Factors Affecting the Necessity of Tracheostomy in Patients with Deep Neck Infection

Abstract

Deep neck infection (DNI) is a serious disease that can lead to airway obstruction, and some patients require a tracheostomy to protect the airway instead of intubation. However, no previous study has explored risk factors associated with the need for a tracheostomy in patients with DNI. This article investigates the risk factors for the need for tracheostomy in patients with DNI. Between September 2016 and February 2020, 403 subjects with DNI were enrolled. Clinical findings and critical deep neck spaces associated with a need for tracheostomy in patients with DNI were assessed. In univariate and multivariate analysis, older age (≥65 years old) (OR = 2.450, 95% CI: 1.163-5.161, p = 0.018), multiple spaces involved (≥3 spaces) (OR = 4.490, 95% CI: 2.153-9.360, p = 0.001), and the presence of mediastinitis (OR = 14.800, 95% CI: 5.097-42.972, p < 0.001) were independent risk factors associated with tracheostomy in patients with DNI. Among the 44 patients with DNI that required tracheostomy, ≥50% of patients had involvement of the parapharyngeal or retropharyngeal space (72.72% and 50.00%, respectively). Streptococcus constellatus (25.00%) was the most common pathogen in patients with DNI who required tracheostomy. In conclusion, requiring a tracheostomy was associated with a severe clinical presentation of DNI. Older age (≥65 years old), multiple spaces (≥3 spaces), and presence of mediastinitis were significant risk factors associated with tracheostomy in patients with DNI. The parapharyngeal and retropharyngeal spaces were the most commonly involved, and Streptococcus constellatus was the most common pathogen in the patients with DNI that required tracheostomy.

Keywords: Streptococcus constellatus; deep neck infection; parapharyngeal space; retropharyngeal space; tracheostomy.

Figure 1

A patient with deep neck infection and mediastinitis with conduction of tracheostomy; micro-abscess (arrowhead) and gas (arrow) formation was noted. Sternum notch (asterisk).

Figure 2

The axial view of CT from a patient with multiple deep neck spaces involved. There were abscess formations in retropharyngeal space, parapharyngneal space, submandibular space, and parotid space. (R: retropharyngeal space; P: parapharyngeal space; S: submandibular space; Pa: parotid space).