Clinical profile of patients with deep neck space infections: a review of 62 patients from a tertiary care hospital of North India

Rohit Verma; Sumeet Angral; Udeyana Singh

doi:10.18203/issn.2454-5929.ijohns20194944

Authors

Rohit Verma Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Sumeet Angral Department of Otorhinolaryngology, All India Institute of Medical Sciences, Rishikesh, India
Udeyana Singh Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20194944

Keywords:

DNSI, Ludwig’s angina, Neck abscess, Parapharyngeal space abscess, Retropharyngeal abscess, Submandibular abscess

Abstract

Background: Deep neck space infection (DNSI) is the infection of the potential spaces in the neck, specifically around the facial planes. Management of DNSI is traditionally by prompt surgical drainage of the abscess followed by antibiotics. In select cases, nonsurgical treatment using appropriate antibiotics may be employed. The objective of this study was to review the clinical profile of patients with DNSI.

Methods: This was a retrospective chart review of 62 patients of DNSI managed at a tertiary care hospital of North India. Various parameters assessed in study included the demographical profile of the patients, symptomatology, possible aetiology, site distribution, bacteriology, the co-morbid conditions and treatment received.

Results: Male preponderance was seen in this study with male:female ratio of 1.69:1. Swelling was the main complaint in majority of the patients (91.9%, 57 of 62 patients). The most common aetiology was odontogenic infection. Diabetes mellitus was seen in 25.8% (n=16) patients. Multiple space involvement was seen in majority of the patients with submandibular space being the most commonly involved site (43.5%). Most patients had negative pus cultures. The most common organism isolated was Staphylococcus aureus. All patients underwent surgical drainage.

Conclusions: Odontogenic pathology is the most common cause related to DNSI. So extreme caution should be exercised by dentists in diabetic patients and in those with other immunocompromised status. Pus culture should be obtained before the start of antimicrobial therapy. If not diagnosed and treated in time, DNSI can turn out to be fatal.

Metrics

Metrics Loading ...

References

Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003;24:111-7.

Myla S, Peruri AR. Clinical study of deep neck space infections – retrospective study. Int J Sci Res. 2015;4(3):1739-41.

Gujrathi A B, Ambulgekar V, Kathait P. Deep neck space infection – a retrospective study of 270 cases at tertiary care center. World J Otorhinolaryngol Head Neck Surg. 2016;2:208-13.

Durazzo MD, Pinto FR, Loures MS, Volpi EM, Nishio S, Brandão LG, et al. Deep neck spaces and their significance in cervical infections. Rev Assoc Med Bras. 1997;43:119-26.

Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, Gonzalez VH, Bluestone CD. Head and neck space infections in infants and children. Otolaryngol Head Neck Surg. 1995;112:375-82.

Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck. 2004;26:854-60.

Hasegawa J, Hidaka H, Tateda M, Kudo T, Sagai S, Miyazaki M, et al. An analysis of clinical risk factors of deep neck infection. Auris Nasus Larynx. 2011;38:101-7.

Viera F, Allen SM, Stocks RSM, Thompson JW. Deep neck infection. Otolaryngol Clin N Am. 2008;12:459-83.

Wills PI, Vernon RP. Complications of space infections of the head and neck. Laryngoscope. 1981;91:1129-36.

Mayor GP, Millan JMS, Martinez VA. Is conservative treatment of deep neck space infections appropriate? J Head Neck. 2001;23:126-33.

Parhiscar A, Har-El G. Deep neck abscess: a retrospective review of 210 cases. Ann Otol Rhinol Laryngol. 2001;110:1051-4.

Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess- A retrospective study of 110 patients. Oral Surg Oral Med Oral Pathol. 1994;77:446-50.

Meher R, Jain A, Sabharwal A, Gupta B, Singh I, Agarwal AK. Deep neck abscess: a prospective study of 54 cases. J Laryngol Otol. 2005;119:299-302.

Bakir S, Tanriverdi MH, Gun R, Yorgancilar AE, Yildirim M, Tekbaş G, et al. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol. 2012;33:56-63.

Sethi DS, Stanley RE. Deep neck abscesses: changing trends. J Laryngol Otol. 1994;108:138-43.

Marioni G, Rinaldi R, Staffieri C, Marchese-Ragona R, Saia G, Stramare R, et al. Deep neck infection with dental origin: analysis of 85 consecutive cases (2000-2006). Acta Otolaryngol. 2008;128:201-6.

Bottin R, Marioni G, Rinaldi R, Boninsegna M, Salvadori L, Staffieri A. Deep neck infection: a presentday complication. A retrospective review of 83 cases (1998-2001). Eur Arch Otorhinolaryngol. 2003;260:576-9.

Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N. Deep neck infections: a retrospective review of 112 cases. Eur Arch Otorhinolaryngol. 2009;266:273-7.

Tschiarsny K. Ludwig’s angina: an anatomic study of the role of the lower molar teeth in its pathogenesis. Arch Otolaryngol. 1943;38:485-96.

SueharaAB, Goncalves AJ, Alcadipani FA, Kavabata NK, Menezes MB. Deep neck space infections – analysis of 80 cases. Bras J Otolaryngol. 2008;74(2):253-9.

Moncada R, Warpeha R, Pickleman J, Spak M, Cardoso M, Berkow A, White H. Mediastinitis from odontogenic and deep cervical infection. Anatomic pathways of propagation. Chest. 1978;73(4):497-500.

Mumtaz RM, Arain AA, Suhail A, Rajput SA, Mohammad A, Nabeel H. Deep neck space infections: retrospective review of 46 patients. J Cranio Max Dis. 2014;3:21-5.

Gidley PW, Ghorayed BY, Stiernberg CW. Contemporary management of deep neck space infections. Ololaryngol Head Neck Surg. 1997;116:16-22.

Boscolo-Rizzo P, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V, et al. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol. 2012;269:1241-9.

Agarwal AK, Sethi A, Sethi D, Mrig S, Chopra S. Role of socio-economic factors in deep neck abscess: A prospective study of 120 patients. Br J Oral Maxillofac Surg. 2007;45:553-5.

Larawin V, Naipao J, Dubey SP. Head and neck space infections. Otolaryngol Head Neck Surg. 2006;135:889-93.

Kauffmann P, Cordesmeyer R, Troltzsch M, Sommer C, Laskawi R. Deep neck infections: A single-center analysis of 63 cases. Med Oral Patol Oral Cir Bucal. 2017;22(5):536-41.