Deep neck abscesses: the Singapore experience

Abstract

This study aims to review our experience with deep neck abscesses, identify key trends, and improve the management of this condition. This is a retrospective chart review of patients diagnosed with deep neck abscesses in the Department of ENT (Otorhinolaryngology) at Tan Tock Seng Hospital, Singapore between 2004 and 2009. Patient demographics, etiology, bacteriology, systemic disease, radiology, treatment, complications, duration of hospitalization, and outcomes were reviewed. 131 patients were included (64.9% male, 35.1% female) with a median age of 51.0 years. 54 (41.2%) patients had diabetes mellitus. The parapharyngeal space (23.7%) was the most commonly involved space. Odontogenic and upper airway infections were the leading causes of deep neck abscesses (28.0% each). Klebsiella pneumoniae (27.1%) was the most commonly cultured organism in this study and among the diabetic patients (50.0%). 108 (82.4%) patients underwent surgical drainage. 42 patients suffered complications. All 19 patients, who had upper airway obstruction, had either a tracheostomy or intubation. Patients with multi-space abscesses, diabetes mellitus, and complications had prolonged hospitalizations. Old age and diabetes are risk factors for developing deep neck abscesses and their sequelae. The empiric choice of antibiotics should recognize that a dental source is likely, and that Klebsiella is most common in diabetics. Surgical drainage and adequate antibiotic coverage remains the cornerstone of treatment of deep neck abscesses. Therapeutic needle aspiration may successfully replace surgical drainage, if the abscesses are small and no complications are imminent. Airway obstruction should be anticipated in multi-space and floor of mouth abscesses.

Pediatric Deep Neck Space Abscesses: A Prospective Observational Study

“…In our study the cause of infection remained unknown in maximum number of patients 40%, probably because deep neck space infections followed the inciting infection by a week or so, which is similar to reported studies who have found that the cause may be unknown in 42.7% and 50% of patients respectively [3,5]. The most common known causative factor was upper airway infection (tonsillitis, pharyngitis) in 23 patients followed by odontogenic focus in 10 patients.…”

“…in the West showed an equal distribution [3].We believe this male predominance is because of our traditional society where males are more fortunate than females in reaching Tertiary hospital for specialized management. Parents sometimes don't take efforts in taking female patients to tertiary setup which is usually far from villages.In our series duration of symptoms ranged from 8 hours to 15 days compared to other studies [13][14][15].…”

“…Despite the introduction of antibiotics, deep neck infections still occur.It remains an important condition as it may potentially lead to life-threatening complications, this is especially so when there is a delay in diagnosis and treatment in immunocompromised patients [3]. In pediatric patients, acute tonsillitis with involvement of the peritonsillar space is the most common cause of deep neck infections.…”

“…Paediatric deep neck infections require more intimate management because of their rapidly progressive nature. Management of paediatric deep neck abscesses involves high dose intravenous antibiotics and surgical drainage of abscess [3]. In the treatment of head and neck space infections in children, empiric antibiotic therapy must cover gram positive organisms, anaerobes, as well as gram negative, and beta-lactamase producing organisms.…”

“…If the size of the abscess is small and there are no imminent complications, a trial of conservative management may be attempted [3]. Securing the airways with tracheostomy or intubation is also necessary when upper airway obstruction occurs, as it is the most likely cause of fatality in this patient group [3].…”