A Study on Deep Neck Space Infections

Abstract

Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. These are commonly seen in low socioeconomic group with poor oral hygiene, and nutritional disorders. These are bacterial infections originating from the upper aerodigestive tract. The incidence of this disease was relatively high before the advent of antibiotics. Treatment of DNSI includes antibiotic therapy, airway management and surgical intervention. Management of DNSI is traditionally based on prompt surgical drainage of the abscess followed by antibiotics or nonsurgical treatment using appropriate antibiotics in the case of cellulitis. This study was conducted to investigate the age and gender, clinical symptoms, site involved, etiology, co-morbidities, bacteriology, complications and outcomes in the patients of DNSI. A prospective study of deep neck space infections was conducted during the period July 2017 to July 2018 on the patients who attended the outpatient department and were admitted as inpatient in Safdarjung hospital, New Delhi. 40 Cases with DNSI all ages and both genders were included in the study. Patients who didn't require surgical intervention to drain pus were excluded. All parameters including age, gender, co-morbidities, presentation, site, bacteriology, complications, and investigations were studied. Due to advent of antibiotics, deep neck space infections are in decreasing trend. The common age group found to be affected is in 2nd and 3rd decade in our study. Out of all deep neck space infections, submandibular space infections were common (37.5%) followed by peritonsillar infections (12.5%). Infection of deep neck space remains fairly common and challenging disease for clinicians. Prompt recognition and treatment of DNSI are essential for an improved prognosis. Odontogenic and tonsillopharyngitis are the commonest cause. Key elements for improved results are the prompt recognition and early intervention. Special attention is required to high-risk groups such as diabetics, the elderly and patients with underlying systemic diseases as the condition may progress to life-threatening complications.

The efficacy of artificial dermis combined with continuous vacuum sealing drainage in deep neck multiple spaces infection treatment

“…Methods for addressing the drainage and the subsequent purulent cavity cleaning should be considered in the treatment of such diseases. [ 2 , 16 ] The traditional treatment method is to expand the abscess cavity, reduce the local pressure, flush and discharge the abscess, and change dressings frequently after surgery. Dressing changes 1–2 times a day after surgery will consolidate the burden of the clinicians and the psychological burden and pain of the patients.…”

Predictive factors of lethality and complications of deep fascial space infections of the neck

“…They are often confused, from a clinical point of view, with the term "cervical abscess". In this condition, we should note, there is no fluctuation, a typical signal of the abscess, but a firm neck bulging and induration [1][2][3][4] .…”

“…The severity of this infection refers to the risk of spreading, through these spaces and fascial planes, to the mediastinum, especially the posterior one, producing necrotizing descending mediastinitis 6 , whose lethality rate varies between 17.5% and 50% 3,6 . In addition, other complications may occur, namely: septic shock, pleural empyema, airway obstruction, pericarditis, pericardial effusion, jugular vein thrombosis, septic embolism, acute renal failure, respiratory distress syndrome, brain abscesses, and disseminated intravascular coagulation [7][8][9] .…”

Biphasic CT imaging of deep neck infections (DNIs): how does dual injection mode helps in differentiation between types of collections?

“…Owing to the impregnation technique, the center of the phlegmon was given time to enhance slowly respective to the hypo-vascular density of its core, as compared to liquefied necrotic of the abscess which should not enhance at all and would give near fluid attenuation. The biphasic injection method is a very good technique to enhance tissue and vessel attenuation and is recommended to be included in routine imaging of the neck [39][40][41][42][43][44][45].…”