The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis

Abstract

Objectives: To summarise current practices in the diagnosis and management of deep neck space infections (DNSIs). To inform future studies in developing a framework in the management of DNSIs.Design: This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with two independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach.Setting: Secondary or tertiary care centres that undertook management of DNSIs.Participants: All adult patients with a DNSI. Main outcome measures:The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs.Results: Sixty studies were reviewed. Thirty-one studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single randomised controlled trial, all other studies were observational (n = 25) or case series (n = 36). Computer tomography (CT) was used to diagnose DNSI in 78% of patients. The mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration, respectively. Qualitative analysis identified seven major themes on DNSI.Conclusions: There are limited methodologically rigorous studies investigating DNSIs.CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.

Factors associated with complications among deep neck infection in the community-based hospital in Thailand

“…The ndings highlight the importance of early recognition and appropriate management to prevent the development of life-threatening complications. [2,10,14] Consistent with previous studies, odontogenic infections were identi ed as the most common etiology of DNIs. [1,8,10,15,16] This underscores the importance of dental hygiene and timely treatment of dental infections to prevent the spread of infection to deeper neck spaces.…”

“…[2,10,14] Consistent with previous studies, odontogenic infections were identi ed as the most common etiology of DNIs. [1,8,10,15,16] This underscores the importance of dental hygiene and timely treatment of dental infections to prevent the spread of infection to deeper neck spaces. [17] In our study, the microorganisms isolated were Klebsiella pneumoniae, Staphylococcus spp., and Viridans streptococcus, whereas previous studies have also demonstrated that S. pyogenes, S. aureus, Streptococcus viridans, and Haemophilus in uenza are the most common bacterial species.…”

“…[17] In our study, the microorganisms isolated were Klebsiella pneumoniae, Staphylococcus spp., and Viridans streptococcus, whereas previous studies have also demonstrated that S. pyogenes, S. aureus, Streptococcus viridans, and Haemophilus in uenza are the most common bacterial species. [10,13,15,16,[18][19][20] Appropriate to a previous study, multiple space involvement tends to cause more complications than single-space involvement; the association between space involvement and complications emphasizes the need for careful evaluation and monitoring of patients with extensive neck involvement. [3,16,21,22] Prompt surgical intervention, such as incision and drainage, may be necessary to prevent the progression of infection and alleviate airway compromise.…”

“…Tracheostomy rates in DNIs have been reported to be up to 30%, with mortality around 5% and mortality rates rising to 17.5-50% if necrotizing mediastinitis occurs. [6, [9][10][11][12][13] The timely diagnosis and appropriate management of DNIs are paramount to prevent the progression of infection and reduce associated morbidity and mortality. However, the diagnosis of DNIs can be challenging due to nonspeci c clinical manifestations and the potential for rapid disease progression.…”

Ultrasound-guided puncture drainage versus surgical incision drainage for deep neck space abscesses: a protocol for a systematic review with meta-analysis and trial sequential analysis

“…Traditionally, the main treatment method for DNAs is complete surgical incision and drainage with appropriate administration of antibiotics. [14][15][16][17][18][19] However, surgical drainage has several drawbacks. First, the risk of inadvertent injuries to neighbouring vital structures (including the internal jugular vein, carotid artery and cranial nerves)…”