We conducted a 10-year retrospective study to determine the prognosis of necrotizing cervical fasciitis (NCF). Our study population included 38 patients-32 males and 6 females, aged 10 months to 70 years (mean: 55 yr)-who had presented for management of NCF at our tertiary care hospital between Jan. 1, 2000, and Dec. 31, 2009. We classified each case into four categories based on the duration of disease prior to presentation, the severity of disease, and other factors that influence outcomes. We found that the most important factor in determining prognosis was the time interval between the onset of NCF and subsequent presentation for specialist or surgical intervention. Patients with a higher grade of NCF had longer hospital stays. Although aggressive surgical and medical intervention is the gold standard for the management of NCF, many of our patients presented with a relatively healthy appearing wound, which could mislead the evaluating clinician and delay prompt management. We believe that our new grading system will help obviate this problem and make clinicians more vigilant when faced with a new case of necrotizing fasciitis.