Comparison of computed tomography and surgical findings in deep neck infections

Abstract

Computed tomography is routinely used in the evaluation of patients suspected to have deep neck infections. This 10-year retrospective study compares preoperative computed tomography scan reports with intraoperative findings in 38 patients who underwent surgical exploration of the parapharyngeal or retropharyngeal space within 48 hours of their radiographic assessment. Overall, intraoperative findings confirmed computed tomography scan interpretation in 76.3% of the patients. The false-positive rate was 13.2%, and the false-negative rate was 10.5%. The sensitivity of computed tomography scan for detection of parapharyngeal space or retropharyngeal space abscess was 87.9%. This study's documentation of false-positive computed tomography scans in the evaluation of deep neck infections emphasizes the importance of correlating radiologic interpretation with clinical examination before surgical intervention.

Deep Neck Infections: A Constant Challenge

“…The presence of an enhancing rim around a nonenhancing central density differentiates cellulitis from an abscess; however, CT is not always able to differentiate between abscess and cellulitis and so helps us in deciding whether surgical drainage is indicated. In one review, the reported sensitivity of CT for the detection of lateral pharyngeal space and retropharyngeal space abscess was 88% [11] . After 1997, CT was routinely used to confi rm clinically suspected DNIs.…”

Intravenous Antibiotic Therapy for Deep Neck Abscesses Defined by Computed Tomography

“…In differentiating deep neck abscesses from phlegmons, several large series have reported the false-positive rate to range from 8% to 25%. [7][8][9]21 Furthermore, Broughton 5 and Sichel et al 6 describe children who responded to treatment with intravenous antibiotics alone with significant CECT evidence of RAs defined by classic radiographic criteria of ring enhancement and large size. Many of the cases reported by Sichel and colleagues showed scalloped rim enhancement, thought by Kirse and Roberson 1 to be an important predictor of abscess formation.…”

Infecções dos espaços cervicais: estudo prospectivo de 57 casos

“…As infecções cervicais podem disseminar-se locoregionalmente através de diferentes vias como a hematogênica e a linfática, mas principalmente por extensão direta (contigüidade) dissecando por entre as fáscias, atingindo e envolvendo múltiplos espaços cervicais 7 .…”

“…Considerando as relações anatômicas entre os espaços e estruturas da face e a maior incidência de disseminação por extensão direta, é clássico o envolvimento de espaços específicos de acordo com o foco de origem da infecção 7 . As infecções odontogênicas acometem principalmente os espaços submandibular, submentoniano e sublingual e, posteriormente, o mastigatório e o parafaríngeo 8 .…”