Clinico-Pathological Profile of Deep Neck Space Infection: A Prospective Study

Abstract

Deep neck space infections (DNI) has been a common and serious disease, involving several spaces created by planes of greater and lesser resistance between the fascial layers of the neck. Infection of deep neck space has been dangerous due to its potential ease of spread from one space to other space, associated sepsis and upper airway obstruction. This prospective study was done in 45 patients of DNI over a period of 1 year. Patients with age of 1 month to 80 years of both the sexes were included. Patient's particular, clinical presentation and associated co-morbid conditions, physical examination, routine laboratory investigations and radiological investigations were analyzed. Patients were treated, response to the treatment was assessed and follow-up was done. In present study, DNI was more commonly seen in rural population (67%) with a male predominance (69%). Mean age of presentation was 34.4 years. Odontogenic infection (64.11%) was the commonest etiological factor and diabetes mellitus (26.66%) was the commonest co-morbid condition. Most common presenting symptom was neck pain and neck swelling (91.1%) and submandibular space (66.6%) was the most commonly involved space followed by sublingual space (44.6%). Both medical and surgical treatment was needed in most of the cases (77.77%). 77.7% cases showed complete regression, 15.5% showed partial regression and they lost to follow-up, 4.4% expired and 2.2% showed progressive deterioration. DNI is a common and life-threatening disease. Early diagnosis and management is necessary for complete cure and to prevent complications associated with DNIs.

Keywords: Deep neck space; Deep neck space infection; Odontogenic infection; Submandibular space; Upper airway obstruction.

Fig. 1

a Details of age distribution. b Distribution of occupation in cases of DNI. c Details of etiological association. d Details of bacteriological association in cases of DNI

Fig. 2

a CT scan of a patient showing hypointense area left parapharyngeal space (arrow). b CT scan of a patient showing hypointense areas in bilateral parapharyngeal spaces (arrow) and retropharyngeal space (curved arrow). c CT scan of a patient showing hypointense area in anterior visceral spaces (arrow). d CT scan of a patient showing hypointense area in retropharyngeal space (arrow). e USG of a patient showing involvement of parotid space with fluid collection. f USG of a patient showing involvement of carotid space with thrombosis of internal jugular vein

Fig. 3

a Clinical photograph of patient-A showing diffuse swelling of lower half of the face (more over right) and submandibular region. b CT scan of patient-A showing hypointense areas in right masticator space (curved arrow) and bilateral submandibular space (arrow). c Clinical photograph of the same patient (patient-A) after recovery. d Clinical photograph of patient-B showing diffuse swelling of lower half of the face (more over right). e CT scan of patient-B showing hypointense areas in bilateral masticator spaces (curved arrow). Pus collection can also be seen in the right masticator space. f Clinical photograph of the same patient (patient-B) after recovery