Prognosis

Mortality is higher in patients over 50 years of age, those with associated systemic illnesses such as diabetes mellitus or peripheral vascular diseases, and when there is a delay in diagnosis. These infections require a rapid diagnosis, because mortality rates up to 76% have been reported without early intervention (15). Even in the setting of optimal management, the mortality due to NF ranges from 30% to 50%. In the small number of cases described in the literature, patients with a peritonsillar abscess demonstrated a mortality rate of 33%, in comparison with 25% for patients with a predominantly odontogenic cause of CNF (17). The mortality rate for CNF is higher than that of the upper face infection, presumably because of the tendency for it to spread to the mediastinum, chest, and carotid sheath. CNF associated with a peritonsillar abscess is an extremely rare condition. The general condition of patients with CNF deteriorates more rapidly than for other regions, resulting in a higher mortality rate than in patients with upper face and scalp infections. The death rate is associated with comorbidity, but also with depth of infection and complications such as mediastinitis and fatal vascular complications. Involvement of the neck carries a death rate of 32%, attributed to the spread of the necrotizing process to the adjoining cervical viscera and thoracic cavity (17). In comparison, NF of the scalp and upper face has been reported to have a better prognosis, with a mortality rate of 12.5%.

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