Deep neck space infections: an upward trend and changing characteristics

Velhonoja, Jarno; Lääveri, Meira; Soukka, Tero; Irjala, Heikki; Kinnunen, Ilpo

doi:10.1007/s00405-019-05742-9

Cited by 101 publications

(103 citation statements)

References 41 publications

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“…These consisted mainly of throat and odontogenic infections, respectively. We found a smaller proportion of odontogenic infections than previous studies of deep neck infections (30%-50%) (12)(13)(14)(15). A likely explanation is that in addition to true deep neck infections, we found many throat infections that did extend to deep neck spaces (e.g.…”

Section: Discussioncontrasting

confidence: 71%

Emergency neck MRI: feasibility and diagnostic accuracy in cases of neck infection

et al. 2020

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Background Computed tomography (CT) has traditionally been the first-line imaging method in neck emergencies such as deep neck infections. Due to superior soft-tissue contrast, magnetic resonance imaging (MRI) may be an alternative to CT, also in emergency situations. Purpose To characterize the use of routine MRI in neck emergencies, with an emphasis on clinical feasibility and diagnostic accuracy in cases of neck infection. Material and Methods We conducted a retrospective cohort study of all primary neck MRI scans performed using a 3-T MRI device during a five-year follow-up period in a tertiary emergency radiology department. Imaging data were compared with final clinical diagnosis and surgical findings as reference standards. Results The search identified 461 primary neck MRI scans, of which 334 (72%) were performed on the basis of clinical suspicion of infection. Radiological evidence of infection was observed in 95% of these scans, and at least one abscess was detected in 229 cases (72% of confirmed infection). MRI had an overall technical success rate of 95% and had high positive predictive value for both infection (0.98) and detection of abscess (0.95). Conclusion We found that emergency neck MRI can be successfully performed on most patients, and that MRI detects neck infection with a high accuracy. These results suggest that MRI may be an alternative to CT as the first or only imaging modality in neck emergencies.

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Section: Discussioncontrasting

confidence: 71%

Emergency neck MRI: feasibility and diagnostic accuracy in cases of neck infection

et al. 2020

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“…DNSI usually occur in patients affected by multiple comorbidities; in par-ticular, diabetes may raise the risk of infection as a consequence of immunological alterations or secondary microangiopathy 2 . Dental and oropharyngeal infections are the most common source of DNSI 3,4 , even if in a fourth of cases a defined trigger cannot be found 5 . Submandibular (36.26%) and sublingual spaces (13%) are the most frequent localisations followed by the para-pharyngeal (12%) and retropharyngeal spaces (3%) 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Dental and oropharyngeal infections are the most common source of DNSI 3,4 , even if in a fourth of cases a defined trigger cannot be found 5 . Submandibular (36.26%) and sublingual spaces (13%) are the most frequent localisations followed by the para-pharyngeal (12%) and retropharyngeal spaces (3%) 5 . The isolated microbes in DNSIs reflect the normal flora of the upper respiratory and digestive tract, with a strong prevalence of Gram+ bacteria (Streptococcus viridans 41.5%, Staphylococcus aureus 20.7%) 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Submandibular (36.26%) and sublingual spaces (13%) are the most frequent localisations followed by the para-pharyngeal (12%) and retropharyngeal spaces (3%) 5 . The isolated microbes in DNSIs reflect the normal flora of the upper respiratory and digestive tract, with a strong prevalence of Gram+ bacteria (Streptococcus viridans 41.5%, Staphylococcus aureus 20.7%) 5 . The presence of Gram-germs (Pseudomonas aeruginosa 4.07%, Klebsiella pneumonia 1.48%) 6 is more frequently related to diabetic comorbidity 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Anaerobic bacteria (Prevotella 4%, Fusobacterium 5%) 7 have been demonstrated to play an important role in the development of cervical necrotising fasciitis (CNF) 7,8 due to the production of specific enzymes involved in the necrotising process 8 . Bacterial cultures can be polymicrobial in 20.8% 5 of cases and negative in 10.74% 6 of patients, probably due to the wide use of prehospitalisation antibiotic therapy or to technical difficulty in isolating anaerobic pathogens 9,10 . Especially when involving para-and retro-pharyngeal spaces, DNSI may extend by continuity and contiguity to the mediastinal and thoracic spaces.…”

Section: Introductionmentioning

confidence: 99%

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New laboratory predictive tools in deep neck space infections

Fiorella

Greco

Madami

et al. 2020

Acta Otorhinolaryngol Ital

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SUMMARY Introduction Deep neck space infections (DNSIs) are a group of infective suppurative diseases involving deep neck spaces and cervical fascia. Necrotising and septic evolutions are rare, but severe complications can dramatically affect the prognosis and should be promptly managed. Clinical examination often has low sensitivity, although instrumental diagnosis may delay te treatment. We investigated two laboratory tools, LRINEC (Laboratory Risk Indicator for the Necrotizing fasciitis) and NLR (neutrophil to lymphocyte ratio), in the expectation to find a rapidly available predictive indicator that may help in distinguishing necrotising complications and/or systemic septic involvement. Methods A retrospective observational cohort study was performed on 118 patients who had underwent surgical treatment for DNSIs at our Surgical Unit. LRINEC, NLR and the product LRINEC x NLR were calculated. Results Statistical analysis showed that these scores may have utility in rapidly predicting the risk of necrotising fasciitis and systemic involvement at an early diagnostic stage. Conclusions Further studies with a larger cohort may be necessary in order to increase the sensitivity and specificity.

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