Deep neck space infections; retrospective review of 46 patients

Abstract

Aims: To study clinical presentation, management, and outcome of deep neck space infections (DNSI). Settings and Design: A retrospective case series was conducted in the Section of Otolaryngology of a tertiary care University Hospital from 2001 to 2011. Materials and Methods: A retrospective review of charts of the patients who were treated for deep neck space (DNSI) at our department from 2001 to 2011 was carried out. Forty-six patients fulfilled our inclusion criterion and were included in the study. A structured Performa was used for data collection and the following variables were recorded including demographics (age and gender), co-morbidities (diabetes mellitus, HIV), symptoms, etiology, infection site, bacteriology, culture growth imaging modality used, surgical intervention, and hospital stay. Results: The mean age of our patients was 30.8 years; 32 were male and 14 were female. Neck pain was the most common symptom found in 38 patients (82.60%) and most common space involved was parapharyngeal space which was seen in 20 patients (43.47%). Etiology of DNSI in majority of our patients, i.e., 18 (39%) was unknown followed by dental and tonsil problems in 12 (26%) and 10 (22%) patients, respectively. Of 46 patients, 36 underwent intervention and of these 26 cases had positive culture results. The most common organism cultured was Streptococcus seen in 8 patients (22.2%). Ten patients (21.73%) were treated medically alone. Mean hospital stay was 3.33 days with a minimum of 2 days and a maximum of 17 days stay. There was no mortality in our series of patients. Conclusions: The deep neck space infection is still a challenging disease in otolaryngology. Its presentation may be masked and bacterial culture might not be conclusive but it still needs early diagnosis and prompt management whether conservative or surgical. CT scan is a standard modality for differentiating between cellulitis and abscess. Most of the patients need surgical intervention and tracheostomy should be considered if air way protection is needed.