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

Eur Arch Otorhinolaryngol (2012) 269:1241–1249

Fig. 3 Necrotizing descending mediastinitis: histological section showing agglomerates of neutrophil cells and bacteria ( Streptococcus oralis ) in a contest of muscular necrosis

Fig. 1 CECT findings of a deep neck spaces abscess with left jugular vein trombosis

Fig. 4 CECT findings of a deep neck space abscess descending in the mediastinum

intubation in cooperative patients and enabling the sur- geon to explore an anatomically distorted upper aerodi- gestive tract [ 23 ]. On the basis of the above considerations, empirical antibiotic therapy with a combination of a penicillin plus a beta-lactamase inhibitor (amoxicillin/clavulanate, ticarcil- lin/clavulanate, piperacillin/tazobactam), cefoxitin, carba- penem, or clindamycin should provide sufficient coverage for both anaerobic and aerobic bacteria. Metronidazole has excellent activity only against strict anaerobic bacteria and therefore is poorly effective as a single-agent in DNIs [ 7 ].

Fig. 2 Angio-MRI showing the absence of venous drainage from the left internal jugular vein

diffuse gangrenous cellulitis of the submandibular and sublingual spaces (Fig. 5 ). In these patients, who are not rarely diabetic, conventional endotracheal intubation and tracheotomy under general anesthesia may be made even more difficult by morbid obesity. In our experience, fiberoptic guided awake endotracheal intubation is an appropriate procedure both allowing a safe and atraumatic

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