Management of Deep Neck Space Infections: A Large Tertiary Center Experience

Abstract

Introduction: Deep neck space infections (DNIs) represent serious bacterial infections affecting the deep cervical space and fascial planes of the neck. This study aims to describe our clinical and surgical experience in the management of DNIs, emphasizing the importance of appropriate imaging in the diagnostic setting and the role of the multidisciplinary approach according to the severity of the infection.Methods: In this retrospective study, we describe 85 patients affected by DNIs coming to the Otolaryngology department observation from the Emergency Room of San Camillo Forlanini Hospital in Rome from January 2006 to December 2021 and treated both by pharmacological and surgical therapy.Results: 54 patients (64%) were male, and 31 (36%) were female, with a mean age of 50.5 years. The most common cause of DNI was odontogenic, accounting for 70% of all collected cases. In 68 patients (80% of all cases), the surgical approach consisted of an extended unilateral cervicotomy, whereas in 17 patients (20% of all cases), a bilateral cervicotomy was performed. Surgical revision was required in 15 cases (18%). A tracheostomy was necessary in seven cases. The overall survival rate was 96.5%.Conclusions: DNI represents a serious and life-threatening condition, remaining a constant challenge for the head and neck surgeon. Contrast-enhanced computed tomography is critical for therapeutic planning, which requires both a surgical approach and antibiotic therapy. Surgical treatment should be performed as soon as possible. In severe cases, the multidisciplinary approach is advisable.

Etiology and Demographic Distribution of Odontogenic Abscesses in the Maxillofacial Area in Patients Over 18 Years of Age: A Five-Year Retrospective Study

“…Despite easy access to dental care and antimicrobial treatment in the 21 st century, odontogenic infections remain a serious clinical problem today. Decreased immune capabilities of the macro-organism, virulence of the causative microorganism and lack of adequate treatment lead to the spread of localized odontogenic infections to the deep maxillofacial spaces [ 1 ]. Odontogenic inflammations of the head and neck, if not treated promptly and adequately, can lead to life-threatening complications including airway obstruction, diffuse inflammatory processes (phlegmon), necrotizing fasciitis, purulent meningitis, cerebrospinal abscess, mediastinitis, sepsis and even end lethally [ 2 , 3 ].…”