Necrotizing fasciitis. (Streptococcal gangrene) of the face. Report of a case and review of the literature.

Necrotizing fasciitis is a rare infection frequently preceded by trauma and usually caused by beta-hemolytic Streptococcus. The disease is characterized by cutaneous necrosis, suppurative fasciitis, and vascular thrombosis. Associated systemic problems are common, with chronic alcoholism and diabetes being the most prominent. Involvement of head and neck structures is exceedingly rare, with only seven cases reported in the literature. We report an additional case that terminated fatally. Management requires high doses of aqueous penicillin G potassium given intravenously, early surgical drainage, and debridement of necrotic tissue. Mortality may be as high as 30%, and it is negatively influenced by delay in diagnosis and treatment.