Penicillin in the Treatment of Patients With Deep Infections of the Neck

Abstract

A review of available literature 1 disclosed no reference to the use of penicillin in the treatment of patients with infections involving the fascial compartments of the neck. Many writers have described the cervical fascial layers, their attachments, the spaces formed, the intercommunications of these and, finally, their communication with the mediastinum by means of so-called fascial planes.2 Suffice it to say that the most frequent locations for the collection of infection, and those of most interest to the surgeon, are (1) the retropharyngeal space, (2) the lateral pharyngeal, parapharyngeal or pharyngomaxillary space and (3) the submandibular space. All these spaces in the normal state are potential; they become distended only under pathologic conditions. The retropharyngeal space lies posterior to the pharynx, between the posterior pharyngeal wall and the prevertebral fascia. Simple abscesses occur here most frequently in infancy and early childhood, the focus of infection usually being in the pharynx or the nasopharynx. The abscess is usually unilateral and is located just behind and below the soft palate. There are fever, restlessness, refusal to take nourishment and change of voice. The mouth is usually held open. There may be enlargement of posterior cervical glands. A fluctuant mass can usually be made out on the posterior or lateral pharyngeal wall. Treatment consists in draining the abscess surgically through the mouth, with the patient's head down, and using suction to remove the pus and prevent its aspiration. The chronic type of retropharyngeal abscess is usually due to tuberculous disease of the cervical vertebrae, and its treatment is that of the tuberculous process.The pharyngomaxillary space, 1I/2 inches (3.5 cm.) in length, is situated lateral to the pharynx, is conical in shape with a base approximately 1 inch (2.5 cm.) in diameter, which is directed upward against the base of the skull at the jugular foramen. The apex is downward and is at the greater cornu of the hyoid bone. The boundaries are as follows: internally, the lateral pharyngeal wall, including the superior constrictor pharyngeal muscle; externally, the ramus of the mandible and a portion of the capsule of the parotid gland; anteriorly, the internal pterygoid muscle, and posteriorly, the prevertebral muscles and fascia. Within the space is the carotid sheath (containing the carotid arteries, the jugular vein and the vagus nerve), the styloid process with its attachments, the ninth and twelfth cranial nerves, 1. (a) Bennett, J.

III Deep Infections of the Neck with Particular Reference to the Role of Dental FOCI

“…The role that penicillin will play in the effective treatment of these infections is as yet not fully determined. Gaines and Hatcher 22 report favorable results with this drug and I had one complete recovery from a large submaxillary abscess where operation was refused.…”