Advertisement

European Archives of Oto-Rhino-Laryngology

, Volume 272, Issue 11, pp 3469–3474 | Cite as

Severe neck infections that require wide external drainage: clinical analysis of 17 consecutive cases

  • Tamás HorváthEmail author
  • Barnabás Horváth
  • Zsuzsa Varga
  • Bálint LiktorJr.
  • Hajnalka Szabadka
  • László Csákó
  • Bálint Liktor
Head and Neck

Abstract

Infections in the neck layers and spaces are potentially life-threatening diseases causing further complications, like mediastinitis, airway obstruction, or sepsis. Despite of the need for a conservative approach, they still regularly require surgical intervention. Records of 17 patients with severe neck infections that were treated by wide external incision and open wound management were retrospectively analyzed. The aim of the study was to clinically characterize these most serious neck infections. The most common presenting symptoms were neck pain and tense neck mass (94-94 %) regularly with fever (65 %), always accompanied by a marked elevation of C reactive protein level (average 192 uG/l). These findings were constant and very similar among both the deep neck infection and necrotizing fasciitis cases. More than half of the patients (53 %) had at least one systemic co-morbidity. The parapharyngeal space was most commonly affected (83 %), but extended disease involving more than two major neck regions was found in 13 cases (76 %). Dental (29 %) was the most common primary infection, followed by peritonsillar abscess (23 %), Microbiological results showed a wide variety of corresponding bacteria. Mediastinitis was developed in three cases (18 %), and airway obstruction requiring tracheostomy in two cases (12 %). All the patients survived. Severe neck infections are a heterogenous group of diseases regarding to the primary site of infection, microbiology, localisation and host reaction. However, rapidly developed, painful, tense neck mass with a highly elevated CRP level should always alert for an extended or phlegmonous process in the layers or spaces of the neck.

Keywords

Deep neck infection Necrotizing fasciitis External drainage Surgery 

Notes

Conflict of interest

Authors declare that they have no conflicts of interest.

References

  1. 1.
    Wills PI, Vernon RP Jr (1981) Complications of space infections of the head and neck. Laryngoscope 91(7):1129–1136CrossRefPubMedGoogle Scholar
  2. 2.
    Colmenero Ruiz C, Labajo AD, Yanez Vilas I, Paniagua J (1993) Thoracic complications of deeply situated serous neck infections. J Craniomaxillofac Surg 21(2):76–81CrossRefPubMedGoogle Scholar
  3. 3.
    Suehara AB, Goncalves AJ, Alcadipani FA, Kavabata NK, Menezes MB (2008) Deep neck infection: analysis of 80 cases. Braz J Otorhinolaryngol 74(2):253–259PubMedGoogle Scholar
  4. 4.
    Plaza Mayor G, Martinez-San Millan J, Martinez-Vidal A (2001) Is conservative treatment of deep neck space infections appropriate? Head Neck 23(2):126–133CrossRefPubMedGoogle Scholar
  5. 5.
    McClay JE, Murray AD, Booth T (2003) Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg 129(11):1207–1212CrossRefPubMedGoogle Scholar
  6. 6.
    Sethi DS, Stanley RE (1994) Deep neck abscesses—changing trends. J Laryngol Otol 108(2):138–143CrossRefPubMedGoogle Scholar
  7. 7.
    Celakovsky P, Kalfert D, Tucek L, Mejzlik J, Kotulek M, Vrbacky A, Matousek P, Stanikova L, Hoskova T, Pasz A (2014) Deep neck infections: risk factors for mediastinal extension. Eur Arch Otorhinolaryngol 271:1679–1683CrossRefPubMedGoogle Scholar
  8. 8.
    Walia IS, Borle RM, Mehendiratta D, Yadav AO (2014) Microbiology and antibiotic sensitivity of head and neck space infections of odontogenic origin. J Maxillofac Oral Surg 13(1):16–21PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Kinzer S, Pfeiffer J, Becker S, Ridder GJ (2009) Severe deep neck space infections and mediastinitis of odontogenic origin: clinical relevance and implications for diagnosis and treatment. Acta Otolaryngol 129(1):62–70CrossRefPubMedGoogle Scholar
  10. 10.
    Anaya DA, Dellinger EP (2006) Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 44(5):705–710Google Scholar
  11. 11.
    Lanisnik B, Cizmarevic B (2010) Necrotizing fasciitis of the head and neck: 34 cases of a single institution experience. Eur Arch Otorhinolaryngol 267:415–421CrossRefPubMedGoogle Scholar
  12. 12.
    Lalwani AK, Kaplan MJ (1991) Mediastinal and thoracic complications of necrotizing fasciitis of the head and neck. Head Neck 13(6):531–539CrossRefPubMedGoogle Scholar
  13. 13.
    Wong CH, Wang YS (2005) The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis 18(2):101–106CrossRefPubMedGoogle Scholar
  14. 14.
    Prasanna Kumar S, Ravikumar A, Somu L (2014) Fungal necrotizing fasciitis of the head and neck in 3 patients with uncontrolled diabetes. Ear Nose Throat J 93(3):E18–E21PubMedGoogle Scholar
  15. 15.
    Banerjee AR, Murty GE, Moir AA (1996) Cervical necrotizing fasciitis: a distinct clinicopathological entity? J Laryngol Otol 110(1):81–86CrossRefPubMedGoogle Scholar
  16. 16.
    Hsu RF, Wu PY, Ho CK (2011) Transcervical drainage for descending necrotizing mediastinitis may be sufficient. Otolaryngol Head Neck Surg 145(5):742–747CrossRefPubMedGoogle Scholar
  17. 17.
    Wang LF, Kuo WR, Tsai SM, Huang KJ (2003) Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol 24(2):111–117CrossRefPubMedGoogle Scholar
  18. 18.
    Santos Gorjon P, Blanco Perez P, Morales Martin AC, Pozo Del, de Dios JC, Estevez Alonso S, Calle de la Cabanillas MI (2012) Deep neck infection: review of 286 cases. Acta Otorrinolaringol Esp 63(1):31–41CrossRefPubMedGoogle Scholar
  19. 19.
    Kantu S, Har-El G (1997) Cervical necrotizing fasciitis. Ann Otol Rhinol Laryngol 106(11):965–970CrossRefPubMedGoogle Scholar
  20. 20.
    Chelsom J, Halstensen A, Haga T, Hoiby EA (1994) Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features. Lancet 344(8930):1111–1115CrossRefPubMedGoogle Scholar
  21. 21.
    Klug TE, Fisher AS, Antonsen C, Rusan M, Eskildsen H, Ovesen T (2014) Parapharyngeal abscess is frequently associated with concomittant peritonsillar abscess. Eur Arch Otorhinolaryngol 271(6):1701–1707CrossRefPubMedGoogle Scholar
  22. 22.
    Wang LF, Tai CF, Kuo WR, Chien CY (2010) Predisposing factors of complicated deep neck infections: 12-year experience at a single institution. J Otolaryngol Head Neck Surg 39(4):335–341PubMedGoogle Scholar
  23. 23.
    Clyne B, Olshaker JS (1999) The C-reactive protein. J Emerg Med 17(6):1019–1025CrossRefPubMedGoogle Scholar
  24. 24.
    Weber AL, Siciliano A (2000) CT and MR imaging evaluation of neck infections with clinical correlations. Radiol Clin North Am 38(5):941–968CrossRefPubMedGoogle Scholar
  25. 25.
    Rozovsky K, Hiller N, Koplewitz BZ, Simanovsky N (2010) Does CT have an additional diagnostic value over ultrasound in the evaluation of acute inflammatory neck masses in children? Eur Radiol 20:484–490CrossRefPubMedGoogle Scholar
  26. 26.
    Har-El G, Aroesty JH, Shaha A, Lucente FE (1994) Changing trends in deep neck abscess: a retrospective study of 110 patients. Oral Med Oral Pathol 77:446–450CrossRefGoogle Scholar
  27. 27.
    Skitarelic N, Mladina R, Morovic M, Skitarelic N (2003) Cervical necrotizing fasciitis: sources and outcomes. Infection 31(1):39–44CrossRefPubMedGoogle Scholar
  28. 28.
    Lee JK, Kim HD, Lim SC (2007) Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J 48(1):55–62PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Brook I (2012) Anaerobic bacteria in upper respiratory tract and head and neck infections: microbiology and treatment. Anaerobe 18(2):214–220CrossRefPubMedGoogle Scholar
  30. 30.
    Lee YQ, Kanagilingam J (2011) Bacteriology of deep neck abscesses: a retrospective review of 96 consecutive cases. Singapore Med J 52(5):351–355PubMedGoogle Scholar
  31. 31.
    Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS (2004) Deep neck infection: analysis of 185 cases. Head Neck 26(10):854–860CrossRefPubMedGoogle Scholar
  32. 32.
    Huang TT, Tseng FY, Liu TC, Hsu CJ, Chen YS (2005) Deep neck infection in diabetic patients: comparison of clinical picture and outcomes with nondiabetic patients. Otolaryngol Head Neck Surg 132(6):943–947CrossRefPubMedGoogle Scholar
  33. 33.
    Chen MK, Wen YS, Chang CC, Lee HS, Huang MT, Hsiao HC (2000) Deep neck infections in diabetic patients. Am J Otolaryngol 21(3):169–173CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Tamás Horváth
    • 1
    Email author
  • Barnabás Horváth
    • 1
  • Zsuzsa Varga
    • 1
  • Bálint LiktorJr.
    • 2
  • Hajnalka Szabadka
    • 1
  • László Csákó
    • 3
  • Bálint Liktor
    • 1
  1. 1.Department of Otolaryngology and Head and Neck SurgeryBajcsy-Zsilinszky HospitalBudapestHungary
  2. 2.Department of Otolaryngology and Head and Neck SurgeryCounty HospitalOberwartAustria
  3. 3.Department of Otolaryngology and Head and Neck SurgeryJahn Ferenc HospitalBudapestHungary

Personalised recommendations