Treatment and prognosis of deep neck infections.

Abstract

Deep neck infections could have serious threats for life of patients, if not noticed adequately. Early diagnosis and correct treatment planning can save the patient's lives and prevent complications of disease extension and also surgical procedures that in some instances may be performed in an emergent situation with higher complication rates. Herein, we have studied 815 cases of deep neck abscesses and infections with especial consideration to treatment and prognosis. In a retrospective case review, we studied 815 cases admitted in our medical center from 1998 until the year 2013. Only patients with abscesses or infections deeper than superficial layer of deep cervical fascia were included in this study, based on the review of their medical records. From 815 cases (485 males and 330 females) surgery was indicated and performed in 428 cases and the rest were treated medically. In cases with dental infections as the etiologic factor, dental procedures were performed as early as possible (extraction in almost all cases). Tracheostomy was performed in five cases. All of the patients in medical treatment group and most of the surgically managed patients were discharged while were stable with relative or complete resolution of their symptoms. One of our patients, a 15year old boy died with symptoms suggestive for mediastinitis and air way compromise. Early diagnosis and medical management can be effective in treating deep neck infections. Dental infections and also procedures are the major cause in our patients, although tonsillitis and peritonsillar abscess also were important leading causes with almost equal numbers in our series. Extraction of the infected tooth as early as possible while medical treatment is continued can be very helpful. In some cases it may be necessary to perform surgical exploration of the neck more than once, and finally, malignant neoplasia, somewhere in the head and neck should be considered in some cases, as in one of our patients with left side submandibular abscess whose underlying disorder was tongue SCC with neck metastasis. Prognosis can be excellent in both medically and surgically managed groups if started and designed early and promptly.