Deep Neck Space Infections: Current Trends and Intricacies of Management?
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ORIGINAL ARTICLE
Deep Neck Space Infections: Current Trends and Intricacies of Management? Rohit Bhardwaj1 • Saurabh Makkar1 • Ankur Gupta1 • Kirti Khandelwal1 Karthika Nathan1 • Chirayata Basu1 • Gowtham Palaniyappan1
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Received: 23 August 2020 / Accepted: 21 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract This study aims to describe the current epidemiological and etiological trends for deep neck space infections (DNIs) with an objective to understand the intricacies of their management. In this retrospective analytical study records of 52 patients with DNIs were reviewed. Patients having superficial abscess, peritonsillar abscess and abscess due to trauma/surgical procedure were excluded. Various epidemiological and etiological parameters (Demography, site, presentation, etiology, association with co-morbidities, bacteriology) and management guidelines (need for surgical interventions for DNIs and airway management, hospital stay duration, treatment outcome and complications) were reviewed and analyzed. Study recorded preponderance of DNIs in males (male:female = 1.6:1) and in younger generation (50% of patients presenting in first 2 decades). Commonest etiology being odontogenic infections (38.46%) followed by URTIs and tonsillopharyngitis (19.23%). Submandibular space involvement was noted in 42.3% cases followed by parapharyngeal space involvement in 21.15%. Nearly 55% cases of submandibular space involvement were because of odontogenic causes. 69.23% culture specimens reported no growth. 61.53% patients were diagnosed with anaemia. Up to 80% required open surgical drainage. All received broad spectrum antibiotics as a starting regime. No severe complications were recorded. Understanding the current epidemiological and etiological trends can help in early and definitive diagnosis of DNIs. Empirical starting treatment regime including broad spectrum antibiotics (till sensitivity & Saurabh Makkar [email protected] 1
Department of Otorhinolaryngology and Head and Neck Surgery, VMMC and Safdarjung Hospital, New Delhi, India
pattern is availed) and maintaining low threshold for required surgical intervention are required to manage DNIs satisfactorily. Selected cases should be given conservative trials with close monitoring. Keywords Deep neck space infections (DNIs) Upper respiratory tract infections (URTIs) Submandibular space Parapharyngeal space Odontogenic Anaemia
Introduction Superficial and multilayered deep fascia of neck creates multiple potential spaces between the fascial planes in neck. Infectious involvement of these fascial planes leading to cellulitis or abscess formation is known as Deep Neck Space Infection (DNI) [1]. Fascial layers prevent this infection from involving important neck structures to some extent however infection can spread from one neck space to another easily travelling through these planes. DNIs are potentially life threatening but modern era experiences reduced mortality from deep neck infections [2, 3]. The reduction in mortality
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