European Archives of Oto-Rhino-Laryngology

, Volume 269, Issue 4, pp 1241–1249

Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment

  • Paolo Boscolo-Rizzo
  • Marco Stellin
  • Enrico Muzzi
  • Monica Mantovani
  • Roberto Fuson
  • Valentina Lupato
  • Franco Trabalzini
  • Maria Cristina Da Mosto
Head and Neck

DOI: 10.1007/s00405-011-1761-1

Cite this article as:
Boscolo-Rizzo, P., Stellin, M., Muzzi, E. et al. Eur Arch Otorhinolaryngol (2012) 269: 1241. doi:10.1007/s00405-011-1761-1

Abstract

The aims of this investigation were to review the clinical behavior of deep neck infections (DNIs) treated in our institution in order to identify the predisposing factors of life-threatening complications and propose valuable recommendations for management and treatment. A total of 365 adult patients with DNIs were retrospectively identified. One-hundred and thirty-nine patients (38.1%) underwent surgical drainage. Overall, 226 patients (61.9%) responded effectively to intravenous antimicrobial therapy only. There were 67 patients (18.4%) developing life-threatening complications. Diabetes mellitus (odd ratio 5.43; P < 0.001) and multiple deep neck spaces involvement (odd ratio 4.92; P < 0.001) were the strongest independent predictors of complications. The mortality rate was 0.3%. Airway obstruction and descending mediastinitis are the most troublesome complications of DNIs. In selected patients, a trial of intravenous antibiotic therapy associated with an intensive computed tomography-based wait-and-watch policy may avoid an unnecessary surgical procedure. However, about one-fourth of patients present significant comorbidities, which may negatively affect the course of the infection. In these cases and in patients with large or multiple spaces infections, a more aggressive surgical strategy is mandatory.

Keywords

AbscessComplicationsComputed tomographyDeep neck infectionsDiagnosisTreatment

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Paolo Boscolo-Rizzo
    • 1
    • 2
    • 5
  • Marco Stellin
    • 1
    • 2
  • Enrico Muzzi
    • 3
  • Monica Mantovani
    • 2
  • Roberto Fuson
    • 1
    • 2
  • Valentina Lupato
    • 1
    • 2
  • Franco Trabalzini
    • 4
  • Maria Cristina Da Mosto
    • 1
    • 2
  1. 1.Department of Medical and Surgical SpecialitiesUniversity of Padua, School of MedicinePaduaItaly
  2. 2.Regional Center for Head and Neck CancerUniversity of Padua, School of Medicine, Treviso Regional HospitalTrevisoItaly
  3. 3.Otorhinolaryngology Unit, University Hospital S. Maria della MisericordiaUdineItaly
  4. 4.Department of Sense Organs, Otology and Skull Base Surgery UnitSiena University HospitalSienaItaly
  5. 5.ChioggiaItaly