexity, resulting in reduced patient hospitalization time and fewer functional and aesthetic sequelaes. Successful outcomes in these instances rely heavily on interdisciplinary collaboration, ensuring the patient receives a comprehensive and integrated treatment."

Reference

Pertea M, Fotea MC, Luca S, et al. Periorbital facial necrotizing fasciitis in adults: A rare severe disease with complex diagnosis and surgical treatment-a new case report and systematic review. J Pers Med. 2023;13(11):1612. Published 2023 Nov 16. doi:10.3390/jpm13111612