Background. Necrotizing fasciitis is a disfiguring condition that can be fatal. The head and neck region is rarely affected. However, when involved, the functional and cosmetic sequelae can be considerable. Materials and Methods. We present two case histories, discuss salient diagnostic points, treatment, and review published data on this topic, Results, With a timely diagnosis we were able to diagnose and appropriately treat these patients, Conclusions, Necrotizing fasciitis is a disfiguring condition that can be fatal if not diagnosed in a timely fashion. Diagnosis and treatment require a high index of suspicion, immediate operative intervention, broad-spectrum antibiotics, and appropriate supportive care. (C) 2002 Wiley Periodicals, Inc.