Deep neck space infections: our experience


  • Naveen Kumar Korivipati Department of ENT, Shadan Institute of Medical Sciences, Hyderabad, Telangana, India
  • Sandeep Irvineti Consultant ENT Surgeon, BBR Hospital, Hyderabad, Telangana, India
  • Mallikarjun Rao M. Department of ENT, Shadan Institute of Medical Sciences, Hyderabad, Telangana, India



Deep neck space, Parapharyngeal, Retropharyngeal, Ludwigs angina, Parotid abcess


Background: Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. The common primary sources of DNSI are tonsil infections, dental infections, salivary gland infections, foreign bodies and malignancies. With widespread use of antibiotics and early detection facilities, the prevalence of DNSI has been reduced. Common complications of DNSI include airway obstruction, jugular vein thrombosis, and sepsis. Treatment principally comprises airway management, antibiotic therapy, and surgical intervention. This study was conducted to investigate the age and sex distribution of patients, symptoms, presentation, sites involved, bacteriology, and management and complications of DNSI.

Methods: A prospective study of deep neck space infections was done during the period July 2015 to February 2017 i.e. 20 months who attended the outpatient and were admitted as inpatient in Shadan hospital, Hyderabad.50 Cases were included in the study. All parameters including age, gender, co-morbidities, presentation, site, bacteriology, complications, and investigations were studied.  

Results: Due to advent of antibiotics, deep neck space infections are in decreasing trend with admission rate accounting to 3% of total inpatients in our hospital. The common age group found to be affected is 10-20 years (28%). Out of all deep neck space infections, Ludwigs infections was common (32%) followed by peritonsillar infections (25%).

Conclusions: Infection of the deep neck spaces is a common and potentially life threatening ENT disease and requires an interdisciplinary approach. Tooth infections and foreign body impaction are the commonest causes of these infections. Diabetes Mellitus is an important predisposing factor. Complications such as mediastinitis, septic shock and pleural effusion are possible; hence the surgeon should be cautious. 


Rizzo PB, Marchiori C, Zanetti F, Vaglia A. Conservative management of deep neck abscesses in adults: The importance of CECT findings Otolaryngol Head Neck Surg. 2006;135(6):894-9.

Sichel JY, Dano I, Hocwald E, Biron A, Eliashar R. Nonsurgical management of parapharyngeal space infections: a prospective study. Laryngoscope. 2002;112(5):906-10.

Lyudmila B, Rossen K, Galina G, Elitsa D, Jivko M, Milen M. Anaerobic bacteria in 118 patients with deepspace head and neck infections. J Med Microbiol. 2006;55:1285-9.

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

Lin HW, O'Neill A, Cunningham MJ. Ludwig's Angina in the Pediatric Population. Clin Paediatr. 2009;48(6):583-7.

Hawkins DB, Austin JR. Abscesses of the Neck in Infants and Young Children a Review of 112 Cases, Annals Otol Rhinol Laryngol. 1991;100:361-5.

Mayor GP, Martinez-San Millan J, Martinez-Vidal A. Is Conservative treatment of deep neck space infectious appropriate? Head Neck. 2001;23:126.

Candamourty R, Venkatachalam S, Babu MR, Kumar GS. Ludwig's angina: An emergency: A case report with literature review. J Nat Sci Biol Med. 2012;3(2):206-8.

Huang TT, Tseng FY, Liu TC, Hsu CJ, Chen YS. Deep neck infection in diabetic patients: Comparison of clinical picture and outcomes with nondiabetic patients. Otolaryngol Head Neck Surg. 2005;132:943-7.

Parhiscar A, Har-El G. Deep Neck Abscess: A Retrospective Review of 210 Cases. Otolaryngol Head Neck Surg. 2001;110(11):1051-4.

Larawin V, Naipao J, Dubey SP. Head and neck space infections. Otolaryngol Head Neck Surg. 2006;135(6):889-93.

Dhanalakshmi S. Lurking Dangers in Deep Neck Abscess Retrospective Study. J Evol Med Dental Sci. 2015;4:7977-85.

Lee J, Kim H, Lim S. Predisposing Factors of Complicated Deep Neck Infection: An Analysis of 158 Cases. Yonsei Med J. 2007;48(1):55-62.

Tom MB, Rice DH. Presentation and management of neck abscess: a retrospective analysis. Laryngoscope. 1988;98(8):877-80.

Juncar M, Lung T, Onisor F. Infections of Head and Neck Soft Tissues – A Statistical Study over a 10-year Period. Applied Med Informatics Original Res. 2010;27(3):37-42.






Original Research Articles