Clinical and epidemiological profile of deep neck space infections: A retrospective study in Hamadan, Western Iran, during 2008-2013

Abstract

Received: April 2017, Accepted: June 2017 Background: The diagnosis of deep neck space infection (DNSI) is difficult due to lack of common clinical symptoms and signs and covering of deep seated infections by regular tissues of neck. There is no evidence of clinical and epidemiological profile of deep neck space infections in western Iran.This study was designed to analyze demographic features, clinical presentations, and outcomes of DNSIs in order to promote diagnosis, management and treatment of the disease. Materials and Methods: This retrospective study was carried out on 202 patients with the diagnosis of DNSI hospitalized in Hamadan hospitals, Iran, during 2008Iran, during -2013. All parameters including demographic characteristics, geographical location, symptoms, site of infection, required interventions and treatments, and complications and outcomes were studied. Finally, the data were reported by descriptive statistics like mean ± standard deviation (SD), median for quantitative parameters, and frequency tables and percentages for qualitative parameters. Results: Among 202 patients, 58.9% (119 patients) were men. The mean age ± SD was 28.4 ± 14.7 years and ranged from 4 months to 82 years. Most admissions were in winter with 25.7% (52 patients), the majority of which came from urban background (60%). The most common site of infection was submandibular abscess (50%). Airway obstruction occurred in 11.8% of the patients as the most common complication. Two top antibiotics were metronidazole (80.8%) and penicillin G (79.8%). Surgical intervention was carried out in 82.7% of the cases. One patient died of Ludwig's angina. Conclusions:The results of this study showed that although DNSIs have proven to be life-threatening diseases, proper diagnosis and management can effectively defeat them and provide cure without complications.

Principles of Treatment and Clinical-Evolutionary Peculiarities of Deep Cervical Spaces Suppurations—Clinical Study

“…The choice of antibiotic regimen requires intense medical judgement, considering the possibility of etiological agents’ resistance. Treatment should be administered correctly in maximum doses with synergistic effects on bacterial populations and to optimize tissue penetration [ 6 , 10 , 23 ]. The duration of antibiotic regimens, according to medical studies, generally lasts between 2 and 3 weeks, with a visible effect on biological constants and local appearance.…”

“…These measures should be implemented especially among rural or low-income populations with low access to health care and poor health education. For this reason, more attention should be paid to physical health, especially dental hygiene, with the early management of dental caries, even from an early age [ 2 , 10 , 12 , 35 , 49 ]. At the same time, psychological support and continuous monitoring of patients with suppurative pathologies should not be neglected [ 25 ].…”

“…Some authors classify the cervical spaces into supra-hyoid: parotid, masticatory, infratemporal, submandibular, parapharyngeal, peritonsillar and buccal spaces. The subhyoid space is also called the visceral space and there are spaces that extend, as mentioned above, from the base of the skull to the mediastinum, namely the prevertebral, retropharyngeal, dangerous and carotid spaces [ 9 , 10 , 11 , 12 , 13 , 14 ]. Suppurative processes frequently affect these compartments.…”

“…The most characteristic signs of a deep cervical suppuration are unilaterality, intense congestion, edema and local fluctuation with bulging of the wall of the affected anatomical structure, asymmetry of local elements, presence of crepitus or tender, woody, indurated skin tissue, sialorrhea, fetid halitosis, toxico-septic signs [ 6 , 21 ]. However, sometimes the diagnosis is difficult to establish, as some patients are asymptomatic [ 10 ], or they may present signs and symptoms characteristic of other common pathologies, or they may be masked by prior self-administration of analgesics, anti-inflammatory drugs or even antibiotics. For this reason these infections are often underdiagnosed or underestimated [ 17 , 27 ].…”

Deep Neck Space Infections a Retrospective Study

“…[11] Potentially and common life-threatening difficulties comprise airway impediment, descending mediastinitis, jugular vein thrombosis, severe respiratory distress disorder, sepsis, disseminated intravascular coagulation, empyema, septic arthritis and septic pulmonary emboli,. [12] Failure to timely identify DNSI could be caused by a changed medical practice resulting from antibiotics misuse, frequency of immunodeficiency patients, modifications in DNSI origins and bacteriology. [13,14] For the diagnosis, antibiograms and cultures should be taken for the identification of microorganism and for proper antibiotic treatment.…”