Clinical Characteristics, Management, and Outcomes of Patients with Cervicofacial Necrotizing Fasciitis in Nigeria: A 5-year multicentre, retrospective, cohort study

Background Cervicofacial necrotizing fasciitis (CNF) is a rare, rapidly progressive, and potentially fatal infection of the head and neck, usually secondary to odontogenic infections. Multicentre data from sub-Saharan Africa are limited. We aimed to describe the demographic, clinical, microbiological characteristics, management, and outcomes of patients with CNF in Nigeria. Methods We conducted a 5-year retrospective multicentre cohort study of patients with CNF of odontogenic origin admitted between January 2019 and December 2023 across eight tertiary hospitals in Nigeria. Data on demographics, clinical features, laboratory findings, microbial isolates, management, and outcomes were extracted using a standardized proforma. Associations between variables and outcomes were assessed with χ² tests for categorical and ANOVA or Kruskal–Wallis tests for continuous data. Kaplan–Meier survival analysis was performed. Results 138 patients were included (mean age 54·5 ± 17·1 years; range 2 months–104 years; 51·4% female). Most had low education (56·5%) and paid out-of-pocket (88·4%). The submandibular (58·4%) and neck (43·2%) regions were most affected, with mandibular molars as the main source. Diabetes mellitus (16·4%) and hypertension (11·9%) were common comorbidities. Gram-negative rods (24·1%) and Staphylococcus species (11·3%) were the most frequent isolates. Almost all patients (99·2%) underwent surgical debridement under local anaesthesia, with healing by secondary intention in 70·4%. Overall survival was 82·2%. Wound closure technique and comorbidities were significantly associated with outcomes (p < 0·05). Delayed presentation and prolonged time before oral and maxillofacial review were linked to poorer outcomes. Conclusion CNF in Nigeria primarily affects middle-aged adults of low socioeconomic status and arises from neglected dental infections. Prompt surgical intervention yielded relatively favourable outcomes despite resource constraints. Strengthening primary oral care, early dental infection management, and integration into national health insurance could reduce CNF morbidity and mortality.