A COMPARATIVE STUDY OF DEEP NECK SPACE INFECTIONS (DNSI) IN DIABETIC VERSUS NON-DIABETIC PATIENTS: OUR EXPERIENCE IN A TERTIARY CARE CENTRE

Abstract

Background:The term deep neck space infections (DNSIs) encompasses infections of several different areas of the neck formed by the potential spaces formed by different fascial layers of the neck. The etiology of DNSI include pharyngo-tonsillar infections (most commonly in children), odontogenic infections, sialolithiasis and sialadenitis, congenital anomalies like cysts and sinuses of the neck. Predisposing factors may include Extremes of age, Immunodeciency, Diabetes mellitus and Intravenous drug abuse. The microbiology of deep neck infections usually reveals mixed aerobic and anaerobic organisms, often with a predominance of oral ora. Both gram-positive and gram-negative organisms may be cultured. DNSI usually mandate early intervention on an urgent basis because of the risk of potentially fatal complications such as airway obstruction, mediastinitis and vascular complications. Airway assessment and intervention plays a pivotal role in the management of DNSI. Aims and Objectives: The present study aims to compare the clinical presentation, complications, treatment outcomes and microbiology of DNSIs in diabetic vs non-diabetic patient populations.The objective is to have a proper understanding of the disease so that a much organized treatment protocol can be established. 70 patients were enrolled for this comparative st Materials and Method: udy in Indoor wards of a Tertiary care centre. The study was conducted from January 2019 to December 2019 for 1year. Patients diagnosed with DNSI (by imaging studies) and admitted in ward of ENT and Head Neck Surgery were selected. Parapharyngeal Space was mos Results: t common involved space in both Diabetics (52.38%) and Non Diabetics (41.46%), followed by Submandibular Space. Most common organism in both groups was Klebsiella pnemoniae. Odontogenic infection and Upper airway infections were 2 leading causes of DNSI in both Diabetics and Non Diabetics in this study. The Diabetic groups affected had much older age with longer hospital stay and had more frequent complications than Non Diabetic group. Diabetics also needed more frequent tracheostomy (28.57%) than Non Diabetics (2.44%). Diabetic patients as a subgroup Conclusion: of DNSIs pose many unique problems including older age at presentation, involvement of multiple neck spaces, prolonged hospital stay and operative interventions. As these patients have higher rate of complications and poorer prognosis, early institution of therapy, strict glycemic control and operative interventions are more often required.