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===Antibiotic Therapy===
===Antibiotic Therapy===
In light of the polymicrobial and rapidly progressive nature of deep neck infection, patients should receive timely empiric treatment with broad-spectrum intravenous antibiotics covering [[Gram-positive cocci]] and [[Gram-negative bacilli]], with or without [[anaerobe]]s. The choice of antibiotic regimen should be tailored based on clinical scenario, host immune status, and local antibiogram data.  In immunocompromised state or nosocomial setting, [[pseudomonal]] coverage should be considered, with additional [[anaerobic]] coverage in fulminant odontogenic deep neck infections.  Antimicrobial therapy should be deescalated as culture and susceptibility results permit.<ref>{{cite book | last = Flint | first = Paul | title = Cummings otolaryngology head & neck surgery | publisher = Mosby/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0323052832 }}</ref><ref>{{Cite journal| doi = 10.1016/j.otc.2008.01.002| issn = 0030-6665| volume = 41| issue = 3| pages = 459–483, vii| last1 = Vieira| first1 = Francisco| last2 = Allen| first2 = Shawn M.| last3 = Stocks| first3 = Rose Mary S.| last4 = Thompson| first4 = Jerome W.| title = Deep neck infection| journal = Otolaryngologic Clinics of North America| date = 2008-06| pmid = 18435993}}</ref>


{{rx|Community-Acquired Deep Neck Infection}}
*'''Deep neck infection'''
* [[Ampicillin-Sulbactam]] 1.5–3.0 g IV q6h {{or}} [[Clindamycin]] 600–900 mg IV q8h {{or}} [[Moxifloxacin]] 400 mg daily (if ''[[Eikenella]]'' is suspected)
:*'''1. Empiric antimicrobial therapy'''<ref>{{cite book | last = Flint | first = Paul | title = Cummings otolaryngology head & neck surgery | publisher = Mosby/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0323052832 }}</ref><ref>{{Cite journal| doi = 10.1016/j.otc.2008.01.002| issn = 0030-6665| volume = 41| issue = 3| pages = 459–483, vii| last1 = Vieira| first1 = Francisco| last2 = Allen| first2 = Shawn M.| last3 = Stocks| first3 = Rose Mary S.| last4 = Thompson| first4 = Jerome W.| title = Deep neck infection| journal = Otolaryngologic Clinics of North America| date = 2008-06| pmid = 18435993}}</ref>
</li>
::* '''1.1 Community-acquired deep neck infection'''
{{rx|Nosocomial Deep Neck Infection or Immunocompromised Host}}
:::* Preferred regimen: [[Ampicillin-Sulbactam]] 1.5–3.0 g IV q6h {{or}} [[Clindamycin]] 600–900 mg IV q8h {{or}} [[Moxifloxacin]] 400 mg IV q24h (if ''[[Eikenella]]'' is suspected)
* [[Ticarcillin-Clavulanate]] 3.0 g IV q6h {{or}} [[Piperacillin-Tazobactam]] 3.0 g IV q6h {{or}} [[Imipenem-Cilastatin]] 500 mg IV q6h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 750 mg IV q24h
</li>
{{rx|Deep Neck Infection with High-Risk of MRSA}}
* [[Clindamycin]] 600–900 mg IV q8h {{or}} [[Trimethoprim-Sulfamethoxazole]] 10 mg/kg/day q8h {{and}}
* [[Vancomycin]] 1.0 g IV q12h
</li>
{{rx|Necrotizing Fasciitis}}
* [[Ceftriaxone]] 2.0 g IV q8h {{and}}
* [[Clindamycin]] 600–900 mg IV q8h {{and}}
* [[Metronidazole]] 500 mg IV q6h
</li>


* '''Parapharyngeal space infection'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
::* '''1.2 Nosocomial deep neck infection or immunocompromised host'''
:* Causative pathogens
:::* Preferred regimen: [[Ticarcillin-Clavulanate]] 3 g IV q6h {{or}} [[Piperacillin-Tazobactam]] 3 g IV q6h {{or}} [[Imipenem-Cilastatin]] 500 mg IV q6h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 750 mg IV q24h
::* Viridans and other streptococci
 
::* Staphylococcus
::* '''1.3 Deep neck infection with high-risk of MRSA'''
::* Peptostreptococcus
:::* Preferred regimen: ([[Clindamycin]] 600–900 mg IV q8h {{or}} [[Trimethoprim-Sulfamethoxazole]] 10 mg/kg/day IV q8h {{and}} [[Vancomycin]] 1 g IV q12h
::* Bacteroides
 
::* Other oral anaerobes
::* '''1.4 Necrotizing fasciitis'''
:* Preferred regimen (immunocompetent host) (1): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h)
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q8h {{and}} [[Clindamycin]] 600–900 mg IV q8h {{and}} [[Metronidazole]] 500 mg IV q6h
:* Preferred regimen (immunocompetent host) (2): [[Ampicillin-Sulbactam]] 2 g IV q4h
 
:* Preferred regimen (immunocompetent host) (3): [[Clindamycin]] 600 mg IV q6h
:* '''2. Specific anatomic considerations'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
:* Preferred regimen (immunocomppromised host) (1): [[Cefotaxime]] 2 g IV q6h  
::* '''2.1 Submandibular space infections including Ludwig angina'''
:* Preferred regimen (immunocomppromised host) (2): [[Ceftizoxime]] 4 g IV q8h  
:::* Causative pathogens
:* Preferred regimen (immunocomppromised host) (3): [[Piperacillin]] 3 g IV q4h  
::::* Viridans and other streptococci
:* Preferred regimen (immunocomppromised host) (4): [[Imipenem]] 500 mg IV q6h  
::::* Peptostreptococcus
:* Preferred regimen (immunocomppromised host) (5): [[Imipenem]] 500 mg IV q6h  
::::* Bacteroides
:* Preferred regimen (immunocomppromised host) (6): [[Gatifloxacin]] 400 mg IV q24h
::::* Other oral anaerobes
:::* Preferred regimen (immunocompetent host): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Tobramycin]] 2 mg/kg IV q8h) {{or}} [[Ampicillin-Sulbactam]] 2 g IV q4h {{or}} [[Clindamycin]] 600 mg IV q6h {{or}} [[Doxycycline]] 200 mg IV q12h {{or}} [[Cefoxitin]] 2 g IV q6h {{or}} [[Cefotetan]] 2 g IV q12h
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Gatifloxacin]] 200 mg IV q24h
 
::* '''2.2 Lateral pharyngeal or retropharyngeal space infections (odontogenic)'''
:::* Causative pathogens
::::* Viridans and other streptococci
::::* Staphylococcus
::::* Peptostreptococcus
::::* Bacteroides
::::* Other oral anaerobes
:::* Preferred regimen (immunocompetent host): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Ampicillin-Sulbactam]] 2 g IV q4h {{or}} [[Clindamycin]] 600 mg IV q6h
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h
 
::* '''2.3 Lateral pharyngeal or retropharyngeal space infections (rhinogenic)'''
:::* Causative pathogens
::::* Streptococcus pyogenes
::::* Fusobacterium
::::* Peptostreptococcus
::::* Other oral anaerobes
:::* Preferred regimen (immunocompetent host): [[Penicillin G]] 2–4 MU IV q4–6h {{or}} ([[Ciprofloxacin]] 200 mg q12h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Gatifloxacin]] 400 mg IV q24h {{or}} [[Clindamycin]] 600 mg IV q6h
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h
 
::* '''2.4 Lateral pharyngeal or retropharyngeal space infections (otogenic)'''
:::* Causative pathogens
::::* Streptococcus pneumoniae
::::* Haemophilus influenzae
::::* Viridans and other streptococci
::::* Peptostreptococcus
::::* Bacteroides
::::* Other oral anaerobes
:::* Preferred regimen (immunocompetent host): [[Penicillin G]] 2–4 MU IV q4–6h {{or}} ([[Ciprofloxacin]] 200 mg q12h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Gatifloxacin]] 400 mg IV q24h {{or}} [[Clindamycin]] 600 mg IV q6h
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h
 
::* '''2.5 Peritonsillar abscess (quinsy)'''
:::* Causative pathogens
::::* Viridans and other streptococci
::::* Peptostreptococcus
::::* Bacteroides
::::* Other oral anaerobes
:::* Preferred regimen (immunocompetent host): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Ampicillin-Sulbactam]] 2 g IV q4h {{or}} [[Clindamycin]] 600 mg IV q6h {{or}} [[Cefoxitin]] 2 g IV q6h
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h
 
::* '''2.6 Suppurative parotitis'''
:::* Causative pathogens
::::* Staphylococcus
::::* Viridans and other streptococci
::::* Bacteroides
::::* Peptostreptococcus
::::* Other oral anaerobes
:::* Preferred regimen (immunocompetent host): ([[Nafcillin]] 1.5 g IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Clindamycin]] 600 mg IV q6h
:::* Preferred regimen (immunocomppromised host): ([[Vancomycin]] 0.5 g IV q6h {{and}} [[Cefotaxime]] 2 g IV q6h) {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h
 
::* '''2.7 Extension of osteomyelitis from prevertebral space infection'''
:::* Causative pathogens
::::* Staphylococcus
::::* Facultative gram-negative bacilli
:::* Preferred regimen (immunocompetent host): ([[Nafcillin]] 1.5 g IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Ciprofloxacin]] 200 mg q12h
:::* Preferred regimen (immunocomppromised host): ([[Vancomycin]] 0.5 g IV q6h {{and}} [[Cefotaxime]] 2 g IV q6h) {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h
 
::* '''2.8 Pott's puffy tumor (frontal osteitis)'''
:::* Causative pathogens
::::* Streptococcus pyogenes
::::* Fusobacterium
::::* Peptostreptococcus
::::* Other oral anaerobes
:::* Preferred regimen (immunocompetent host): [[Penicillin G]] 2–4 MU IV q4–6h {{or}} ([[Ciprofloxacin]] 200 mg q12h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Gatifloxacin]] 400 mg IV q24h {{or}} [[Clindamycin]] 600 mg IV q6h
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h
 
::* '''2.9 Malignant otitis media'''
:::* Causative pathogens
::::* Pseudomonas aeruginosa
:::* Preferred regimen (immunocompetent host): [[Ciprofloxacin]] 200 mg q12h {{or}} ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h
:::* Preferred regimen (immunocomppromised host): ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h
 
::* '''2.10 Petrous osteitis'''
:::* Causative pathogens
::::* Pseudomonas aeruginosa
:::* Preferred regimen (immunocompetent host): [[Ciprofloxacin]] 200 mg q12h {{or}} ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h
:::* Preferred regimen (immunocomppromised host): ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h
 
::* '''2.11 Septic jugular thrombophlebitis (Lemierre syndrome)'''
:::* Causative pathogens
::::* Fusobacterium
::::* Viridans and other streptococci
::::* Staphylococcus
::::* Peptostreptococcus
::::* Bacteroides
::::* Other oral anaerobes
:::* Preferred regimen (immunocompetent host): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Ampicillin-Sulbactam]] 2 g IV q4h {{or}} [[Clindamycin]] 600 mg IV q6h
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h


===Surgical Management===
===Surgical Management===

Revision as of 13:10, 13 August 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: cervical fascial space infection; DNI; perimandibular space infection

Overview

Deep neck infection is a potentially life-threatening condition which arises from a septic nidus affecting one or more of the deep neck spaces. Fever, neck pain, and neck swelling are the most prevalent symptoms in adults. Pediatric patients commonly present with fever, neck mass, neck stiffness, sore throat, drooling, or poor oral intake. Contrast-enhanced CT scan of the neck is recommended to scrutinize the extent of involvement and differentiate the nature of lesion. Securing the airway is the key initial management for known or suspected deep neck infection. In view of the rapidly progressive course of deep neck infection, patients should receive timely empiric treatment with broad-spectrum intravenous antibiotics covering Gram-positive cocci, Gram-negative bacilli, and/or anaerobes, tailored on the basis of clinical scenario, host immune status, and local antibiogram data. Surgical interventions may be required for complicated cases.

Pathophysiology

Anatomic Considerations of Deep Neck Spaces

Based on their spatial relation to the hyoid, deep neck spaces may be divided into three anatomic groups:[1][2]

  • Spaces above the level of the hyoid
  • Peritonsillar space
– The peritonsillar space lies between the palatine tonsil and the lateral superior pharyngeal constrictor muscle and is bounded anteriorly and posteriorly by the tonsillar pillars. Infection of the peritonsillar space is commonly associated with tonsillitis in older children or young adults.[3]
  • Submandibular space
– The submandibular space encloses the space between the mandible and the hyoid and consists of two compartments: the supramylohyoid compartment and the inframylohyoid compartment. Infection of the submandibular space is typically caused by odontogenic pathogens, including Streptococcus viridans, Staphylococcus spp., Prevotella spp, and Peptostreptococcus spp.[4]
– Ludwig's angina denotes the condition of rapidly spreading cellulitis in the submandibular space resulting in acute respiratory distress secondary to upper airway obstruction.
  • Parapharyngeal space (lateral pharyngeal space or pharyngomaxillary space)
– The parapharyngeal space lies between the middle layer and the superficial layer of deep cervical fascia. Infection of the parapharygeal space often arises from pharyngitis, tonsillitis, otitis, mastoiditis, parotitis, and cervical lymphadenitis.
  • Masticator space (temporal space)
– The masticator space locates between the pterygoid muscle medially and the masseter muscle laterally. Infection of the masticator space generally originates from the posterior mandibular molars.
  • Buccal space
– The buccal space lies between the buccinator muscle medially and the skin of the cheek laterally. Infection of the buccal space is often odontogenic in origin.
  • Parotid space
– The parotid space lies between the parapharyngeal space and the parotid fascia. Infection of the parotid space frequently stems from parotid duct obstruction or lymphadenitis.
  • Spaces that involve the entire length of the neck
  • Retropharyngeal space (retrovisceral space or retroesophageal space)
– The retropharyngeal space is bounded by the carotid sheaths laterally and extends from the skull base to the mediastinum. Infection of the retropharyngeal space is typically polymicrobial in origin and commonly observed in children younger than 5 years.
  • Danger space
– The danger space lies between the alar fascia anteriorly and the prevertebral fascia posteriorly. Infection in the danger space tends to complicate mediastinitis, empyema, and sepsis.
  • Prevertebral space
– The prevertebral space extends between the prevertebral fascia and the underlying vertebral bodies. Infection in the prevertebral space may be secondary to Pott's disease or retropharyngeal and danger space infections.
  • Carotid space (visceral vascular space)
– The carotid space is encased by the carotid sheaths and harbors the carotid artery, internal jugular vein, cranial nerves IX, X, XI, and XII, and cervical sympathetic chain. Infection of the carotid space may result from disseminated infections of the adjacent spaces or direct inoculation.
  • Spaces below the level of the hyoid
  • Anterior visceral space (pretracheal space)
– The anterior visceral space lies between the infrahyoid strap muscles and the esophagus. Infection of the anterior visceral space is commonly associated with traumatic insult to the anterior esophageal wall.

Causes

Aerobes

Frequently Isolated Aerobes

Less Frequently Isolated Aerobes

Anaerobes

Frequently Isolated Anaerobes

Less Frequently Isolated Anaerobes

Atypical Pathogens

Natural History, Complications, and Prognosis

Complications

Diagnosis

History

In the absence of acute respiratory distress, history taking should attempt to identify potential sources of the deep neck infection, such as any recent illness affecting oropharyngeal structures, dental caries or procedures, upper airway surgeries, penetrating injuries in the head and neck, or intravenous drug use. Other pertinent history includes host immune status (e.g., human immunodeficiency virus infection, recent use of chemotherapeutic agent or corticosteroids) and past medical history of chronic hepatitis, diabetes mellitus, rheumatic disorders, or hematologic malignancy. In these settings, patients are at an increased risk of rapidly progressive diseases or atypical clinical presentations not featured by marked inflammatory responses.[6]

Signs and Symptoms

Symptoms may reflect generalized or local inflammatory processes in response to the infection. Fever, neck pain, and neck swelling are the most prevalent symptoms in adults. Dysphagia, odynophagia, drooling, hoarseness ("hot potato" voice), shortness of breath, trismus, or otalgia may also occur. Pediatric patients commonly present with fever, neck mass, neck stiffness, sore throat, drooling, or poor oral intake.[7][8]

Physical Examination

Head and Neck

  • Palpation of the neck disclose localizing tenderness, swelling, or crepitus due to gas-producing organisms or trauma to the airway.

Eyes

  • Extraocular movement abnormalities or absent papillary light reflex may be indicative of orbital inflammation or abscess.

Ear

Mouth

  • Pain or difficulty with mouth opening suggests dissenminated infection involving the parapharyngeal or masticator space.
  • Decayed teeth with swollen dental alveoli may indicate odontogenic infection.
  • Tenderness, edema, or purulent discharge at the floor of the mouth may be noted.

Throat

  • Examination of the throat may reveal inflammation and swelling of the epiglottis and other upper airway structures.

Laboratory Findings

Imaging Studies

Treatment

Airway Management

Securing the airway is the key initial management of any patient with suspected deep neck infection. Airway patency should be confirmed before transporting the patient for radiographic evaluation. A tracheotomy set should be made available and tracheotomy may be considered in cases where minimal airway lumen can be visualized. Other options of airway interventions include endotracheal intubation, nasal fiberoptic intubation, and cricothyrotomy.

Fluid Resuscitation

Intravenous access should be established for rapid administration of medications and fluids. Timely infusion of 1 to 2 liters of isotonic fluids is necessary for treating dehydration as a result of poor intake associated with dysphagia, odynophagia, or trismus in patients with deep neck infections affecting peritonsillar or retropharyngeal space.

Antibiotic Therapy

  • Deep neck infection
  • 1. Empiric antimicrobial therapy[9][10]
  • 1.1 Community-acquired deep neck infection
  • 1.2 Nosocomial deep neck infection or immunocompromised host
  • 1.3 Deep neck infection with high-risk of MRSA
  • 1.4 Necrotizing fasciitis
  • 2. Specific anatomic considerations[11]
  • 2.1 Submandibular space infections including Ludwig angina
  • Causative pathogens
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • 2.2 Lateral pharyngeal or retropharyngeal space infections (odontogenic)
  • Causative pathogens
  • Viridans and other streptococci
  • Staphylococcus
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • 2.3 Lateral pharyngeal or retropharyngeal space infections (rhinogenic)
  • Causative pathogens
  • Streptococcus pyogenes
  • Fusobacterium
  • Peptostreptococcus
  • Other oral anaerobes
  • 2.4 Lateral pharyngeal or retropharyngeal space infections (otogenic)
  • Causative pathogens
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • 2.5 Peritonsillar abscess (quinsy)
  • Causative pathogens
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • 2.6 Suppurative parotitis
  • Causative pathogens
  • Staphylococcus
  • Viridans and other streptococci
  • Bacteroides
  • Peptostreptococcus
  • Other oral anaerobes
  • 2.7 Extension of osteomyelitis from prevertebral space infection
  • Causative pathogens
  • Staphylococcus
  • Facultative gram-negative bacilli
  • 2.8 Pott's puffy tumor (frontal osteitis)
  • Causative pathogens
  • Streptococcus pyogenes
  • Fusobacterium
  • Peptostreptococcus
  • Other oral anaerobes
  • 2.9 Malignant otitis media
  • Causative pathogens
  • Pseudomonas aeruginosa
  • 2.10 Petrous osteitis
  • Causative pathogens
  • Pseudomonas aeruginosa
  • 2.11 Septic jugular thrombophlebitis (Lemierre syndrome)
  • Causative pathogens
  • Fusobacterium
  • Viridans and other streptococci
  • Staphylococcus
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes

Surgical Management

  • Surgical drainage may be indicated in the following circumstances:[12][13][14]
– When an air-fluid level is evident radiographically
– When aspiration culture yields gas-forming organisms
– When compromised airway occurs as a complication of abscess formation
– When the patient fails to respond to empiric antibiotic therapy within 48 to 72 hours
– When the abscesse is greater than 3 cm in diameter and involves the carotid space, prevertebral , anterior visceral spaces, or more than two spaces

Related Chapters

References

  1. ↑ Vieira, Francisco; Allen, Shawn M.; Stocks, Rose Mary S.; Thompson, Jerome W. (2008-06). "Deep neck infection". Otolaryngologic Clinics of North America. 41 (3): 459–483, vii. doi:10.1016/j.otc.2008.01.002. ISSN 0030-6665. PMID 18435993. Check date values in: |date= (help)
  2. ↑ Flint, Paul (2015). Cummings otolaryngology--head & neck surgery. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455746965.
  3. ↑ Ungkanont, K.; Yellon, R. F.; Weissman, J. L.; Casselbrant, M. L.; González-Valdepeña, H.; Bluestone, C. D. (1995-03). "Head and neck space infections in infants and children". Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 112 (3): 375–382. ISSN 0194-5998. PMID 7870436. Check date values in: |date= (help)
  4. ↑ Rega, Anthony J.; Aziz, Shahid R.; Ziccardi, Vincent B. (2006-09). "Microbiology and antibiotic sensitivities of head and neck space infections of odontogenic origin". Journal of Oral and Maxillofacial Surgery: Official Journal of the American Association of Oral and Maxillofacial Surgeons. 64 (9): 1377–1380. doi:10.1016/j.joms.2006.05.023. ISSN 0278-2391. PMID 16916672. Check date values in: |date= (help)
  5. ↑ Vieira, Francisco; Allen, Shawn M.; Stocks, Rose Mary S.; Thompson, Jerome W. (2008-06). "Deep neck infection". Otolaryngologic Clinics of North America. 41 (3): 459–483, vii. doi:10.1016/j.otc.2008.01.002. ISSN 0030-6665. PMID 18435993. Check date values in: |date= (help)
  6. ↑ Vieira, Francisco; Allen, Shawn M.; Stocks, Rose Mary S.; Thompson, Jerome W. (2008-06). "Deep neck infection". Otolaryngologic Clinics of North America. 41 (3): 459–483, vii. doi:10.1016/j.otc.2008.01.002. ISSN 0030-6665. PMID 18435993. Check date values in: |date= (help)
  7. ↑ Coticchia, James M.; Getnick, Geoffrey S.; Yun, Romy D.; Arnold, James E. (2004-02). "Age-, site-, and time-specific differences in pediatric deep neck abscesses". Archives of Otolaryngology--Head & Neck Surgery. 130 (2): 201–207. doi:10.1001/archotol.130.2.201. ISSN 0886-4470. PMID 14967751. Check date values in: |date= (help)
  8. ↑ Vural, Cetin; Gungor, Anil; Comerci, Susan (2003-06). "Accuracy of computerized tomography in deep neck infections in the pediatric population". American Journal of Otolaryngology. 24 (3): 143–148. ISSN 0196-0709. PMID 12761699. Check date values in: |date= (help)
  9. ↑ Flint, Paul (2010). Cummings otolaryngology head & neck surgery. Philadelphia, PA: Mosby/Elsevier. ISBN 978-0323052832.
  10. ↑ Vieira, Francisco; Allen, Shawn M.; Stocks, Rose Mary S.; Thompson, Jerome W. (2008-06). "Deep neck infection". Otolaryngologic Clinics of North America. 41 (3): 459–483, vii. doi:10.1016/j.otc.2008.01.002. ISSN 0030-6665. PMID 18435993. Check date values in: |date= (help)
  11. ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
  12. ↑ Boscolo-Rizzo, Paolo; Marchiori, Carlo; Zanetti, Federica; Vaglia, Alberto; Da Mosto, Maria Cristina (2006-12). "Conservative management of deep neck abscesses in adults: the importance of CECT findings". Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 135 (6): 894–899. doi:10.1016/j.otohns.2006.05.013. ISSN 0194-5998. PMID 17141080. Check date values in: |date= (help)
  13. ↑ Huang, Tung-Tsun; Liu, Tien-Chen; Chen, Peir-Rong; Tseng, Fen-Yu; Yeh, Te-Huei; Chen, Yuh-Shyang (2004-10). "Deep neck infection: analysis of 185 cases". Head & Neck. 26 (10): 854–860. doi:10.1002/hed.20014. ISSN 1043-3074. PMID 15390207. Check date values in: |date= (help)
  14. ↑ Flint, Paul (2015). Cummings otolaryngology--head & neck surgery. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455746965.
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