Spectrum and management of deep neck space infections: Seven year prospective study

Abstract

Objectives: Antibiotics have reduced the prevalence and improved the outcome of deep neck space infections; however, they continue to be associated with high rates of morbidity and mortality. It is essential for the otolaryngologist to understand the etiology and pathogenesis of those infections in order to induce the necessary diagnostic steps and the appropriate therapy as soon as possible. Methods: Between January 1997 and December 2003, we conducted a prospective clinical study including 189 patients with deep neck space infections. Dental abscesses as well as abscesses evolving from tonsillitis or infections of the large salivary glands were not included in this study. Results: The median age was 44 years (1–90 years) and there were 104 male and 85 female patients, respectively. We performed a surgical drainage in 86.2% of subjects. The bacteria most commonly involved included streptococci (n = 48), anaerobes (n = 37) and staphylococci (n = 26). We found 15 abscesses to be caused by Bartonella henselae (cat-scratch disease) and another 7 by Mycobacterium tuberculosis. In 10 cases, the deep neck space abscess represented the first manifestation of a malignant head and neck tumor. Conclusions: Ensuring a secure airway is the first priority in the management of a deep neck space infection. Surgical intervention is indicated in most cases. However, abscesses caused by B henselae or M tuberculosis may be managed with antibiotic therapy alone. The indication for a simultaneous panendoscopy should be regarded generously, especially in patients with the well-known risk factors for head and neck carcinomas.