Airway management in patients with deep neck infections

Abstract

Securing the airway in patients undergoing surgical intervention to control a deep neck infection (DNI) is challenging for anesthesiologists due to the distorted airway anatomy, limited mouth opening, tissue edema, and immobility. It is critical to assess the risk of a potential difficult airway and prepare the most appropriate airway management method.We reviewed our anesthetic experiences managing patients with DNIs, focusing on the need for video-laryngoscope or awake fiberoptic intubation beyond a standard intubation from the anesthesiologist's perspective.When patients had infections in the masticatory space, mouth of floor, oropharyngeal mucosal space, or laryngopharynx, their airways tended to be managed using methods requiring more effort by the anesthesiologists, and more extensive equipment preparation, compared with use of a standard laryngoscope. The degree to which the main lesion influenced the airway anatomy, especially at the level of epiglottis and aryepiglottic fold was related to the airway management method selected.When managing the airways of patients undergoing surgery for DNIs under general anesthesia, anesthesiologists should use imaging with computed tomography to evaluate the preoperative airway status and a comprehensive understanding of radiological findings, comorbidities, and patients’ symptoms is needed.

Comparison of intubation and tracheotomy in patients with deep neck infection

“…It is crucial to consider that patient may experience trismus, and the anatomy of the neck may be distorted or show edema, which can further hinder conventional laryngoscopy and intubation. The exact location of the infection may also affect the choice of airway management [5]. The most often affected spaces regarding DNI include parapharyngeal, Abstract Possible airway compromise further complicates treatment of deep neck infections (DNI).…”

Deep neck space infection – diagnostic and therapeutic challenges: two case reports

“…The clinical and surgical experience of the medical team is crucial in saving these cases, with as small sequelae as possible. The surgical drainage of the collection is the standard treatment, and tracheotomy has to be carried out whenever there is a risk of obstruction or aspiration at the level of the respiratory tract [17][18][19] . Even if the incidence of the cervical suppurations decreased as a result of the large-scale use of antibiotics, they remain some of the most frequent ENT emergencies, requiring long intensive care and a high rate of hospitalization.…”

Life-threatening parapharyngeal and retropharyngeal abscess in an infant

“…Direct laryngoscopy and oral intubation have a risk of puncturing the abscess and causing aspiration of the pus 9. As a result of multiple unsuccessful intubation, the pus may tract into the airway and spread the infection downwards causing pneumonitis, bronchitis and tracheitis.…”

“…As a result of multiple unsuccessful intubation, the pus may tract into the airway and spread the infection downwards causing pneumonitis, bronchitis and tracheitis. In such situations, flexible fibre-optic nasal intubation may be necessary to secure the airway and avoid a tracheostomy 9. Retromolar intubation may be an option in patients with trismus, but again not without the risk of abscess wall puncture from manipulation.…”