Retrospective Study of Deep Neck Space Infections

Abstract

BACKGROUND Deep neck space infections are bacterial infections of the fascial planes and potential spaces of the head and neck. DNSIs are seen across all age groups depending on the primary cause. The primary causes of DNSI include odontogenic infections, tonsillar and peritonsillar infections, malignancies and foreign body ingestion. The advent of antibiotics has reduced the incidence of DNSI, b ut DNSI poses a challenge due its propensity to cause life-threatening complications and decompensates a well looking patient very rapidly. Treatment of DNSI includes prompt surgical drainage and administering appropriate antibiotics with or without airway support based on the alert signs like respiratory distress, stridor and neck stiffness. This study aims to investigate and understand the patterns of DNSI across all ages and gender with its presentation, signs, sites involved, bacteriology, management and complications. MATERIALS AND METHODS This is a retrospective descriptive study of 94 patients with DNSI admitted in the ENT Department from February 2015 to October 2016. Patients of all age groups and gender were included. All clinical parameters were included in the study including comorbidities, clinical presentation, site, causative organism, complications, treatment and management across all age groups with mean age being 45 years. RESULTS In our report, there were 55 male patients and 25 female patients. Diabetes was found as a comorbid condition in 19 cases (23.7%). The mean age was 45 years. Our study found out that the most frequent causes of DNSI were odontogenic conditions (27.5%). Neck and/ or facial oedema in all patients with local pain in 79 patients (98.75%) were the most common symptoms of DNSI. The most commonly isolated bacterium was Staphylococcus aureus in 30 patients (37.5%) followed by Group G Streptococcus in 20 patients (25%). Among complications, the presence of septic shock and mediastinitis were statistically significant variables associated with the demise group. Surgery was done in 78 patients (97.5%), of which 55 patients underwent neck drainage only. CONCLUSION DNSI carries significant risks of life-threatening complications including death. This necessitates the need for accurate diagnosis and prompt management to provide a cure without complications, and to always promptly identify alert signs such as stridor and neck stiffness. Management of DNSI traditionally is based on antibiotic treatment with prompt surgical drainage of abscess. T he study brings to light the importance of prompt diagnosis and treatment of DNSI and the importance of oral hygiene, especially in developing countries.