Deep neck infection

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S [2]

Overview

Deep neck infection refers to an infection or abscess located deep in the neck near the blood vessels, nerves, and muscles. Common causes of Deep neck infections include retropharyngeal abscess, parapharyngeal abscess, Ludwig's angina, among others.

Pathophysiology

Cervical fascia of the neck divides it into superficial and deep spaces. The deep space is in turn divided into many small spaces by deep fascia. Infection from head and neck structures spread to the lymph nodes present in these deep areas causing abscesses.

• Retropharyngeal space - lymph nodes that drain the adenoids, sinuses and nose are located in this space. Infections can result in spread of infection to these lymph nodes, and eventually abscess formation causing a Retropharyngeal abscess. It is common in children younger than 5 years.
• Peritonsillar space - this space is located above and behind the tonsils. Untreated Tonsillitis can cause an infection in this space. This infection occurs most frequently in young adults.
• Parapharyngeal space - this space is located on each side of the neck behind the Carotid arteries. Infections in this area are due to common upper respiratory infections that spread to the lymph nodes located in this space.
• Submandibular space - located under the jaw on each side, infection of this space is usually the result of a dental infection and is known as Ludwig's angina.

Causes

• Adenoides
• Sinusitis
• Tonsillitis
• Upper respiratory infections
• Dental infection

Symptoms

• Asymmetric swelling of the neck, face, under the jaw or back of the throat
• Fever
• Difficulty or pain when swallowing
• Drooling
• Voice change
• Decreased ability to move the neck
• Sick appearance

Complications

• Airway obstruction
• Spread of the infection to mediastenum, lungs, blood stream etc.,
• Thrombus formation in the arteries of the neck

Diagnosis

• Complete blood counts
• Differential counts
• ESR
• Blood cultures
• CT scan of the neck to know the extent of involvement.
• X-ray neck
• Dental radiography

Treatment

• Hospitalization
• Hydration
• I.V antibiotics
• Surgical drainage in unresponsive cases.