Management Of Deep Neck Infections Research Articles

Imaging assessment of deep neck spaces infections: an anatomical approach.

Despite the widespread use of antibiotics, deep neck infections are still a relevant clinical problem and can cause severe and potentially life-threatening complications. Imaging plays a pivotal role into the clinical management of deep neck infections, allowing identification of the source of infections, definition of the precise extension of the disease and early diagnosis of local or distant complications. The complex anatomy of deep neck spaces may hide the actual extent of disease: the knowledge of neck anatomy enables radiologists to rapidly evaluate expected routes of spread of infections and to effectively communicate crucial information to surgeons. Computed Tomography is the most used imaging modality for assessing primary site of infection, extent of disease and local complications. Magnetic resonance imaging may be used as a second level imaging modality for individuating intracranial or spinal complications. The present work aims to review the imaging of deep neck spaces infections, focusing on relevant anatomy and clinical scenarios, underlining practical teaching points for each of them. Familiarity with deep neck spaces anatomy and knowledge of most common routes of spread of infections allow the radiologist to make a prompt diagnosis and to look for early signs of potential complications.

107. Deep Neck Infections – A single centre analysis of 100 cases in West of Scotland (WOS)

This study reviews the clinical presentation, investigation, and management of deep neck infections in our department. We aim to identify predisposing factors for serious complications, with a view to improve prognosticating.

A novel model for predicting mortality in the management of deep neck infections.

Deep neck infections (DNIs) are a common and intractable disease encountered in ENT clinics that impose a significant medical and financial burden on affected individuals and their families. However, insufficient data are currently available for predicting outcomes in cases of DNI. The present study thus sought to develop a novel model capable of predicting treatment outcomes of DNI patients just using indicators at the visit. Patients with DNIs treated from 2010 to 2022 were included in the present study. Patient data were retrospectively collected from medical records. Risk factors associated with mortality were identified using logistic regression models. A predictive model was constructed based on odds ratios for factors calculated using a multivariate regression model. In total, 153 patients were enrolled in the present study. Risk factors associated with mortality included age >50years, residence in a rural area, dyspnea at visit, the involvement of multiple infected sites, serum albumin<34g/L, renal insufficiency, mediastinitis, pulmonary infection, and septic shock. A multivariate regression model revealed that mediastinitis (OR: 7.308, P < 0.001), serum creatinine>95μmol/L (OR: 23.363, P < 0.05), and serum albumin<34g/L (OR: 13.837, P < 0.05) were independent predictors of mortality in deep neck infection patients, with serum creatinine>95μmol/L being particularly critical to the outcomes. Diabetes was not the predictor of mortality but was associated with long-term hospitalization (P < 0.001). In summary, the model constructed in the present study was capable of estimating the potential for poor outcomes in DNI patients before the initiation of treatment. These findings may help improve doctor-patient communication, especially for those struggling financially.

Management of deep neck infections in adults and importance of clinical and laboratory findings

This study aimed to analyze laboratory and radiological imaging results in the prediction of treatment strategy in patients with deep neck infections. Eighty-three patients (55 (66.3%) men, mean age: 38.2±14.5...

Changing trends of deep neck infections in southern China: A review of 127 cases.

This study aimed to review our experience with the clinical characteristics and management of deep neck infections (DNIs) and determine the changing trends of their characteristics over time in southern China. Patients diagnosed with a DNI between January 2009 and December 2018 were screened retrospectively for their demographic characteristics, etiology of infection, site of infection, microbiology, treatment, and complications. In total, 127 patients were included: 41 (32.3%) were treated between 2009 and 2013 (group A), and 86 (67.7%) were treated between 2014 and 2018 (group B). The most common site of infection in group A was the parapharyngeal space (15 patients, 36.6%), while that in group B involved multiple spaces (36 patients, 41.9%). The leucocyte count (×109 cells/L) was 13.23 ± 4.19 in group A and 16.04 ± 4.33 in group B (p < 0.001). Streptococcus viridans was the most common bacteria in both groups. The mean hospital stay was 21.46 ± 33.09 days in group A and 10.44 ± 6.19 days in group B. The rate of diabetes mellitus (DM) in group A was lower than that in group B (8/41 and 33/86, respectively; p = 0.034). Airway obstruction was the most common complication in both groups. DNIs are more likely to show multi-space involvement, affect more DM patients, and be associated with higher leucocyte counts over time. We infer that the duration from morbidity to admission and that from admission to operation play roles in the successful management of DNIs, possibly causing fewer complications, lower mortality rates, and shorter hospital stays. DM patients require increased attention.

Management of deep neck infections from cervical esophageal perforation caused by foreign body: A case series study

PurposeEsophageal perforation caused by foreign body is common in Chinese medical institutions, and resultant deep neck infections (DNI) is quite different from typical DNI. The purpose of this article was to share our experience on management of this particular type of DNI. Material and methodsA retrospective review was conducted on a consecutive sample of such patients at Capital Medical University Beijing Friendship Hospital from 2015 to 2019. ResultsIn total, 24 cases were recorded. CT scan of the neck and upper thorax was the most useful tool for early diagnosis. Gas formation was not predictive of a worse clinical course. Eleven patients with minor DNI were treated with antibiotics and foreign body removal; while 13 patients with major DNI were treated with neck incision and drainage, ICU observation, and prolonged usage of antibiotics. Outcome was generally good, but major complications, including sepsis and lingual artery rupture, could occur. ConclusionsConservative management, focusing on prompt extraction of esophageal foreign body and adequate antibiotic coverage, can lead to good outcome for mild cases; while in addition to these measures, neck incision, cervical and superior mediastinal exploration, and high negative pressure drainage, should be performed for severe cases.

Severe deep neck infections successfully treated with negative pressure wound therapy with instillation - a case report

Background: Deep neck infection (DNI) is a life-threatening complication associated with significant mortality and morbidity rates. The most common causes of DNI are the tonsilitis, dentitis, salivary glands inflammation, malignancies, and foreign bodies. As a result of neck infection, patients are at high risk of potential secondary complications which include: descending mediastinitis, pleural empyema, septicemia, jugular vein thrombosis, pericarditis. We presented a case of successful management of DNI with the utility of negative pressure wound therapy with instillation (iNPWT).&#x0D; Method: A 37-year-old male with deep neck infection due to dentitis was qualified for iNPWT. Due to previous incisions and drainage of the neck abscesses, some undermined wounds drained towards each other’s were revealed with an excessive amount of purulent content. Standard NPWT dressing was placed and polyurethane foam was covered with contact layer dressing. Additionally, an inflow drain was placed within one of the wounds in regard to instill an antimicrobial solution. The wound was instilled four times daily.&#x0D; Results: The patient underwent a total of eight iNWPT sessions. Locally, a reduction in purulent content was achieved with a decrease of wounds’ dimensions and improvement of wound bed granulation. Moreover, improvement of the patient’s general condition and decrease of inflammatory markers was achieved.&#x0D; Conclusions: iNPWT may play an important role in the management of combined, complicated wounds due to DNI. The instilled antimicrobial solution facilitates dissolving and removing of the purulent content that impairs the wound healing.

Management of pediatric peritonsillar and deep neck infections- cross- sectional retrospective analysis.

ObjectiveDeep neck infections (DNI) are responsible for significant morbidity in children and healthcare expenditures. Few studies exist specifically addressing the clinical and epidemiologic characterization and management of DNI's in the pediatric population. Our goal was to analyse the demographic characteristics, clinical presentation, diagnostic and therapeutic approaches of peritonsillar and DNI in pediatric patients.MethodsThe medical records of patients, aged up to 18 years, admitted for peritonsillar and DNI at our department, from 2011 to 2016, were retrospectively reviewed and compared with the literature available. Ninety-eight patients were enrolled.ResultsThe mean age was higher in patients with peritonsillar abscess and lower in patients with retropharyngeal and parapharyngeal infections. Admissions have significantly increased from 2011. There was a seasonal variation for DNI incidence, with a peak incidence in Summer and Spring. All patients included were treated as inpatient and received empirical intravenous antibiotic therapy and steroids regardless of drainage procedures. Incision and drainage was performed in 72 patients. The hospital length of stay was higher among patients with retropharyngeal abscess and in the group with complications. Only 2 patients developed complications during hospital stay. The most common microbiological pattern was monomicrobial and the most commonly isolated pathogens were Streptococcus Pyogenes, Streptococcus Mitis and anaerobic bacteria.ConclusionsSurgical incision and drainage followed by intravenous antibiotic and steroids proved to be successfull with low morbidity related to surgical approach. However, in selected cases, medical therapy may be an alternative to surgical management in uncomplicated infections.

Infrahyoid involvement may be a high-risk factor in the management of non-odontogenic deep neck infection: Retrospective study

ObjectivesThis study sought to investigate the impact of involvement of the infrahyoid neck space on the management of non-odontogenic DNI. MethodEighty-one patients treated for non-odontogenic DNI over 5 years were retrospectively recruited into this study. Demographics, etiology, radiology results, treatments, duration/cost of hospital stay, and complications were recorded. Differences between DNIs with and without infrahyoid involvement, as defined based on an anatomical chart, were analyzed. ResultsSixty-two male and 19 female patients with a median age of 46.22 years were included. Fifteen patients had cellulitis, and 66 patients had abscesses. Streptococcus was the most commonly observed bacterium. Compared with DNIs only in suprahyoid spaces (n = 60, 74.07%), DNIs with infrahyoid space involvement (n = 21, 25.93%) were associated with higher incidences of the involvement of ≥3 spaces (85.71%, P = 0.000), mediastinitis (38.10%, P = 0.000), tracheostomy (28.57%, P = 0.008), surgery using a transcervical approach (66.67%, P = 0.000), and intensive care unit therapy (19.05%, P = 0.004), as well as longer hospital stays (16 days, P = 0.000) and higher costs ($2872, P = 0.000). ConclusionInfrahyoid involvement should be regarded as a high-risk factor in the management of deep neck infection (DNI). A relatively aggressive plan that includes transcervical surgery and tracheostomy should be considered at earlier stages for DNI with infrahyoid involvement.

Less invasive management of deep neck infection and descending necrotizing mediastinitis: A single-center retrospective study.

By a 7-year retrospective review, we reported our experience in management of descending necrotizing mediastinitis (DNM) and deep neck infection (DNI). A retrospective design was used to reveal the clinical characteristics of DNI and DNM. The clinical outcome was analyzed to validate less invasive management. We reviewed 82 patients between 2009 and 2016, 12 of which were diagnosed as DNM by clinical and computed tomography findings. A total of 35 patients had relevant systemic conditions, mainly diabetes mellitus (19 patients). Most cases were secondary to oropharyngeal or dental infections. All patients underwent transcervical drainage, and 10 DNM patients were treated with additional closed thoracic drainage simultaneously. Twenty patients accepted more than 1 operation. Seven patients died as a result of sepsis and/or multiple organ failure. The mortality rate in our study was similar to that in other studies. In our opinion, less invasive therapies are useful to most patients. Transcervical drainage alone is optimal management for all DNI cases and some DNM cases. Additional closed thoracic drainage is enough for type I and IIA DNM with pleural effusion or empyema.

Deep neck infections: A single-center analysis of 63 cases.

Background and PurposeWith the use of antibiotic therapy, the incidence of deep neck infections has decreased in recent decades. The aim of this investigation was to review the clinical course and the management of deep neck infections in our department, compare them to the experiences of the common literature and identify predisposing factors for lethal complications.Material and MethodsIn this single-center analysis, 63 patients with deep neck infections were treated surgically. The following clinical data were analyzed and compared: age, gender, laboratory data, spatial manifestation, therapeutic modalities, comorbidities, length of hospitalization and complications.ResultsThere was a predominance of male patients (58.7%) and a mean age of 57.9 years. The most common symptoms at diagnosis were sore throat (96.8%) and neck swelling (92.0%). Cardio/pulmonary diseases and diabetes mellitus were the most common comorbidities. There was a significantly longer hospital stay for patients with diabetes mellitus. The most common manifestation was a parapharyngeal abscess in 24 patients (38.1%), followed by peri-/retrotonsillar infections in 19 patients (30.2%). In 29 patients, a multiple space infection was observed, with a significantly longer duration of hospitalization and a higher rate of complications. The main life-threatening complication was the development of airway obstruction in 20 patients (31.7%), who all received a tracheostomy. The duration of hospitalization for patients with complications was significantly longer.ConclusionsClose attention must be paid to the management of patients with deep neck infections, especially patients with diabetes mellitus and cardio/pulmonary diseases or patients with multiple space infections. Key words:Deep neck infections, comorbidities, surgical treatment, tracheostomy, diabetes mellitus.

Diagnosis and management of deep neck infections in children: the experience of an Italian paediatric centre.

Deep neck infection (DNI) is a severe occurrence in children. We've examined the presenting signs and symptoms, the value of single diagnostic procedures, the rate of complications and the impact of the therapeutic options on the final outcome, in children with a DNI. We retrospectively evaluated patients, aged 0-18 years, who were admitted for a DNI, from January 2006 through December 2012, at Regina Margherita Children's Hospital, Turin, Italy. We subdivided them on the basis of type of treatment: pharmacological treatment alone or antimicrobial treatment plus surgery. An univariate analysis has been performed to examine the differences between the two groups. Sixty patients (32 males, 28 females) with diagnosis of DNI were enrolled; 33 children only received medical treatment (group 1), whereas 27 patients underwent also surgical interventions (group 2). The mean abscess size was significantly higher in group 2 than in group 1 (p = 0.01). The predominant organisms were Streptococcus sp. (11 cases, 52.4%, mostly Streptococcus pyogenes). The most frequent antibiotic regimen was a β lactam alone (either III generation cephalosporin or amoxicillin/clavulanate). The duration of intravenous antibiotic varied between the two groups, without statistical significance (p = 0.052); whereas the oral antibiotic administration was significantly shorter in group 1 than in group 2 (p = 0.0003). Three patients (5%) developed complications. This research confirms that the medical approach, with high doses of intravenous antibiotics for a minimum of 5 days, could be a tolerable and safe option for the treatment of patients with stable condition and/or small DNIs.

Deep Neck Infections. Assessment in 54 Pediatric Patients

Background and aims: To review and assess the epidemiology, clinical presentation, diagnosis and management of deep neck infections (DNI). Methods: During the last 14 years, 54 patients with DNI were seen in our Pediatric Dpt. Diagnosis was made on clinical and radiological grounds. Results: Overall 54 patients were diagnosed with DNI. In 39 patients abscesses were peritonsillar, 10 patients had parapharyngeal and 5 retropharyngeal abscesses. Mean ages were 9.3, 6.6 and 4.6 years old respectively. Thirty patients (55.6%) received antibiotic therapy prior their arrival at the hospital. The main clinical signs were: odynophagia (89%), pharynx asymmetry (80%), fever (71%) and dysphagia (69%). Uvular deviation, torticollis or trismus were observed in 1/3 of all patients. Neck computed tomography (CT) were done in 22 patients and in 20 of them (91%) abscesses were diagnosed. In 2/3 of the DNI cultures yielded positive results. Streptococci sp were isolated in 79% of cultures. All patients received intravenous antibiotics. 43 ( 80%) patients underwent surgery. Incision and needle aspiration in 16, drainage in 19 and 8 patients both techniques. 13 patients underwent tonsillectomy. Outcome was good in all without mortality. Recurrence occurred in 9 patients. Mean stay at the hospital was 5-8 days in peritonsillar, 12.9 days in parapharyngeal and 13.1 days in the retropharyngeal group. Conclusions: There were an increased incidence of pediatric DNI in the last years. Neck CT scans are most useful in the diagnosis. Most patients underwent surgical treatment. Recurrence and tonsillectomy rates are similar to other studies.

Rational Diagnostic and Therapeutic Management of Deep Neck Infections: Analysis of 233 Consecutive Cases

Rational Diagnostic and Therapeutic Management of Deep Neck Infections: Analysis of 233 Consecutive Cases

Rational Diagnostic and Therapeutic Management of Deep Neck Infections: Analysis of 233 Consecutive Cases

Although deep neck infections are less common nowadays because of the widespread use of antibiotics, they continue to carry significant morbidity and mortality rates. Between 2000 and 2008, deep neck infections were treated in 233 patients at the University of Padova. Cases of peritonsillar abscess, superficial infections, infections due to external neck injuries, and infections in head and neck tumors were excluded. Clinical, radiologic, laboratory, and microbiological assessments were analyzed. The site of origin was identified in 189 of the 233 cases (81.1%), and the most common cause of deep neck infection was dental infection (39.5%). Intravenous antibiotic therapy was given to 78 patients, and 155 required both medical and surgical procedures. The bacteria most often isolated were gram-positive anaerobic cocci. None of our patients died of the deep neck infection or its complications. It is worth emphasizing that airway support is the priority in patients with deep neck infections. Empirical antibiotic treatments must cover gram-positive and gram-negative aerobic and anaerobic pathogens. Surgical exploration and drainage may be mandatory in selected cases at presentation or in cases that fail to respond to parenteral antibiotics within the first 24 to 48 hours. It is important to perform cultures during operation to establish the pathogen(s) involved and to obtain an antibiogram to tailor the antibiotic treatment.

Management of deep neck infection by a transnasal approach: a case report

IntroductionDeep neck infection is a life-threatening condition, and intravenous antibiotic therapy is preferable in the early stages of the disease. However, in the advanced stages, surgical drainage should be performed. Although several surgical treatment strategies are available, it is necessary to standardize treatment according to the patient's general condition and history.Case presentationWe report the case of a 68-year-old man with a deep neck abscess and with severe diabetes mellitus and inflammation. Computed tomography identified a deep neck infection extending from the level of the epipharynx to that of the hyoid bone. We performed surgical drainage by transnasal endoscopy. The patient exhibited no evidence of either recurrent disease or post-surgical complications within 30 months of follow-up.ConclusionsThis case report provides evidence that transnasal endoscopic drainage should be recommended as a standard approach in patients with a deep neck abscess and with a severe general condition, diabetes mellitus, and inflammation.

頸部外切開を要した小児深頸部膿瘍例

Deep neck infection is a serious life-threatening infection that spreads in the spaces surrounded by the cervical fasciae. We report a case of deep neck infection in an infant. The patient was a 15-month-old boy who was brought to a nearby pediatrician with chief complaints of right neck tenderness and fever. Deep neck infection was diagnosed based on the results of computed tomography, cervical incision and tracheotomy was performed under general anesthesia and subsequent intravenous antibiotic administration was conducted after the operation. He recovered in about 2 weeks with the disappearance of deep neck abscess. In conclusion, early diagnosis and surgical drainage are important for the management of deep neck infection. For infants, we must consider abscess incision not only performed orally but also external cervical incision.

Deep neck infections in children: A case study and review of the literature

A case study of a 2-year-old patient that presents to an emergency department with a 1-day history of neck swelling is used to emphasize the importance of early identification and management of deep neck infections in children. Although rare, deep neck infections can lead to fatal complications if not identified and treated early. This article presents the case followed by a detailed discussion of the pathophysiology, microbiology, and management of children with deep neck infections.

Carotid artery occlusion in association with a retropharyngeal abscess

Deep neck space infections in children are not an uncommon presentation to an otolaryngologist and with appropriate antibiotic therapy, often in conjunction with surgical drainage, complications are rare. We report on a case of a 4-year boy who presented with a retropharyngeal abscess that was complicated by ipsilateral carotid artery and internal jugular vein compression. The patient was treated with intravenous broad-spectrum antibiotics and heparin. There were no subsequent neurological or vascular complications. An overview of the management of deep neck infections and their complications are discussed.

Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection

Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. Non-randomized retrospective study. Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the submandibular triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.