A response to the letter to editor named “Diagnostic value of radiologic evaluation in deep neck space infections” by Marco Carifi.

Daya et al reported that the 21 patients with deep neck infection (DNI) who underwent surgery were found to have a sensitivity of 81% in detecting an abscess by computed tomographic (CT) scan but the specificity was 57%. However, their study was limited only retropharyngeal and parapharyngeal infections in children, whereas in our study, 173 patients (mostly adult) were reviewed, and retropharyngeal and parapharyngeal infections were consisted only 15.1% of patients . In my opinion, these 2 different works are not equivalent to make a reasonable comparison. Daya et al concluded that “CT scans are helpful in diagnosing and assessing the extent of these infections, but they are not always accurate in detecting an abscess. So, a decision to drain an abscess should therefore not be made based solely on the CT findings” . However, according to our results, contrast-enhanced CT (CCT) scan is highly sensitive (91%) and very useful to identify the extent of the DNI and distinguish cellulitis from abscesses . Ultrasonography cannot always identify small or deep abscess and cannot provide the specific anatomical information necessary for surgical intervention . Magnetic resonance imaging has similar prognostic value to CCT scanning, but it is more expensive and requires longer scanning time when compared with CCT, so that not commonly preferred in imaging DNI . In conclusion, developing imaging techniques have made the management of DNI better. Contrast-enhanced CT should be the part of the routine investigation in patients with DNI because clinical evidence and early radiologic diagnosis with CCT provide valuable information in defining the origin, location, and extension of neck infections . In addition, CCT helps to decide whether surgical intervention is indicated .

On the other hand, Wang et al showed that “a high C-reactive protein frequently tend to develop complications in patients affected with DNI and this information might complementary to CT findings in guiding towards the more appropriate treatment.” It is probably true but so far, we did not make such a study about C-reactive protein. Already, our study clearly indicated that there is a serious requirement for such a study because according to our results, neither fever nor leukocytosis are constant findings in deep neck infections .