Deep neck space infections remain a surgical challenge. a study of 72 patients

Stalfors, Joacim; Adielsson, Anna; Ebenfelt, Anders; Nethander, Gunnar; Westin, Thomas

doi:10.1080/00016480410017864

Cited by 57 publications

(55 citation statements)

References 11 publications

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“…Life-threatening complications attributable to DNIs, such as upper airway obstruction, mediastinitis, internal jugular thrombosis, carotid artery erosion and sepsis, still occur despite improvement in diagnostic imaging and in medical therapy [1,2,5,7,10] . In this series, 18.6% of patients developed a potentially lethal complication.…”

Section: Discussionmentioning

confidence: 99%

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Deep Neck Infections: A Constant Challenge

Boscolo‐Rizzo¹,

Marchiori²,

Montolli³

et al. 2006

ORL

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Background: Although the advent of antibiotics and improved dental care decreased the incidence and mortality, deep neck infections (DNIs) are not uncommon and present a challenging problem due to the complex anatomy and potentially lethal complications that may arise. Objectives: This study reviews our experience with DNIs and tries to identify the predisposing factors of life-threatening complications. Methods: A retrospective review was conducted of patients who were diagnosed as having DNIs in the Department of Otolaryngology and in the Department of Infectious Diseases at Treviso Regional Hospital from 1995 to 2003. Associations between life-threatening complications and other factors were determined by χ² test, Fisher’s exact test and Student’s t test as appropriate. Results: One hundred sixty-seven charts were recorded; 95 (56.9%) were men, and 72 (43.1%) were women, with a mean age of 49.6 ± 20.4 years (range: 2–96). There were 39 patients (23.4%) who had associated systemic diseases, with 53.8% (21/39) of those having diabetes mellitus. The lateral pharyngeal and submandibular spaces were the most commonly involved spaces. Upper airway infections and odontogenic infections were the two most common causes of DNIs (47.5 and 27.9% of the known causes, respectively). The pathogenesis remained unknown in 45 patients (26.9%). Coagulase-negative staphylococcus (36.9%) and Streptococcusviridans (28.8%) were the most common organisms, identified through cultures. Of the abscess group (77 patients), 42 patients (54.5%) underwent surgical drainage under general anesthesia. Thirty-one patients (18.6%) developed life-threatening complications: airway obstruction (n = 18), descending mediastinitis (n = 6), jugular vein thrombosis (n = 4), and pneumonia (n = 3). Compared with other patients, the unique features of patients with life-threatening complications were as follows: older age (p = 0.04), a higher white blood cell count (p = 0.01), abscess formation (p = 0.02), associated systemic disease (p < 0.001), diabetes mellitus (p < 0.001), anterior visceral space involvement (p < 0.001), and multiple-space involvement (p < 0.001). Conclusions: DNIs continue to occur and these are associated with significant morbidity and mortality even in this era of antibiotics. Furthermore, the widespread and inappropriate use of antibiotics may change the clinical presentation and course of these infections, making them more elusive and less predictable also in complicated cases. The clinical assessment of patients who are older, with abscess formation, underlying systemic diseases, diabetes mellitus, visceral anterior space or multiple-space involvement requires careful consideration of potential complications.

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Section: Discussionmentioning

confidence: 99%

“…The critical contributions of contrast-enhanced studies are the identifi cation of an abscess, the delineation of involved spaces and the diagnosis of complications, allowing a more accurate planning of the surgical approach [9,10] . Both CT and MRI provide high-resolution images of head and neck compartments.…”

Section: Discussionmentioning

confidence: 99%

Deep Neck Infections: A Constant Challenge

Boscolo‐Rizzo¹,

Marchiori²,

Montolli³

et al. 2006

ORL

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“…This differed in comparison with various studies, [9,11,18,19] among which sub Mandibular space was the most commonly involved space. This can be explained by the fact that the most common etiological factor was foreign body upper aero-digestive tract which would contribute to the retropharyngeal space involvement.…”

Section: Spaces Involvedmentioning

confidence: 73%

“…[17] Clinical Features According to most of the recent studies, pain and swelling of the neck are the most prevalent symptoms. [2,15,16,18,19,20] In this study, pain was the most common presenting complaint, which was followed by dysphagia and neck swelling. Presenting complaints varied according to the space involved.…”

Section: Co Morbiditiesmentioning

confidence: 99%

Clinical Profile of Deep Neck Space Infections in a Tertiary Care Hospital in Kerala

Santhosh¹,

Yadev²,

Arun³

et al. 2017

jemds

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BACKGROUNDDeep Neck Infection (DNI) is a potentially life threatening disease commonly seen in middle aged men. Associated co-morbidities like Diabetes Mellitus, Hypertension and Cardiac diseases result in life threatening complications. DNI are observed in the population who are addiction to drugs, smoking and alcoholism. DNI are associated with complications like mediastinitis, Pneumothorax, pericarditis, renal failure and multi organ failure. The present study is a prospective clinical profile study of DNIs treated in a Tertiary Care Hospital in Kerala. Aim-To describe the profile of aetiology, clinical features and outcomes of patients with DNIs.

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“…Therefore, high index of suspicion is suggested for prompt diagnosis. Epiglottitis, sialoadenitis and infected laryngocele have been implicated in the development of deep neck abscesses [13]. Calcific retropharyngeal tendinitis and RPA [14] have similar clinical features.…”

Section: Discussionmentioning

confidence: 99%

Giant Retropharyngeal Abscess in a Nigerian Adult Following Fish Bone Throat Injury

Amutta¹,

Aliyu²,

Abdullahi³

et al. 2013

IJOHNS

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Retropharyngeal abscess (RPA) is an uncommon disease entity that typically occurs in children under 5 years of age, which has the potential to cause upper airway obstruction. Upper respiratory tract infection is the most common predisposing factor to RPA in children while cervical spine tuberculosis and trauma are the major aetiological factors in the adult. We report a case of a 21-year-old Nigerian farmer with giant retropharyngeal abscess following fish bone throat injury causing life-threatening upper airway obstruction. The patient responded well to emergency tracheostomy, intraoral surgical drainage and empirical antibiotic therapy. We highlight the diagnostic and therapeutic challenges of managing such a patient.

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Deep neck space infections remain a surgical challenge. a study of 72 patients

Cited by 57 publications

References 11 publications

Deep Neck Infections: A Constant Challenge

Deep Neck Infections: A Constant Challenge

Clinical Profile of Deep Neck Space Infections in a Tertiary Care Hospital in Kerala

Giant Retropharyngeal Abscess in a Nigerian Adult Following Fish Bone Throat Injury

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