Prise en charge des cellulites cervicofaciales en réanimation

Cervical fasciitis is a severe infection, sometimes associated with necrosis, with difficult diagnosis at the early stage. Often due to a benign pharyngeal or dental infection, fasciitis spreads along fascia from the head to the neck and possibly to the mediastinum. It is a life-threatening condition, which requires immediate treatment by a multidisciplinary team. Initial surgery requires drainage of all the spaces affected by the infection, as evidenced by cervico-mediastinal CT, in order to stop the spread of bacteria and possibly necrosis. This surgical step has to be associated with treatment of sepsis in an ICU where the patient is kept intubated and sedated. Antibiotherapy is combined with hemodynamic support and organ failure suppleance. The origin of the infection, if identified, is treated in the meantime. Repeated debridement is performed, combined with surgical draping, until the healing process develops. In case of unfavorable septic conditions, CT is repeated to evidence unforeseen sites of infection in order to plan revision neck surgery or even thoracotomy.