Deep Neck Space Infections

Fascial Planes of the Neck Superficial cervical fascia

Envelopes; Boundaries; Significance

Deep cervical fascia Superficial layer (investing layer)▪ Envelopes; Boundaries; Significance

Middle layer (visceral fascia)▪ Envelopes; Boundaries; Significance

Deep layer (prevertebral fascia)▪ Envelopes; Boundaries; Significance

Carotid sheath fascia Envelopes; Boundaries; Significance

Neck Spaces(Boundaries & Contents)

Parapharyngeal space Pterygopalatine (pterygomaxillary) fossa Masticator space Temporal fossa Infratemporal fossa Parotid space Peritonsillar space Submandibular space Carotid sheath space Visceral (pretracheal) space Retropharyngeal (retrovisceral) space Danger space Prevertebral space

Etiology

Dental infections (most common in adults) Acute pharyngitis of Waldeyer’s ring (most common

in children) Cervical lymphadenitis (r/o cancer in adult) Acute rhinosinusitis (retropharyngeal lymphadenitis) Acute mastoiditis (Bezold abscess) Iatrogenic (oral surgery; intubation; endoscopic

trauma) Sialadenitis Foreign body Penetrating cervicofacial trauma (including IV drug) Cellulitis Congenital cysts (thyroglossal duct; branchial cleft) Acquired cysts (laryngoceles; saccular cysts)

Microbiology

Mixed aerobic & anaerobic oropharyngeal flora (most common)

Strep. viridans Strep. pyogenes Peptostreptococcus Staph. epidermidis Staph. aureus MRSA Bacteroides Fusobacterium Neisseria, Pseudomonas, Escherichia, Haemophilus Actinomyces Mycobacteria Baronella henselae

History

Inflammatory symptomsLocalizing symptomsRecent infectionRecent traumaRecent surgery Immunodeficiency status

Physical Examination

PalpationOtoscopyOral cavity & Pharynx

Dentition Trismus Salivary ducts Unilateral tonsil swelling

Awake flexible fiberoptic airway evaluation

Diagnostic Testing

Blood testsPlain x-rays

Lateral neck film Chest film

CT with IV contrastMRIUltrasound

Treatment

Airway management Fluid resuscitation IV antibiotics Surgical management

Indications Goals Needle aspiration Transoral incision & drainage (peritonsillar

abscess, buccal space, masticator space, pterygomaxillary space)

Tonsillectomy Transcervical incision & drainage Surgical technique

Complications

Ludwig’s anginaCavernous sinus thrombosisLemierre syndromeCarotid artery pseudo-aneurysm

or ruptureMediastinitisNecrotizing fasciitis