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

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

Abscess Complications Computed tomography Deep neck infections Diagnosis Treatment 

References

  1. 1.
    Daramola OO, Flanagan CE, Maisel RH et al (2009) Diagnosis and treatment of deep neck space abscesses. Otolaryngol Head Neck Surg 141:123–130PubMedCrossRefGoogle Scholar
  2. 2.
    Reynolds SC, Chow AW (2007) Life-threatening infections of the peripharyngeal and deep fascial spaces of the head and neck. Infect Dis Clin North Am 21:557–576PubMedCrossRefGoogle Scholar
  3. 3.
    Brook I (2004) Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 62:1545–1550PubMedCrossRefGoogle Scholar
  4. 4.
    Levitt GW (1970) Cervical fascia and deep neck infections. Laryngoscope 80:409–435PubMedGoogle Scholar
  5. 5.
    Lin HT, Tsai CS, Chen YL et al (2006) Influence of diabetes mellitus on deep neck infection. J Laryngol Otol 120:650–654PubMedGoogle Scholar
  6. 6.
    Boscolo-Rizzo P, Da Mosto MC (2009) Submandibular space infection: a potentially lethal infection. Int J Infect Dis 13:327–333PubMedCrossRefGoogle Scholar
  7. 7.
    Brook I (2007) The role of anaerobic bacteria in upper respiratory tract and other head and neck infections. Curr Infect Dis Rep 9:208–217PubMedCrossRefGoogle Scholar
  8. 8.
    Leibovici L, Yehezkelli Y, Porter A (1996) Influence of diabetes mellitus and glycaemic control on the characteristics and outcome of common infections. Diabetic Med 13:457–463PubMedCrossRefGoogle Scholar
  9. 9.
    Slovenkai MP (1998) Foot problems in diabetes. Med Clin North Am 82:949–971PubMedCrossRefGoogle Scholar
  10. 10.
    Lassmann B, Gustafson DR, Wood CM et al (2007) Reemergence of anaerobic bacteremia. Clin Infect Dis 44:895–900PubMedCrossRefGoogle Scholar
  11. 11.
    Brook I (2010) β-Lactamase-producing bacteria in upper respiratory tract infections. Curr Infect Dis Rep 12:110–117PubMedCrossRefGoogle Scholar
  12. 12.
    Moran GJ, Krishnadasan A, Gorwitz RJ et al (2006) Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 355:666–674PubMedCrossRefGoogle Scholar
  13. 13.
    Popovich KJ, Weinstein RA, Hota B (2008) Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 46:787–794PubMedCrossRefGoogle Scholar
  14. 14.
    Nagy M, Backstrom J (1999) Comparison of the sensitivity of lateral neck radiographs and computed tomography scanning in pediatric deep-neck infections. Laryngoscope 109:775–779PubMedCrossRefGoogle Scholar
  15. 15.
    Boscolo-Rizzo P, Marchiori C, Zanetti F et al (2006) Conservative management of deep neck abscesses in adults: the importance of CECT findings. Otolaryngol Head Neck Surg 135:894–899PubMedCrossRefGoogle Scholar
  16. 16.
    Elden LM, Grundfast KM, Vezina G (2001) Accuracy and usefulness of radiographic assessment of cervical neck infections in children. J Otolaryngol 30:82–89PubMedCrossRefGoogle Scholar
  17. 17.
    Wang LF, Tai CF, Kuo WR et al (2010) Predisposing factors of complicated deep neck infections: 12-year experience at a single institution. J Otolaryngol Head Neck Surg 39:335–341PubMedGoogle Scholar
  18. 18.
    Smith JL, Hsu JM, Chang J (2006) Predicting deep neck space abscess using computed tomography. Am J Otolaryngol 27:244–247PubMedCrossRefGoogle Scholar
  19. 19.
    Kirse DJ, Roberson DW (2001) Surgical management of retropharyngeal space infections in children. Laryngoscope 111:1413–1422PubMedCrossRefGoogle Scholar
  20. 20.
    Gahleitner A, Watzek G, Imhof H (2003) Dental CT: imaging technique, anatomy, and pathologic conditions of the jaws. Eur Radiol 13:366–376PubMedGoogle Scholar
  21. 21.
    Giyanani VL, Mirfakhraee M, Gerlock AJ et al (1985) Computed tomography of internal jugular thrombosis. J Comput Assist Tomogr 9:33–37Google Scholar
  22. 22.
    Ridder GJ, Maier W, Kinzer S et al (2010) Descending necrotizing mediastinitis: contemporary trends in etiology, diagnosis, management, and outcome. Ann Surg 251:528–534PubMedCrossRefGoogle Scholar
  23. 23.
    Allan AG (2004) Reluctance of anaesthetists to perform awake intubation. Anaesthesia 59:413PubMedCrossRefGoogle Scholar
  24. 24.
    Boyanova L, Kolarov R, Mitov I (2007) Antimicrobial resistance and the management of anaerobic infections. Expert Rev Anti Infect Ther 5:685–701PubMedCrossRefGoogle Scholar
  25. 25.
    Sichel JY, Dano I, Hocwald E et al (2002) Non surgical management of parapharyngeal space infections: a prospective study. Laryngoscope 112:906–910PubMedCrossRefGoogle Scholar
  26. 26.
    Boscolo Rizzo P, Scotton PG, Da Mosto MC et al (2003) Sindrome di Lemierre da Streptococcus constellatus. Caso clinico e rassegna della letteratura. Giorn It Mal Inf 9:167–170Google Scholar
  27. 27.
    Syed MI, Baring D, Addidle M et al (2007) Lemierre syndrome: two cases and a review. Laryngoscope 117:1605–1610PubMedCrossRefGoogle Scholar

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

Personalised recommendations