Infrahyoid spread of deep neck abscess: anatomical consideration

Abstract

The aim of this study was to determine the pathway of infrahyoid extension of the oropharyngeal abscess considering the anatomy of the fascial spaces by cross-sectional imaging. CT scans and MR images were retrospectively reviewed in ten patients with known infrahyoid extension of oropharyngeal abscesses (eight with acute tonsillitis, two with acute phlegmonous oropharyngitis). In seven of eight patients tonsillar abscesses descended along the deep cervical fascia converging on the hyoid bone and further accumulated in the anterior cervical space through which extension to the mediastinum took place in four patients. In seven patients the abscesses involved the retropharyngeal space at the infrahyoid neck. In two of these seven patients the abscesses directly extended down into the upper mediastinum through the retropharyngeal space. In one patients of the seven mediastinal spread of an abscess occurred through the posterior cervical space, not through the retropharyngeal space. Cross-sectional imaging is valuable in the evaluation of deep neck abscesses and the pathway of spread. The anterior cervical space in the infrahyoid neck is important for mediastinal extension of pharyngeal abscesses.

Prediction of deep neck abscesses by contrast‐enhanced computerized tomography in 76 clinically suspect consecutive patients

“…Extension of a deep neck abscess into multiple adjacent compartments was seen in almost one half of our patients, confirming the findings in the literature 1, 6. Most of deep neck abscesses have extended into adjacent compartments at the time of diagnosis as demonstrated by CECT.…”

“…Because of the compartmental anatomic structure of the neck, abscesses may spread from the primary locations (peritonsillar, dental focus, neck) into adjacent compartments (parapharyngeal space, retropharyngeal space, paralaryngeal space, masticator space) and/or descend into the mediastinum. Deep neck abscesses therefore represent an emergency that requires immediate diagnosis and treatment because the disease may lead to serious complications of airway compression, mediastinitis, empyema, pseudoaneurysm, and jugular vein thrombosis 3, 5, 6…”

Treatment and Prognosis of Deep Neck Infections

“…Cross-sectional imaging is valuable in the evaluation of abscess and the pathway of spread [1,8]. However, in many cases, a definite cause cannot be found.…”

Idiopathic Pretracheal Deep Neck Space Infection with Mediastinal Extension: A Series of 3 Cases and Review of the Literature

“…10 Direct spread from other deep neck spaces has also been described, albeit infrequently. 6,11 Clinically important infections not attributable to congenital lesions are exceedingly rare; sources include an underlying malignancy, hematogenous spread, and abscess formation secondary to an upper respiratory infection, including an epiglottic infection. [11][12][13] In our 3 patients, no history of trauma and no congenital abnormality were identified, and despite thorough investigations, the source of infection remained elusive.…”