Necrotizing fasciitis of the head and neck in era of COVID-19: a single-institution experience

Necrotizing Fasciitis (NF) of the head and neck is a critical condition, known for its severe impact and high mortality rates, often linked with diabetes, odontogenic infections, and immunosuppression. Observations from the University of Ottawa's Department of Otolaryngology – Head and Neck Surgery indicate an increase in NF cases since the COVID-19 pandemic began, suggesting a possible association between COVID-19 and NF. This study aims to assess the incidence of NF since the pandemic's onset and explore its association with COVID-19. Conducted as a single-center retrospective review from January 1, 2015, to April 7, 2023, this study included patients over 18 with histopathological confirmation of NF, analyzing clinical risk factors, treatment, and outcomes. Patients were divided into pre- and post-COVID-19 groups for comparison. Out of 16 patients, 68.7% were in the post-COVID-19 group, with a notable increase in 2022. The most common risk factors were diabetes mellitus (43.8%) and history of odontogenic infection or extraction (31.3%). Only one patient (6.3%) presented with concomitant COVID-19 infection and NF. All patients underwent treatment with serial surgical debridement and IV antibiotics with mortality rates rising to 12.5% post-pandemic. Our study demonstrates an increased incidence of necrotizing fasciitis cases in our institution following the COVID-19 pandemic.