DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20174322

A study on presentation, etiology, complications and management of deep neck space infections: our experience

Pradip Khokle, Vaibhav J. Lahane, Swati Mishra, Moinnudin Choudhary

Abstract


Background: To analyze our experience in presentation, etiology, complications and difficulties encountered in diagnosis and management of deep neck space infections.

Methods: 52 cases of deep neck space infections were analyzed within the period of November 2013 to November 2015 in ENT OPD at GMC Latur. Patients with airway compromise or in failures were managed with intubation or tracheostomy. All patients were investigated with detail history, hematological and radiological investigations like X- Ray, USG or CT scan. Although all patients were treated with intravenous antibiotics, surgical drainage was the definitive management.  

Results: Study includes 29 males and 23 females. Neck pain was most common presentation in 90.38% with airway compromise being most common complication. Submandibular (34.61%) and peritonsillar (21%) space were commonly involved with odontogenic and upper airway infections being leading causes. Diabetes was common comorbidity found among patients. Staphylococcus aureus being common isolate (Klebsiella in diabetics). Surgical drainage with antibiotics as per culture sensitivity was treatment modality of choice.

Conclusions: Early diagnosis and appropriate management is key for better outcome. Odontogenic etiology being most common correlates well with poor oral hygiene and tobacco chewing. Surgical drainage and antibiotics are the treatment modalities. Complications and associated comorbidities affect the course of DNSI and hence require appropriate management. 


Keywords


Deep neck space abscess, Submandibular space, Tonsillar infection, Parapharyngeal space

Full Text:

PDF

References


Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, Gonzalez‑Valdepena H, 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.

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(2):111–7.

Boscolo-Rizzo P, Marchiori C, Montolli F, Vaglia A, Da Mosto MC. Deep neck infections: a constant challenge. ORL J Otorhinolaryngol Relat Spec. 2006;68(5):259–65.

Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N. Deep neck infections: a retrospective review of 112 cases. Eur Arch Otorhinolaryngol. 2009;266(2):273–7.

Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases. Otolaryngol Head Neck Surg. 2005;133(5):709–14.

Kataria G, Saxena A, Bhagat S, Singh B, Kaur M, Kaur G. Deep Neck Space Infections: A Study of 76 Cases. Iranian J Otorhinolaryngol. 2015;27(4):293-9.

Suehara AB, Gonçalves AJ, Alcadipani FAMC, Kavabata NK, Menezes MB. Deep neck infection – analysis of 80 cases. Rev Bras Otorrinolaringol. 2008;74(2):253-9.

Parhiscar A, Har-El G. Deep neck abscess: a retrospective review of 210 cases. Ann Oto Rhinol Laryngol. 2001;110(11):1051-4.

Anil S, Al-Ghamdi HS. The impact of periodontal infections on systemic diseases. An update for medical practitioners. Saudi Med J. 2006;27(6):767–76.

Bakir S, Tanriverdi MH, Gün 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.

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

Kamath MP, Shetty AB, Hegde MC, Sreedharan S, Bhojwani K, Padmanabhan K, et al. Presentation And management of deep neck space abscess. Indian J Otolaryngol Head Neck Surge O'. 2003;55(4):271-5.

Zamiri B, Hashemi SB, Haeshami SH, Rafiee Z, Ehsani S. Prevalence of odontogenic deep head and neck space infection and its correlation with length of hospital stay. Shiraz Univ Dent. 2012;13(1):29-35.

Rega AJ, Aziz SR, Ziccardi VB. Microbiology and antibiotic sensitivities of head and neck space infections of odontogenic origin. J Oral Maxillofac Surg. 2006;64:1377-80.

Kataria G, Saxena A, Bhagat S, Singh B, Goyal I, Vijayvergia S, Sachdeva P. Prevalence of odontogenic deep neck space infections (DNSI): a retrospective analysis of 76 cases of DNSI. Int J Otorhinolaryngol Head Neck Surg. 2015;1:11-6.

Lee YQ, Kanagalingam J. Deep neck abscesses: the Singapore experience. Eur Arch Otorhinolaryngol. 2011;268(4):609-14.

Sethi DS, Stanley RE. Deep neck abscesses--changing trends. J Laryngol Otol. 1994;108(2):138-43.

Georgalas C, Kanagalingam J, Zainal A, Ahmed H, Singh A, Patel KS. The association between periodontal disease and peritonsillar infection: a prospective study. Otolaryngol Head Neck Surg 2002;126(1):91-4.

Cmejrek RC, Coticchia JM, Arnold JE. Presentation, diagnosis, and management of deep-neck abscesses in infants. Arch Otolaryngol Head Neck Surg. 2002;128(12):1361-4.

Scott BA, Stienberg CM, Driscoll BP. Deep Neck space Infections. In: Byron J. Bailey Head and Neck Surgery - Otolaryngology, second editon Lippincott-Raven publisher; 1998: 819-835.

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(5):446–50.

Sakaguchi M, Sato S, Ishiyama T, Katsuno S, Taguchi K. Characterization and management of deep neck infections. Int J Oral Max Surg. 1997;26(2):131-4.

Chen MK, Wen YS, Chang CC, Lee HS, Huang MT, Hsiao HC. Deep neck infections in diabetic patients. Am J Otolaryngol. 2000;21(3):169–73.

Crespo AN, Chone CT, Fonseca AS, Montenegro MC, Pereira R, Milani JA. Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection. Sao Paulo Med J. 2004;122(6):259–63.

Freling N, Roele E, Schaefer-Prokop C, Fokkens W. Prediction of deep neck abscesses by contrast-enhanced computerized tomography in 76 clinically suspect consecutive patients. Laryngoscope. 2009;119(9):1745–52.

Endicott JN, Nelson RJ, Saraceno CA. Diagnosis and management decisions in infections of the deep fascial spaces of the head and neck utilizing computerized tomography. Laryngoscope. 1982;92(6):630–3.

Mayor GP, Millan JMS, Martinez VA. Is conservative treatment of deep neck space infections appropriate? J Head Neck. 2001;23(2):126–33.

Smith JL, Hsu JM, Chang J. Predicting deep neck space abscess using computed tomography. Am J Otolaryngol. 2006;27:244–7.

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(1):21–5.

Ochi K, Ogino S, Fukamizu K, Yazaki H, Ohashi T, Ashida H, Takeyama I. US - guided drainage of deep neck space abscesses. Acta Otolaryngol Suppl. 1996;522:120-3.

Reynolds SC, Chow AW. Severe soft tissue infections of the head and neck: a primer for critical care physicians. Lung. 2009;187(5):271–9.

Shetty N, Thomas B, Ramesh A (2008) Comparison of neutrophil functions in diabetic and healthy subjects with chronic generalized periodontitis. J Indian Soc Periodontol. 2008;12(2):41-4.