Deep neck infections: a retrospective review of 112 cases

Abstract

The purpose of this study was to review our recent experience with deep neck infections and compare it to the experiences in the available literature. A total number of 112 charts of patients treated for deep neck infections at the department of otolaryngology of our hospital between August 1996 and September 2007 were retrospectively reviewed. All the relevant clinical charts including presentation, origin and site of deep neck infection, radiological, and bacteriological studies and interventions along with demographic profile, details of hospital stay, and outcomes were evaluated. The findings were compared to those in the available literature. Until 2002, we had nearly constant number of patients annually but since then we have found an increasing number of them. The most common presenting symptom was neck swelling (88.4%). Fever was present in 63.4 and 78% had leukocytosis. The most common known cause was dental infection (31.3%) and in 32.1% of them origin remained unknown. The most commonly encountered site was the submandibular space and 23.2% of patients had two or more involved spaces. Exactly 20.5% were treated with intravenous antibiotic therapy alone whereas 79.5% had surgical procedures with successful results in 98.2% of them. Diabetes mellitus was diagnosed in 20.5% of cases. There was no case of known primary or acquired immunodeficiency. We had two deaths from septic shock but there was not any other complication. Mean hospitalization time was 7 days. Deep neck infections remain potentially lethal infections if they are not diagnosed early and treated promptly. Widespread diffusion of empirical broad-spectrum oral antibiotic and anti-inflammatory treatments may cause masked presentations of deep neck infections without swelling, fever, or leukocytosis. Our tailored approach (medical or medical and surgical) based on clinical and radiological evidence was successful in 98.2% of the patients with a short mean hospitalization time.

Neck abscess as the initial manifestation of pharyngeal cancer

“…Of the 58 patients with DNI, only in two patients (3 %) was DNI the first manifestation of malignant tumour. Similar results for DNI origin have been observed by other authors (Ridder et al, 2005;Eftekharian et al, 2009;Bakir et al, 2012). The incidence of head and neck cancer initially manifested as DNI was found to be increased in patients aged over 40 years (Lin et al, 2012).…”

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

“…The same was observed in the study of Zamiri which reported 61.8% and 38.2% patients were from urban and rural areas, respectively. These results show a higher percentage of hospital admissions for the urban citizens despite fewer admissions of rural patients which is probably due to difficulties of access to care or transportation issues, and lower settlements in rural areas (18). The most frequent site of DNSI in our study was submandibular space (50%), followed by parapharyngeal space (25%), peritonsillar (12.3%) and Ludwig's angina (5.4%).…”

“…In a study by Bottin 42% of DNSI cases were odontogenic in origin (17). In a retrospective study by Zamiri, odontogenic infection was declared as the most common cause of DNSI (34.3%) (18). Kataria also reported similar results to Zamiri with 34.21% of DNSI due to odontogenic origin (11).…”

“…Our results were not consistent with following studies: Parhiscar study in which parapharyngeal space had the most involvement (43%), followed by submandibular space (27%) and Ludwig's angina (17%) (5), Kataria study that showed Ludwig's angina (28.9%) as the most common infected site, followed by peritonsillar abscess and submandibular abscess (10), Mumtaz study in which parapharyngeal space was seen in 20 patients (43.4%) and was at top of the list (21), and the study by YeganehMoghadam that reported peritonsillar (28.7%) and submandibular (21.2%) as the most common sites of infection (12). Neck pain was the most common symptom, found in 95% of the patients in Zamiri study (18) and 82.6% in Mumtaz study (21). The other signs and symptoms in order of prevalence were: pain, fever and chills, trismus, dysphagia and breathing difficulties in Zamiri study (18) and odynophagia and fever in 28 patients in Mumtaz study (21).…”

Clinical profile and management options in patients of Ludwig’s angina: a 5 year prospective study

“…[9][10][11][12][13] The lower second and third molar was most common source of infection in our study. 11% of the patients were found to have osteoradionecrosis of the mandible after a course of radiotherapy for oral cancer.…”