Univariate and multivariate models for the prediction of life-threatening complications in 586 cases of deep neck space infections: retrospective multi-institutional study

2017 ◽  
Vol 131 (9) ◽  
pp. 779-784 ◽  
Author(s):  
J Mejzlik ◽  
P Celakovsky ◽  
L Tucek ◽  
M Kotulek ◽  
A Vrbacky ◽  
...  
Keyword(s):  
Bacterial Culture ◽  
Infection Type ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Retropharyngeal Space ◽  
Deep Neck Infection ◽  
Neck Movement ◽  
Neck Infection ◽  
Life Threatening ◽  
Deep Neck Infections

AbstractObjective:To identify deep neck infection factors related to life-threatening complications.Methods:This retrospective multi-institutional study comprised 586 patients treated for deep neck infections between 2002 and 2012. The statistical significance of variables associated with life-threatening complications of deep neck infections was assessed.Results:During treatment, life-threatening complications occurred in 60 out of 586 cases. On univariate analysis, life-threatening complications were linked to: dyspnoea, neck movement disturbance and dysphonia (all p < 0.001); and parapharyngeal, anterior visceral or pretracheal deep neck involvement (all p < 0.002). Aetiology was significantly linked to tonsils (p < 0.001). Regarding infection type, fasciitis was a significant factor (p < 0.001). Candida albicans was a significant bacterial culture (p < 0.001). A multivariate step-wise model disclosed fewer significant variables: retropharyngeal space (p = 0.005) and major blood vessels area (p = 0.006) involvement, and bacterial culture C albicans (p < 0.001).Conclusion:It can be predicted that patients with deep neck infections, with neck movement disturbances, dysphonia, dyspnoea and swelling of the external neck, accompanied by severe pain, and inflammatory changes in the retropharyngeal space and large vessel areas, with culture-confirmed infection of C albicans, are likely to develop life-threatening complications.

scholarly journals Surgical Management of Parapharyngeal Abscess

2012 ◽  
Vol 4 (3) ◽  
pp. 122-124 ◽  
Author(s):  
Jagadish Tubachi ◽  
Arsheed Hakeem ◽  
DC Pradeep ◽  
Puneeth Nayak
Keyword(s):  
Surgical Management ◽  
Deep Neck Infection ◽  
Surgical Drainage ◽  
Space Management ◽  
Neck Infection ◽  
Parapharyngeal Abscess ◽  
Life Threatening ◽  
Deep Neck Infections ◽  
Spread Of Infection ◽  
Extent Of Disease

ABSTRACT Parapharyngeal abscess is a life-threatening infection. It occurs due to spread of infection form anatomical locations in the vicinity of the space. Management of the deep neck infection is governed by the general condition of the patient, the extent of disease and patency of airway. In treatment of deep neck infections intensive antibiotic therapy and surgical drainage are complementary to each other. How to cite this article Tubachi J, Hakeem A, Pradeep DC, Nayak P. Surgical Management of Parapharyngeal Abscess. Int J Otorhinolaryngol Clin 2012;4(3):122-124.

A dangerous cause of airway obstruction: deep neck infection

2020 ◽  
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Deep Neck Infection ◽  
Jugular Vein Thrombosis ◽  
Neck Infection ◽  
Vein Thrombosis ◽  
Lethal Complications ◽  
Life Threatening ◽  
Fascial Spaces ◽  
Emergency Doctors

Deep neck infection (DNI) is an infection in the fascial spaces of the neck. Complications of DNI, including mediastinitis, internal jugular vein thrombosis, and upper airway obstruction, are severe and potentially life threatening. Therefore, early identification and accurate management of DNI are essential. We review the anatomy of the deep spaces of the neck to determine the route of DNI spread so that emergency doctors, physicians, and otorhinolaryngologists can quickly recognize the development of lethal complications of DNI, such as asphyxia from airway obstruction.

scholarly journals Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 29
Author(s):  
Chia-Ying Ho ◽  
Yu-Chien Wang ◽  
Shy-Chyi Chin ◽  
Shih-Lung Chen
Keyword(s):  
Risk Factors ◽  
Airway Obstruction ◽  
Parapharyngeal Space ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Deep Neck Infection ◽  
Acute Epiglottitis ◽  
Neck Infection ◽  
Submandibular Space ◽  
Independent Risk Factors

Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. A total of 502 subjects with DNI were enrolled in the study between June 2016 and August 2021. Among these patients, 30 had concurrent DNI and AE. The relevant clinical variables were assessed. In a univariate analysis, involvement of the parapharyngeal space (OR = 21.50, 95% CI: 2.905–158.7, p < 0.001) and involvement of the submandibular space (OR = 2.064, 95% CI: 0.961–4.434, p < 0.001) were significant risk factors for concurrent DNI and AE. In a multivariate analysis, involvement of the parapharyngeal space (OR = 23.69, 95% CI: 3.187–175.4, p = 0.002) and involvement of the submandibular space (OR = 2.465, 95% CI: 1.131–5.375, p < 0.023) were independent risk factors for patients with concurrent DNI and AE. There were no differences in pathogens, therapeutic managements (tracheostomy, intubation, surgical drainage), or hospital staying period between the 30 patients with concurrent DNI and AE and the 472 patients with DNI alone (all p > 0.05). However, we believe it is significant that DNI and AE are concurrent because both DNI and AE potentially cause airway obstruction, and concurrence of these two diseases make airway protection more difficult. The infections in critical spaces may cause the coincidence of these two diseases. Involvement of the parapharyngeal space and involvement of the submandibular space were independent risk factors associated with concurrent DNI and AE. There were no differences in pathogens between the concurrent DNI and AE group and the DNI alone group.

scholarly journals Deep Neck Infection and Descending Mediastinitis as a Complication ofPropionibacterium acnesOdontogenic Infection

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Evgeni Brotfain ◽  
Leonid Koyfman ◽  
Lisa Saidel-Odes ◽  
Abraham Borer ◽  
Yael Refaely ◽  
...  
Keyword(s):  
Propionibacterium Acnes ◽  
Interesting Case ◽  
Deep Neck Infection ◽  
Positive Bacterium ◽  
Gram Positive ◽  
Neck Infection ◽  
Deep Neck Infections ◽  
Descending Mediastinitis

Propionibacterium acnesis an anaerobic, Gram-positive bacterium which causes numerous types of infections. IsolatedPropionibacterium acnesdeep neck infections are very rare. We present an interesting case of deep neck infection complicated by descending mediastinitis of isolatedPropionibacterium acnesinfection.

scholarly journals Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection

2004 ◽  
Vol 122 (6) ◽  
pp. 259-263 ◽  
Author(s):  
Agricio Nubiato Crespo ◽  
Carlos Takahiro Chone ◽  
Adriano Santana Fonseca ◽  
Maria Carolina Montenegro ◽  
Rodrigo Pereira ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Evaluation ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Clinical Findings ◽  
Deep Neck Infection ◽  
Disease Extent ◽  
Neck Infection ◽  
Increased Temperature ◽  
Deep Neck Infections

CONTEXT: Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. OBJECTIVE: To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. TYPE OF STUDY: Non-randomized retrospective study. SETTING: Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. METHODS: Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. RESULTS: The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the submandibular triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. DISCUSSION: The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. CONCLUSIONS: The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.

scholarly journals The Result of Treatment of Deep Neck Infection in Patients Referred According to Public Health System

2019 ◽  
Vol 99 (10) ◽  
pp. 627-632
Author(s):  
Chuan Cheepcharoenrat
Keyword(s):  
Public Health ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Deep Neck Infection ◽  
Neck Infection ◽  
Public Health Systems ◽  
Results Of Treatment ◽  
Appropriate Treatment ◽  
Treatment Morbidity ◽  
The Cost

There are many factors that result in the treatment of deep neck infection (DNI). This study aims to compare the results of DNI treatment between referred and walk-in patients. This retrospective cohort study reviewed the data of 282 DNI patients. The peritonsillar abscesses and limited intraoral abscesses were excluded. The outcome of treatment such as duration of hospital stay, the expense of treatment, morbidity, and mortality were reviewed during staying in the hospital. A total of 282 patients were included in this study, there were 152 referred patients and 130 walk-in patients. Patients who were sent to have treatment results were not significantly different from those who had come directly to the hospital regardless of the length of stay, the cost of medical treatment, complications, and death due to complications with sepsis ( P = .013). However, the referred patients exhibited a risk to have sepsis 1.1 times more than the patients who went straight to the medical specialists (univariate analysis risk ratio [RR]: 1.1, 95% confidence interval [CI]: 0.8-1.3; P = .620). The results were confirmed in the multivariate analysis after adjusting for age, gender, diabetes, chronic renal failure, cirrhosis, and dental care. It was found that the risk to have sepsis in the “refer in” group was 1.1 times more than the other group (multivariate analysis RR: 1.1, 95% CI: 0.8-1.3; P = .658). In conclusion, the results of treatment in referred patients were not different from walk-in patients. Deep neck infection patients at hospitals that do not have a specialized doctor will receive appropriate treatment because of the effective DNI referral system according to public health systems. However, in referred patients, sepsis should be maintained prior to delivery.

Deep neck infection in diabetic patients: Comparison of clinical picture and outcomes with nondiabetic patients

2005 ◽  
Vol 132 (6) ◽  
pp. 943-947 ◽  
Author(s):  
Tung-Tsun Huang ◽  
Fen-Yu Tseng ◽  
Tien-Chen Liu ◽  
Chuan-Jen Hsu ◽  
Yuh-Shyang Chen
Keyword(s):  
Diabetes Mellitus ◽  
Hospital Stay ◽  
Clinical Picture ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Deep Neck Infection ◽  
Neck Infection ◽  
Duration Of Hospital Stay ◽  
Patients With Diabetes ◽  
Deep Neck Infections

OBJECTIVE: To compare the difference in the clinical picture and outcomes between diabetic and nondiabetic patients with deep neck infections. STUDY DESIGN AND SETTING: We retrospectively reviewed the records of patients who were diagnosed with deep neck infections and who received treatment at the Department of Otolaryngology of National Taiwan University Hospital between 1997 and 2002. One hundred eighty-five patients were included in our study. Fifty-six patients with diabetes mellitus were enrolled for further analysis (diabetic group) and compared with the other 129 patients without diabetes mellitus (nondiabetic group) in demography, etiology, bacteriology, treatment, duration of hospital stay, complications, and outcome. RESULTS: The parapharyngeal space was the space most commonly involved in both the diabetic (33.9%) and nondiabetic groups (40.3%). Odontogenic infections and upper airway infections were the 2 leading causes of deep neck infection in diabetic and nondiabetic groups. Streptococcus viridans is the most commonly isolated organism in the nondiabetic group (43.7%). However, the most common organism in the diabetic group was Klebsiella pneumoniae (56.1%). There were 89.3% of diabetic patients, versus 71.3% of nondiabetic patients, with abscess formation ( P = 0.0136). Surgical drainage was performed more frequently in the diabetic group than in the nondiabetic group (86.0% versus 65.2%, P = 0.0142). In comparison with the nondiabetic group, the diabetic group tended to have older mean age (57.2 y versus 46.2 y, P = 0.0007), longer duration of hospital stay (19.7 days versus 10.2 days, P >0.0001), more frequent complications (33.9% versus 8.5%, P >0.0001), and more frequent tracheostomy or intubation (19.6% versus 6.2%, P = 0.0123). CONCLUSIONS: Patients with diabetes mellitus are susceptible to deep neck infection. We should pay more attention when dealing with deep neck infections in patients with diabetes mellitus because those patients tend to have complications more frequently and a longer duration of hospital stay. Empirical antibiotics should cover K. pneumoniae in patients with deep neck infection who have diabetes mellitus.

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

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1536
Author(s):  
Shih-Lung Chen ◽  
Chi-Kuang Young ◽  
Tsung-You Tsai ◽  
Huei-Tzu Chien ◽  
Chung-Jan Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Clinical Findings ◽  
Older Age ◽  
Retropharyngeal Space ◽  
Deep Neck Infection ◽  
Neck Infection ◽  
Factors Associated ◽  
Streptococcus Constellatus ◽  
Common Pathogen

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.

Deep neck cellulitis: a challenging diagnosis

2020 ◽  
Vol 13 (12) ◽  
pp. e236415
Author(s):  
Ana Isabel Gonçalves ◽  
Ditza Vilhena ◽  
Delfim Duarte ◽  
Nuno Trigueiros
Keyword(s):  
Soft Tissues ◽  
Deep Neck Infection ◽  
Central Nervous System Infections ◽  
C Reactive Protein ◽  
Intense Pain ◽  
Neck Infection ◽  
Reactive Protein ◽  
Deep Neck Infections ◽  
T2 Hyperintensity ◽  
High Degree

A 38-year-old woman with Crohn’s disease, under immunosuppressive therapy, was referred to the emergency department for severe progressive neck pain and fever, with 1 week of evolution. She was unable to perform neck mobilisation due to the intense pain aroused. She referred dysphagia. Oral cavity, oropharynx, hypopharynx and larynx showed no alterations. She had an increased C reactive protein. Central nervous system infections were excluded by lumbar puncture. CT was normal. Only MRI showed T2 hyperintensity of the retropharyngeal and prevertebral soft tissues of the neck without signs of abscess. The patient was treated with broad spectrum antibiotics. Complications of deep neck infection include abscess formation, venous thrombosis and mediastinitis. In this case, no complications occurred. A high degree of clinical suspicion is essential as deep neck infections need to be promptly diagnosed and treated given their rapidly progressive character, especially in immunocompromised patients.

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