Parotid Space, a Different Space from Other Deep Neck Infection Spaces.

Shih-Lung Chen,Tsung-You Tsai,Shiang-Fu Huang,Chi-Kuang Young,Chun-Ta Liao,Chung-Jan Kang

doi:10.3390/microorganisms9112361

Shih-Lung Chen, Tsung-You Tsai + Show 4 more

Open Access

https://doi.org/10.3390/microorganisms9112361

Copy DOI

Abstract

Deep neck infections (DNIs) such as parotid abscesses are medical emergencies with a seemingly different etiology and treatment course from other DNIs. We sought to confirm this in the present retrospective population-based cohort study. Between August 2016 and January 2020, 412 patients with DNIs seen at a tertiary medical center were enrolled in this study. Infections of the parotid space were compared with those of other deep neck spaces, according to patient characteristics. All patients were divided into parotid space (PS; n = 91, 22.08%) and non-parotid space (NPS; n = 321, 77.92%) subgroups. We further divided the patients into single parotid space (PS-single; n = 50, 12.13%), single non-parotid space (NPS-single; n = 149, 36.16%), multiple parotid space (PS-multiple; n = 41, 9.95%), and multiple non-parotid space (NPS-multiple; n = 172, 41.76%) DNI subgroups. In the PS-single and PS-multiple subgroups, a longer duration of symptoms (p = 0.001), lower white blood cell count (p = 0.001), lower C-reactive protein level (p = 0.010), higher rate of ultrasonography-guided drainage (p < 0.001), and lower rates of surgical incision and drainage (p < 0.001) were observed compared with the NPS-single and NPS-multiple subgroups. The PS group had a higher positive Klebsiella pneumoniae culture rate (p < 0.001), and lower positive Streptococcus constellatus (p = 0.002), and Streptococcus anginosus (p = 0.025) culture rates than the NPS group. In a multivariate analysis, K. pneumoniae was independently associated with parotoid space involvement in comparisons of the PS and NPS groups, PS-single and NPS-single subgroups, and PS-multiple and NPS-multiple subgroups. The clinical presentation of a parotid space infection differs from that of other deep neck space infections.

Highlights

Deep neck infection (DNI) refers to infection of a space or fascial plane of the neck [1].A Deep neck infections (DNIs) can be lethal and may cause complications such as airway obstruction [2]
We retrospectively reviewed the medical records of the patients
We found significant differences between DNIs of the parotid space and other deep neck spaces

Summary

Introduction

Deep neck infection (DNI) refers to infection of a space or fascial plane of the neck [1]. A DNI can be lethal and may cause complications such as airway obstruction [2]. Treatment involves securing the airway, surgical- or ultrasonography (US)-guided drainage, adequate and prompt antimicrobial coverage, and appropriate management of complications [3]. Life-threatening complications of a DNI include carotid artery erosion, sepsis, disseminated intravascular coagulation, descending necrotizing mediastinitis, jugular vein thrombosis, necrotizing fasciitis, and airway obstruction [4]. DNIs continue to occur despite the widespread use of antibiotics [1]. The parotid space is relatively distant from other deep neck spaces. Most lymph nodes are located in the superficial parotid region or parotid tail [5,6].

Methods

Results

Discussion

Conclusion