SRS212 - Cervicofacial necrotising fasciitis with orbital involvement requiring exenteration: a multidisciplinary case report

Abstract Background Cervicofacial necrotising fasciitis is a rare but fulminant soft tissue infection involving the dermis, subcutaneous fat, and fascial planes. Rapid progression necessitates prompt diagnosis and emergent surgical intervention to mitigate the risk of systemic sepsis, multi-organ dysfunction, and mortality. Case Presentation A 61-year-old female with a background of psychiatric comorbidities and prior intravenous drug use presented with a two-week history of progressive left periorbital oedema culminating in complete palpebral occlusion and monocular visual loss. On admission, she was septic. Contrast-enhanced computed tomography revealed extensive cervicofacial cellulitis with involvement of the orbital and temporal compartments, masticator space, and anterior cervical fascia extending into the supraclavicular region. Blood cultures isolated Streptococcus pyogenes (Group A). Management and Outcome The patient underwent urgent cervicofacial debridement under general anaesthesia, followed by targeted antimicrobial therapy. Due to progressive orbital involvement and risk of sympathetic ophthalmia, a left orbital exenteration was performed. Reconstructive efforts included application of biosynthetic dermal matrices. Multidisciplinary input was integral, involving oral and maxillofacial surgery, oculoplastics, microbiology, intensive care, pain services, and addiction liaison. The patient demonstrated clinical improvement and was discharged after six weeks with ongoing outpatient follow-up. Conclusions This case underscores the virulence of cervicofacial necrotising fasciitis and the necessity for early recognition, aggressive surgical management, and coordinated multidisciplinary care to optimise patient outcomes and preserve function.