Deep Neck Space Infection

55 Deep Neck Space Infection

55.1 Sites

• Retropharynx

• Parapharyngeal

• Anterior deep neck

55.2 Anatomy

• Fascial layers:

figure Fascial compartments are potential spaces between fascial planes

figure Superficial and deep layers

figure Deep,* divided into:

– Superficial: investing

– Middle: visceral

– Deep: prevertebral, alar

• Spaces

figure See Table 55.1

* All 3 contribute to carotid sheath

55.3 Retropharyngeal Abscess (Fig. 55.1)

• 2nd most common neck abscess in children (peritonsillar abscess/quinsy most common)

• Retropharyngeal lymph nodes atrophy with age

• Aetiology:

figure Suppurative adenoiditis

figure Trauma

figure Vertebral osteomyelitis

• Presentation:

figure Pyrexia*

figure Neck pain*

figure Airway obstruction

figure Drooling

figure Torticollis

figure Age of presentation is typically 6 months to 6 years (mean 3–5 years)

• Management:

figure Airway is the priority

figure Transoral aspiration/drainage if abscess medial to great vessels unless other neck spaces involved

figure Specimen pus urgent Gram stain and culture and sensitivity and abscess wall

figure Intravenous antibiotics (discuss with microbiology common regimes include: clindamycin/piperacillin or penicillin/gentamicin + metronidazole) ± steroids

* Most common

55.4 Anterior Deep Neck

• Ludwig angina; floor of mouth cellulitis

• Anatomy

figure

Fig. 55.1 Retropharyngeal abscess.

figure

figure Submandibular space extends from hyoid to mandible divided by mylohyoid muscle

figure Sublingual space superior to muscle

figure Submaxillary space inferior

• Features

figure Mouth pain

figure Drooling

figure Dysphagia

figure Neck pain

figure Swelling in floor of mouth

figure Superior tongue displacement

• Aetiology

figure 80% dental—typically lower 3rd molar

figure 20% soft tissue/tonsil infection

• Management

figure Airway is priority consider HDU for observation

figure Timely surgical intervention with appropriate IV ABx

figure Surgical drainage

– Sublingual space only—intra-oral

– Submaxillary space—external

55.5 Parapharyngeal Abscess

• Anatomy

figure Parapharyngeal space 2 compartments: pre- (anterior) and post-styloid

figure Communicates anterior with submaxillary space via buccopharyngeal gap created by styloglossus

figure Communicates posteriorly with the retropharyngeal and danger spaces

• Presentation

figure Airway obstruction—stridor/stertor

figure Pain

figure Dysphagia/dysphonia

figure Trismus (20%)

figure Snoring/OSA

figure Neck swelling/fullness/increasing erythema

• Aetiology

figure Tonsillitis (particularly immunocompromised) (Fig. 55.2)

figure Dental

figure IV drug abusers

figure Epiglottitis

figure Parotitis

figure Foreign body

figure Branchial cleft cysts (if recur)

figure Extension from petrous apex/mastoid tip (Citelli abscess)

• Treatment

figure Ensure airway stable, may need tracheostomy

figure May require ICU admission

figure Preop CT scan for surgical planning (if airway stable), and cardiothoracic referral if mediastinum involved

figure Incision guided by imaging and clinical examination

figure Urgent microbiology inc. Gram stain and culture

figure Multiple neck spaces may need opening, finger dissection useful at breaking down loculations and entering planes

figure

Related posts:

  1. Ciliary Motility Disorders
  2. Facial Flaps, Scars, and Keloids
  3. Olfactory and Gustatory Disorders
  4. Tumours of the Ear and Skin

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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Deep Neck Space Infection

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