Parotid Space, a Different Space from Other Deep Neck Infection Spaces

Deep neck infections (DNIs) such as parotid abscesses are medical emergencies with a seemingly different etiology and treatment course from other DNIs. We sought to confirm this in the present retrospective population-based cohort study. Between August 2016 and January 2020, 412 patients with DNIs seen at a tertiary medical center were enrolled in this study. Infections of the parotid space were compared with those of other deep neck spaces, according to patient characteristics. All patients were divided into parotid space (PS; n = 91, 22.08%) and non-parotid space (NPS; n = 321, 77.92%) subgroups. We further divided the patients into single parotid space (PS-single; n = 50, 12.13%), single non-parotid space (NPS-single; n = 149, 36.16%), multiple parotid space (PS-multiple; n = 41, 9.95%), and multiple non-parotid space (NPS-multiple; n = 172, 41.76%) DNI subgroups. In the PS-single and PS-multiple subgroups, a longer duration of symptoms (p = 0.001), lower white blood cell count (p = 0.001), lower C-reactive protein level (p = 0.010), higher rate of ultrasonography-guided drainage (p < 0.001), and lower rates of surgical incision and drainage (p < 0.001) were observed compared with the NPS-single and NPS-multiple subgroups. The PS group had a higher positive Klebsiella pneumoniae culture rate (p < 0.001), and lower positive Streptococcus constellatus (p = 0.002), and Streptococcus anginosus (p = 0.025) culture rates than the NPS group. In a multivariate analysis, K. pneumoniae was independently associated with parotoid space involvement in comparisons of the PS and NPS groups, PS-single and NPS-single subgroups, and PS-multiple and NPS-multiple subgroups. The clinical presentation of a parotid space infection differs from that of other deep neck space infections.

Deep neck space infections in Adolescents

Adolescent deep neck space infection is an important pathology that often requires hospitalization for antimicrobial therapy. The aim of the study was to identify the inciting organisms and their resistance profiles in the adolescent population of patients with deep neck space infection. We performed a single-center cross-sectional retrospective analysis of patients between 10 and 16 years of age, with deep neck space infections. From the 319 cases of deep neck space infections that presented over the study period, nine patients met the criteria to be included in the study. The mean age being 11.8 years. The microbiology of the specimens revealed mainly Staphylococcus and Streptococcus species and in some patients microscopy and culture showed no predominant bacteria. There was an overall 86% resistance of organisms to penicillin and ampicillin but most organisms were sensitive to amoxicillin-clavulanic acid Deep neck space infections in adolescents can initially be managed with amoxicillin-clavulanic acid, source control and surgical drainage if required. Culture directed therapy can be initiated after microbiology results. The spaces involved are similar to adults with 44% of patients having deep neck abscess secondary odontogenic infection. The microbiology however is similar to that of children with Streptococcus and staphylococcus species being the most predominant.

Deep Space Neck Infections

Deep neck space infections are a common reason for otolaryngology consultation. The anatomic spaces and their relationships are complex, and inappropriately treated infections may pose life-threatening consequences. It is critical for the practicing otolaryngologist to understand the boundaries and contents of the fascial spaces, microbiology of involved organisms, clinical workup, indications for medical and surgical management, and potential complications. This review contains 15 figures, 3 tables and 25 references. Key Words: Nodes of Rouviere, Danger space, Ludwig’s angina, Lemierre syndrome, Cavernous sinus thrombosis, Necrotizing fasciitis, Bezold abscess

Deep neck space infections: comparison of outcomes between diabetic and non-diabetic patients

Background: The objective of the study was to study the clinical presentation, microbiological profile, treatment protocol of deep neck space infections in diabetics and non diabetics.Methods: This was a prospective study conducted on 76 patients (diabetics and non diabetics) admitted in the Department of Otorhinolaryngology, TD Medical college, Alappuzha over a period of 18 months from January 2012 to June 2013.Results: The age distribution was 15-75 years. Male to female ratio was 2:1. Fever, pain, neck swelling and odynophagia were the common symptoms with dyspnoea and chest pain indicative of complications. The most common etiology was odontogenic (68.4%) followed by tonsillopharyngeal infection and foreign bodies. No etiological factor was found in 34.2%. The commonest site was submandibular space (64.2%) followed by parapharyngeal space (26.6%). Abscess was present in majority needing surgical drainage. The most common organism isolated was streptococcus viridans (37.5%). Preponderance of klebsiella species was noted in diabetics. Streptococcus showed susceptibility to pencillin (83.33%), ampicillin (92%), cefotaxime (60.526%). Klebsiella showed susceptibility to gentamicin (42.3%) and ciprofloxacin (28.57%). The complication rate was more in diabetics (34.21%). Contrast enhanced CT was done in cases suspected to have complication. The mean hospital stay was longer in diabetics (19.6 days) than non diabetics (6.4 days).Conclusions: Deep neck space infection still remains life threatening if not heeded promptly. Senescence and diabetes demand surgical intervention and meticulous glycemic control to prevent complications. Judicious use of antimicrobials and timely radiological and surgical interventions have come a long way in the management and in providing a cure to this dreaded condition.

A COMPARATIVE STUDY OF DEEP NECK SPACE INFECTIONS (DNSI) IN DIABETIC VERSUS NON-DIABETIC PATIENTS: OUR EXPERIENCE IN A TERTIARY CARE CENTRE

Background:The term deep neck space infections (DNSIs) encompasses infections of several different areas of the neck formed by the potential spaces formed by different fascial layers of the neck. The etiology of DNSI include pharyngo-tonsillar infections (most commonly in children), odontogenic infections, sialolithiasis and sialadenitis, congenital anomalies like cysts and sinuses of the neck. Predisposing factors may include Extremes of age, Immunodeciency, Diabetes mellitus and Intravenous drug abuse. The microbiology of deep neck infections usually reveals mixed aerobic and anaerobic organisms, often with a predominance of oral ora. Both gram-positive and gram-negative organisms may be cultured. DNSI usually mandate early intervention on an urgent basis because of the risk of potentially fatal complications such as airway obstruction, mediastinitis and vascular complications. Airway assessment and intervention plays a pivotal role in the management of DNSI. Aims and Objectives: The present study aims to compare the clinical presentation, complications, treatment outcomes and microbiology of DNSIs in diabetic vs non-diabetic patient populations.The objective is to have a proper understanding of the disease so that a much organized treatment protocol can be established. 70 patients were enrolled for this comparative st Materials and Method: udy in Indoor wards of a Tertiary care centre. The study was conducted from January 2019 to December 2019 for 1year. Patients diagnosed with DNSI (by imaging studies) and admitted in ward of ENT and Head Neck Surgery were selected. Parapharyngeal Space was mos Results: t common involved space in both Diabetics (52.38%) and Non Diabetics (41.46%), followed by Submandibular Space. Most common organism in both groups was Klebsiella pnemoniae. Odontogenic infection and Upper airway infections were 2 leading causes of DNSI in both Diabetics and Non Diabetics in this study. The Diabetic groups affected had much older age with longer hospital stay and had more frequent complications than Non Diabetic group. Diabetics also needed more frequent tracheostomy (28.57%) than Non Diabetics (2.44%). Diabetic patients as a subgroup Conclusion: of DNSIs pose many unique problems including older age at presentation, involvement of multiple neck spaces, prolonged hospital stay and operative interventions. As these patients have higher rate of complications and poorer prognosis, early institution of therapy, strict glycemic control and operative interventions are more often required.

A clinical study of deep neck space infections

<p><strong>Background:</strong> Deep neck space infections are usually due to excessive growth of normal flora, mostly of polymicrobial in origin. Patients present acutely with complaints of, throat and neck pain, raised body temperature. The clinical presentation depends on the deep neck space affected.<strong></strong></p><p><strong>Methods:</strong> Current study was carried out in 25 patients who were diagnosed to have various deep neck infections</p><p><strong>Results:</strong> It was observed that the maximum number of cases were seen in the age group of 31-40 at 28%, followed by 21-30 age group at 20%, 16% each between 41-50 years and above 60 years. The male to female ratio is 1:0.78. The most common presenting complaints included fever (24 patients; 96%) and dysphagia (18 patients; 72%). 13 patients (52%) had associated systemic disease, 5 patients (20%) had history of diabetes mellitus and were on irregular treatment, 4 patients (16%) was on treatment for hypertensive. The most common infection was Ludwig’s angina seen in 13 patients (52%), followed by peritonsillar abscess 4 patients (16%). Out of 25 patients, 20 (80%) cases were treated successfully by incision and drainage. No growth was observed in 32% of the patients.</p><p><strong>Conclusions:</strong> Early diagnosis of deep neck space infection based on symptoms in susceptible patients is advisable to prevent complications and early recovery.</p>

Study on presentation and predisposing factors for pediatric deep neck space infection

<p class="abstract"><strong>Background:</strong> Aim were to study the clinical presentation and predisposing factors in children with deep neck space infections and to study the effective mode of management of pediatric deep neck space infections and its complications. </p><p class="abstract"><strong>Methods:</strong> This prospective study was done in a tertiary care hospital on 163 pediatric patients with deep neck space infections who were thoroughly examined to know the source of the infection. Ultrasonography of neck and Radiological investigations were done to determine the location and extent of the abscesses. All patients were started on empirical antibiotic therapy of amoxicillin and clavulanic acid and metronidazole. Patients with small abscess were blindly aspirated with wide bore needle, while incision and drainage were done for large abscess. The pus samples from both were sent for culture and sensitivity. Patients presenting with complications, underwent incision and drainage. Patients, who failed empirical antibiotic therapy and needle aspiration, then underwent incision and drainage. </p><p class="abstract"><strong>Results:</strong> The most common symptom and sign was neck swelling (85%). The next most common symptom was neck pain (70%). Most of the patients had unknown source of infection and others had history of recurrent sore throat, dental infections, acute cervical lymphadenopathy, parotitis and furuncle over neck. </p><p class="abstract"><strong>Conclusions:</strong> Deep neck space infections (DNI’s) in pediatric population constitutes of medical emergency as it could lead to life threatening complications in a short time. Though with changing times of new diagnostic and therapeutic tools have drastically reduced the incidence of complications.</p>