Periocular necrotizing fasciitis following surgical site infection in aesthetic rhinoplasty: a report of two cases.

purposeTo report a rare presentation of periocular necrotizing fasciitis (NF) following a surgical site infection after aesthetic rhinoplasty. CASE PRESENTATION: We present two otherwise healthy patients who developed periocular swelling, erythema, and pain extending to the temporal region and nasal bridge, accompanied by areas of periocular necrosis. Neither patient had a history of trauma. One patient underwent an uneventful aesthetic rhinoplasty more than one month earlier, followed by a recent postoperative nasal hump shaving performed in an outpatient setting at the surgeon's office. The second patient had a similar history of uneventful aesthetic rhinoplasty two weeks earlier. The laboratory risk indicator for necrotizing fasciitis (LRINEC) scores were 6 and 7, suggesting a high likelihood of the disease. Orbital computed tomography (CT) revealed severe preseptal soft tissue swelling extending to adjacent areas with no evidence of intraorbital involvement. A clinical diagnosis of periocular NF was established, and both patients were treated with intravenous broad-spectrum antibiotics, followed by prompt surgical debridement of necrotic tissue. Bacterial cultures revealed growth of Streptococcus viridans and Staphylococcus species. Both patients achieved complete recovery without recurrence or significant complications.

conclusionsAlthough periocular NF is rare, a high index of suspicion is essential for early diagnosis, particularly in patients with a recent history of facial surgery or trauma. Prompt recognition and management can prevent catastrophic outcomes, including orbital involvement and vision-threatening complications.