Deep Neck Infections

Excerpt

Deep neck infections are serious but treatable infections that affect the deep cervical spaces. These infections can rapidly progress and lead to life-threatening complications, making them a significant health concern with notable morbidity and potential mortality. Deep neck infections commonly arise from local extensions of infections in the tonsils, parotid glands, cervical lymph nodes, and odontogenic structures. Symptoms often result from local pressure effects on the respiratory, nervous, or gastrointestinal tracts, including neck swelling, dysphagia, dysphonia, and trismus.

Understanding the pathophysiology of these infections requires knowledge of the cervical compartments and interfacial spaces. Additionally, host factors such as immunocompromised states, comorbid conditions, trauma, recent instrumentation, and intravenous drug use can influence the spread and severity of infections. Clinical presentations vary depending on the deep neck space involved (e.g., parapharyngeal, retropharyngeal, prevertebral, submental, masticator) and the extent of infection, often involving fever, neck pain, and respiratory distress. Diagnosis can be challenging due to the deep location of abscesses, making imaging techniques like computed tomography (CT) with contrast essential for accurate detection.

Management includes empiric antimicrobial therapy tailored to the expected microbiology, local resistance patterns, and surgical drainage for significant abscesses. Ensuring airway security is paramount, especially in patients with submandibular or odontogenic infections and those exhibiting airway symptoms. Surgical consultation is recommended for persistent infections despite antibiotic treatment.