2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Reprinted by permission of Eur Arch Otorhinolaryngol. 2012; 269(4):1241-1249.

Eur Arch Otorhinolaryngol (2012) 269:1241–1249 DOI 10.1007/s00405-011-1761-1

HEAD AND NECK

Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment

Paolo Boscolo-Rizzo • Marco Stellin • Enrico Muzzi • Monica Mantovani • Roberto Fuson • Valentina Lupato • Franco Trabalzini • Maria Cristina Da Mosto

Received: 2 May 2011 / Accepted: 26 August 2011 / Published online: 14 September 2011 Springer-Verlag 2011

Abstract The aims of this investigation were to review the clinical behavior of deep neck infections (DNIs) treated in our institution in order to identify the predisposing factors of life-threatening complications and propose valuable recommendations for management and treatment. A total of 365 adult patients with DNIs were retrospec- tively identified. One-hundred and thirty-nine patients (38.1%) underwent surgical drainage. Overall, 226 patients (61.9%) responded effectively to intravenous antimicrobial therapy only. There were 67 patients (18.4%) developing life-threatening complications. Diabetes mellitus (odd ratio 5.43; P \ 0.001) and multiple deep neck spaces involve- ment (odd ratio 4.92; P \ 0.001) were the strongest inde- pendent predictors of complications. The mortality rate was 0.3%. Airway obstruction and descending mediastinitis are

the most troublesome complications of DNIs. In selected patients, a trial of intravenous antibiotic therapy associated with an intensive computed tomography-based wait-and- watch policy may avoid an unnecessary surgical procedure. However, about one-fourth of patients present significant comorbidities, which may negatively affect the course of the infection. In these cases and in patients with large or multiple spaces infections, a more aggressive surgical strategy is mandatory.

Keywords Abscess Complications Computed tomography Deep neck infections Diagnosis Treatment

Introduction

The deep neck spaces are regions of loose connective tissue filling the areas between the three layers of deep cervical fascia. Deep neck infections (DNIs) are suppurative infections that develop within deep neck spaces. Deep neck infections usually starts as cellulitis in the soft tissues adjacent to the source of upper aero-digestive tract infection: if left untreated and depending on the vir- ulence of the causative pathogen, the infection will even- tually lead to an abscess and spread along cervical into to the mediastinum [ 1 ]. The insidious evolution of this pathology still represents an open problem. An unsuspecting physician may under- estimate an initially localized infection, which could shortly present as airway collapse or descending mediastinitis. In most of cases, the source of the infection is a peri- apical infection, involving the mandibular second or third molar teeth, or an acute follicular tonsillitis [ 2 , 3 ]. The microbiology of DNIs reflects the normal endogenous

P. Boscolo-Rizzo M. Stellin R. Fuson V. Lupato M. C. Da Mosto Department of Medical and Surgical Specialities, University of Padua, School of Medicine, Padua, Italy

P. Boscolo-Rizzo M. Stellin M. Mantovani R. Fuson V. Lupato M. C. Da Mosto

Regional Center for Head and Neck Cancer, University of Padua, School of Medicine, Treviso Regional Hospital, Treviso, Italy P. Boscolo-Rizzo ( & ) Viale Umbria 6, 30019 Chioggia, Italy e-mail: paolo.boscolorizzo@unipd.it

E. Muzzi Otorhinolaryngology Unit, University Hospital S. Maria della Misericordia, Udine, Italy F. Trabalzini Department of Sense Organs, Otology and Skull Base Surgery Unit, Siena University Hospital, Siena, Italy

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