Neck Space Infections Research Articles

Retrospective Cohort Study on the Management of Diffuse Deep Neck Space Infections Using a Modified Submental Approach and Placement of Wound Vacuum

Diffuse deep neck space infection (DDNSI) is an emergent condition that requires efficient surgical and airway management. A novel surgical approach has been developed to enhance access and improve visualization of the involved deep neck spaces, which allows for better evaluation of the extent of tissue necrosis. This study will compare the treatment of DDNSI with traditional incision and drainage with drain placement (Conventional) versus the new incision and drainage design with the use of a wound vacuum (VAC). This retrospective cohort study was performed on DDNSI cases treated with the VAC versus Conventional techniques from July 2014 to September 2020 at Memorial Hermann Hospital by the oral and maxillofacial surgery service. To be categorized as a DDNSI, the patient had to demonstrate radiographic evidence of an infection bilaterally in a minimum of four spaces, such as bilateral submandibular, sublingual, and submental spaces. Primary predictor variable was treatment method for DDNSI, Conventional versus VAC. Primary outcome variables were hospital length of stay (LOS), number of washouts, and days of intubation. Covariates were age, sex, number of spaces involved, presence of necrotic tissues, comorbidities, and mortality. Appropriate uni- and bi-variate statistics were calculated. Statistical significance was set a P < .05. Fifty-one patients (17 female and 34 male) aged 18 to 65years were treated for DDNSI. Twenty-eight patients were treated using the VAC approach and 23 patients were treated with the conventional approach. The average LOS 8.3± 0.8days (P-value=.0001), number of days intubated 3± 0.3 (P-value=.0001), and number of required washouts 2± 0.2 (P-value=.004) were statistically lower in the VAC group compared to the Conventional group. There were significant improvements encountered with overall length of hospital stay, number of days intubated, and the number of required wash outs. There were significant differences in outcomes between patients with comorbidities when compared to those who had none.

Negative Pressure Wound Therapy in the Head and Neck: A Summary of Uses and Application Techniques.

Negative pressure wound therapy (NPWT) has had an expanded role in the management of complex wounds including its increasing use for complex wounds in the head and neck region. Challenges for use in the head and neck region include variations in surface topography and the proximity of sensitive mouth, nose, ear, eye, and tracheal openings. Despite these challenges, NPWT has been used in the head and neck immediately following free flap surgery, to prepare wounds for skin grafting or local flaps, to treat orocutaneous and pharyngocutaneous fistulas, to treat necrotizing and deep neck space infections, to temporize and palliate, and to treat chronic wounds with exposed bone and hardware among others. This review demonstrates the proven track record of successful uses of NPWT in the aforementioned scenarios, provides suggestions to improve efficacy, as well as an algorithm for use in certain clinical situations.

LEMIERRE'S SYNDROME: A REVIEW

Lemierre's syndrome is a rare and less commonly occurring clinical condition that generally relates to the septic thrombophlebitis of the Internal Jugular vein. Mostly the clinicians have forgotten about this due to less incidence, the most common bacteria causing infection are and Streptococci followed by styaphylococci and Klebsiella [1] . The major proportion of cases that come to light are due to deep neck space infections that ultimately leads to thrombotic involvement of IJV, accounts for for majority of the cases. The other causes include complications of chronic suppurative otitis media and thrombosis occurring in deep veins. Since the Internal Jugular Vein is involved the infection can also undergo hematogenous spread. The infection generally spreads to Spleen, Liver, Kidney, Heart and Brain. [3][4] Lemierre's syndrome can be diagnosed on the basis of clinical symptoms, multitude of blood series and Imaging. Since it is an infectious condition the treatment involves systemic antibiotic therapy and early administration of broad spectrum antibiotics in high dose become necessary for prevention of complications and systemic spread of infection. [3][4] We are presenting a case series of 5 cases over a period of six years from November 2015 to November 2021.

Hypoglossal Nerve Palsy Due to a Sublingual Space Abscess

We report an unusual case of a hypoglossal nerve palsy secondary to a sublingual space abscess in a previously fit and healthy 59-year-old man. The patient presented with fever, dysphagia, trismus, and a left-sided tongue and floor-of-mouth swelling with left hypoglossal nerve palsy. Computed tomography (CT) scan revealed a 3.5-cm abscess of the left sublingual space. The abscess drained spontaneously while awaiting surgery with resolution of symptoms. Urgent investigation with CT is recommended for every deep neck space infection. Hypoglossal nerve palsy is a rare sign that warrants further investigation to exclude malignancy.

Predictive value of serum interleukin-6 to determine surgical drainage of deep neck space infection in adults.

The aim of this study was to determine whether interleukin-6 (IL-6) could be used as a predictor for surgical drainage in deep neck space infection (DNSI). A retrospective study was conducted to analyze 69 adult patients newly diagnosed as DNSI from January 2017 to December 2021 at a single center. The patients were treated with either surgical drainage or not. The following clinical data including age, gender, maximum diameter of abscess (MDA), laboratory data, therapeutic modalities, comorbidities, duration of hospitalization and complications were collected and evaluated. Patients in drained group had significantly elevated MDA, IL-6, procalcitonin, C-reactive protein and neutrophil to lymphocyte ratio compared to patients in non-drained group (all P < 0.01). Significant predictors for surgical drainage were IL-6 and MDA as independent factors, with the optimum cutoff values of 52.5pg/mL and 14.4mm, respectively. Moreover, the IL-6 had a wider area under the curve than MDA for prediction of surgical drainage in DNSI. IL-6 as a promising predictor of the need for surgical drainage can be effectively used for routine assessment in the early stage of DNSI to determine the optimal treatments.

A Case Report on Anesthesia Management for a Patient with Deep Neck Space Infection (Retropharyngeal and Parapharyngeal Abscess)

A 44-year-old woman complained of neck swelling, discomfort, and swallowing difficulties. She was admitted to the hospital on an emergency basis for incision and drainage. Deep neck space infection was diagnosed using a neck X-ray, ultrasonography, and contrast enhanced computed tomography. The successful anesthetic management of this patient at the Pacific Institute of Medical Sciences in Udaipur is presented here.

Opioid-free total intravenous anesthesia for thyroid and parathyroid surgery: Protocol for a randomized, double-blind, controlled trial.

BackgroundOpioid-free anesthesia (OFA) may improve postoperative outcomes by reducing opioid-related adverse effects. This study aims to evaluate the effects of OFA on postoperative nausea and vomiting (PONV), postoperative pain, and 30-day outcomes after thyroid and parathyroid surgery.MethodsThis two-center, randomized, double-blind, controlled trial will include 400 adult patients scheduled for thyroid and parathyroid surgery. Patients will be randomly assigned, 1:1 and stratified by sex and site, to an OFA group (esketamine, lidocaine, and dexmedetomidine) or a control group (opioid-based anesthesia with sufentanil). All patients will receive propofol-based total intravenous anesthesia and PONV prophylaxis with dexamethasone and ondansetron. The primary outcome is the incidence of PONV (defined as experiencing any event of nausea, retching, or vomiting) during the first 48 h postoperatively. The secondary outcomes include the severity of PONV, antiemetic rescue therapy, pain scores at rest and while coughing, need for rescue analgesia, perioperative adverse effects related to anesthetics or analgesics (hypotension, bradycardia, hypertension, tachycardia, desaturation, dizziness, headache, hallucination, and nightmare), time to extubation, length of post-anesthesia care unit stay, length of postoperative hospital stay, patient satisfaction, and a composite of 30-day major adverse events (myocardial infarction, cardiac arrest, cerebrovascular accident, coma, acute renal failure, pulmonary embolism, sepsis, septic shock, deep neck space infection, reintubation, reoperation, blood transfusion, failure to wean off ventilator, and death). Analyses will be performed in the modified intention-to-treat population.DiscussionWe hypothesize that our OFA regimen reduces PONV after thyroid and parathyroid surgery. We will also investigate whether OFA leads to improvements in postoperative pain and major adverse events. Our results will offer evidence for optimizing anesthesia regimens in patients who undergo thyroid and parathyroid surgical procedures.Clinical trial registrationhttp://www.chictr.org.cn, identifier: ChiCTR2200059656.

394 The COVID-19 Pandemic's Impact on Deep Neck Space Infections: A Retrospective Cohort Study

Abstract Aim This study aimed to evaluate whether changes in practice and patient behaviour due to the covid-19 pandemic impacted the presentation, management, and outcomes of patients with deep neck space infections (DNSI). Method Retrospective cohort study including all adults presenting to the otolaryngology department at a tertiary UK centre with a DNSI during the first 12 months of the covid-19 pandemic (n = 27), and those from the previous 12-month period (n = 26). Patients with peritonsillar abscess which did not involve deep neck spaces radiologically were excluded. Results The covid-19 pandemic cohort tended to present later after onset of symptoms (5.96 days vs 3.25 days, p = 0.0277), have abscess formation rather than inflammation only (77.8% vs 34.6%, p &amp;lt; 0.01), and develop complications (33.3% vs 7.7%, p = 0.0394). Not reaching statistical significance, the covid-19 pandemic cohort also had larger volume abscess (25.18cm3 vs 14.5cm3, p = 0.291), longer hospital stays (14.48 days vs 6.35 days, p = 0.114), and longer intensive care stay (7.88 days vs 1.78 days, p = 0.0992). Non-significant changes were noted in management, with the covid-19 pandemic cohort being seven times more likely to undergo tracheostomy (25.9% vs 3.8%, p = 0.0504), and more likely to undergo trans-cervical drainage (37% vs 19.2%, p = 0.224) and hot tonsillectomy (11.1% vs 0%, p = 0.236). Conclusion This study demonstrates the covid-19 pandemic led to delayed presentation and more severe infection, requiring more radical management in patients with DNSI.

Observational Study of 100 Cases of Deep Neck Space Infection in a Tertiary Hospital of Central India

Observational Study of 100 Cases of Deep Neck Space Infection in a Tertiary Hospital of Central India

Asymptomatic idiopathic submandibular abscess — a diagnostic conundrum

BackgroundFacial and neck abscesses are often seen in patients. Usually, they are linked to a primary source of infection in orofacial, dental, or otolaryngeal region and are associated with the classic signs and symptoms of infection and inflammation. We came across a case of submandibular abscess whose behavior pattern defied the typical trends.Case presentationA completely asymptomatic boy reported with a huge swelling below the left-side lower jaw, extending onto the neck region. The history of swelling was acute with progressive nature since the last 5–6 days. His clinical examination and the laboratory investigations were quite routine without any deviation from usual. Despite exploring for all probable causes, authors could not find the definitive reason for such unusual presentation.ConclusionAlthough the patient was cured with conventional medical and surgical treatment for head and neck space infection, the pathophysiology of such asymptomatic and idiopathic abscess remained a diagnostic dilemma.

Complications and Management of Neck Space Infection

Background: Neck Space Infections are serious and common diseases that involve several spaces in the neck. Deep neck space infections can be life threatening in diabetic, immunocompromised and elderly patients and special attention should therefore be given to these groups.&#x0D; Objectives: This study was conducted to assess complications of deep neck space infections and its management, etiology, risk factors, presentation, spaces affected and complications among patients admitted in Department of ENT and Head- Neck Surgery in Dhaka Medical College &amp; Hospital.&#x0D; Methods: This was a Cross Sectional Study conducted in the ENT and Head- Neck Surgery Department, Dhaka Medical College &amp; Hospital from January 2016 to June 2016. A total of 150 patients were included who fulfill the selection criteria. Purposive sampling was used to collect data. Statistical analysis was done by SPSS version 21.&#x0D; Results: More than half of the patients (53.30%) came from middle class. Diabetes Mellitus was the most common risk factor (74.5%). Almost all patients presented with neck pain followed by neck swelling, dysphagia, fever and trismus. Organism isolated from drainage fluid was polymicrobial. Streptococcus (51.34%) and staphylococcus (18.60%) were most common organisms isolated. Airway was secured first and then high doses of antibiotics, immediate surgical drainage under local anesthesia were done in 130 (86%) patients. Commonly used antibiotics were ceftriaxone 132(82%), Metronidazole 113(75%) and flucloxacillin 98(65%). Complications were recorded in 55 patients. Most common was airway complication 40(73%). Tracheostomy was done in 17(11.33%) patients. Mortality occurred in 17(11.33%) patients.&#x0D; Conclusion: Early diagnosis and management is essential to prevent complications. Odontogenic infections, poor oral hygiene, lack of nutrition, smoking and tobacco chewing, DM were associated with neck space infection and we can prevent &amp; control those factors.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 56-61

Organism Growth and Antibiotic Treatment for Patients Diagnosed with Deep Neck Space Infection in Asir Central Hospital, Saudi Arabia, 2022

Background: Deep neck infections (DNIs) are characterized by inflammation in the deep spaces and fasciae of the head and neck, with or without pus. Parapharyngeal, infratemporal, pterygomaxillary, temporal, parotid, masticator, submandibular, visceral, carotid sheath, peritonsillar-pharyngeal mucosal, retropharyngeal, danger, and prevertebral spaces are the different types of DNIs. These infections are potentially fatal, and they spread quickly, causing serious problems. Even in recent research on DNSI cases, potentially life-threatening complications have been recorded at a rate of 10%–20%. Objective: The objective of this study was to identify the most common organisms causing DNIs in Asir Central Hospital (ACH), Saudi Arabia in addition to identifying the most common sensitive antibiotic using to treat DNIs in ACH. Results: Data were retrieved from the records of 108 patients with DNIs (67.6% males, 91.7% Saudis). These included 23 patients in the pediatric group (21.3%) and 85 patients (78.7%) in the adult group. The most common sites for neck abscesses in the whole sample included the submandibular abscess (46.3%). Two types of DNIs were predominating in the pediatric group, including submandibular abscess and anterior neck abscess (30.4% for each type), while submandibular neck abscess was the most common type in the adult group (50.6%). Regarding the previous onset of a recent infection, a total of 67 infections were reported in 63 patients. Upper respiratory tract infections represented the majority of infectious conditions (77.6%) followed by dental infections (22.4%). Among the whole sample, the most commonly isolated pathogen was Staphylococcus species (n = 14, 13.0%), of which 12 Staphylococcus aureus isolates were detected. The 25 isolates with positive cultural growth had undergone culture sensitivity analysis; these showed sensitivity to 89 antibiotics. Bacterial isolates were predominantly sensitive to vancomycin (n = 16, 18.0%), linezolid (n = 14, 15.7%), and ciprofloxacin (n = 13, 14.6%). Conclusion: DNIs in children feature different characteristics from those in adults regarding severity and preceding illness. However, the causative microorganisms and antibiotics sensitivity were similar. S. aureus and vancomycin were the most common bacteria and sensitive antibiotic, respectively.

Role of steroids in conservative treatment of parapharyngeal and retropharyngeal abscess in children

PurposeTo characterize the clinical features and outcomes of pediatric patients with retropharyngeal (RPA) or parapharyngeal abscesses (PPA) managed only with medical treatment and showing the importance of early symptoms and imaging studies in the diagnosis of deep neck space infections (DNIs) in children.MethodsA retrospective analysis of all patients diagnosed with RPA and PPA between 2007 and 2017 was performed in Hospital Universitario Central de Asturias.Results30 children were identified, with 11 RPA and 19 PPA. 23 children (76.7%) were under 5 years old, and all were treated with intravenous amoxicillin/clavulanic acid and corticosteroids. Torticollis and fever were present in all patients. The mean length of hospital stay was 7.5 days. There were no complications associated.ConclusionDNIs can be treated in a conservative way, reserving the surgical drainage for cases with a complication associated (airway compromise, lack of response to antibiotic therapy, immunocompromised patients). Treatment with intravenous antibiotics and corticosteroids is a safe option, reducing the duration of symptoms and the length of hospital stay.

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...

Need for tracheostomy in major head and neck ablative surgery: a paradigm shift during the COVID-19 pandemic.

Management of the airway in the perioperative period for patients requiring major head and neck ablative surgery has commonly included the performance of elective surgical tracheostomy. This has been standard practice in most maxillofacial units across the UK, including ours. However, the COVID-19 pandemic and emerging guidelines on aerosol-generating procedures required us to revisit the need for a perioperative tracheostomy. We present our series of 29 consecutive cases, cared for during the first wave of the COVID-19 pandemic, that were managed either using surgical tracheostomy or overnight tracheal intubation. Out of 29 patients 3 received a surgical tracheostomy. The average duration of tracheostomy use was 8 days. Twenty patients were managed using a period of overnight tracheal intubation. Average duration of tracheal intubation was 1.2 days, with an average intensive care unit stay of 1.7 days. The average duration of hospital stay was 15.8 days for patients managed with overnight tracheal intubation and 30.1 days for patients who received a surgical tracheostomy. The return to theatre rate was 13.8% for reasons including flap failure and neck space infection. There were no airway issues reported in this series of patients. Our findings suggest that overnight tracheal intubation can be a safe alternative to surgical tracheostomy in the majority of cases.

Characteristics and patterns of adult and pediatric deep neck space infection in a tertiary care institute

BackgroundDeep neck space infections are a serious but treatable group of infections affecting the fascial planes of the neck. The objective of this study is to determine various etiological causes, common sites, bacteriology, and complications in adult and pediatric patients suffering from deep neck space infections.ResultsWe studied 80 patients retrospectively who were admitted and treated for deep neck space infections in the otolaryngology department in a tertiary care institute over 2 years between March 2019 and March 2021. The study cohort was divided into two major age groups; 20 patients belonged to the pediatric group, while 60 patients belonged to the adult group. In this study, odontogenic infection was the most common etiological factor, Ludwig’s angina and submandibular space abscess were the common sites of presentation. Methicillin-resistant Staphylococcus aureus was the most common isolated microorganism. Septicemia was the most common complication developed after drainage of deep neck space infections.ConclusionIn the wake of an increase in the prevalence of deep neck space infections, close attention must be paid to the management of patients with deep neck space infections to prevent the complications.

Retropharyngeal abscess: A rare complication of nasogastric tube insertion

Pediatric deep neck space abscesses are increasing in incidence, most children presenting with deep neck space abscesses respond to medical and/or surgical management, including intravenous antibiotics and surgical incision and drainage. However, despite adequate treatment, some patients may develop complications. Complications of pediatric deep neck space infections can be severe. Such complications include mediastinitis, internal jugular vein thrombosis, carotid artery aneurysm or rupture, and airway obstruction.

Antibiotic Resistance Pattern in Pediatric Deep Neck Space Infection.

Introduction Neck space infection in the pediatric age group is common but can be life-threatening if not diagnosed properly. Since it is a polymicrobial disease, antibiotic usage should be guided by culture sensitivity pattern. Objectives To assess the microbiology, antibiotic resistance pattern and the outcome of the medical and surgical management of deep neck space infection in children. Methods This was a prospective study of children admitted for management of neck space infection from August 2017 to August 2018. The age, gender, organisms isolated, sensitivity and resistance to antibiotics, length of hospital stay, complications, and recurrence were noted. The descriptive data were analyzed. Results Out of 108 cases, there were 51 males (47.2%) and 57 females (52.8%) ranging from 1 month to 15 years, with a mean age of 5.32 +/- 4.35 years. The mean period of hospitalization was 6.98 days. Staphylococcus aureus was the most common organism isolated with less coagulase-negative staphylococci and streptococci. Clindamycin was the most sensitive drug (82.35%) followed by vancomycin and cloxcillin, while amoxicillin/ampicillin, a commonly used drug, was the least sensitive (20.58%). The abscess recurrence rate was 9.28%. The outcomes of either medical treatment or a combined medical or surgical treatment in properly selected cases were comparable. Conclusion Clindamycin or cloxacillin can be used as a first-line option for neck infection in children. Ampicillin/amoxicillin alone has a small role in neck abscess because of high resistance to this type of antibiotic.

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

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.

Cervicofacial necrotizing fasciitis after topical application of herbal medicine

Cervical necrotizing fasciitis represents an aggressive form of deep neck space infection with a high mortality rate. The origin is generally odontogenic, in most cases, resulting from a dental abscess. A series of three cases developed after local application of herbal medicine in patients with no co-morbidities and with a history of a toothache in the lower quadrants for >2 weeks is presented. All patients were managed with antibiotics, extraction of offending tooth and serial wound debridement. Two patients recovered with a resultant skin defect on the neck and one died due to multiple organ failure. This case series demonstrated that early diagnosis, prompt surgical intervention and appropriate medical treatment are very important to increase patient survival. Late report to hospital because of financial constraints and over-reliance on herbal preparation could lead to the development of serious complication in patients with dental infections and could even lead to death of the patient.