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  • Print publication year: 2008
  • Online publication date: December 2009

10 - Deep Neck Space Infections

from Part I - Systems
    • By Theresa A. Gurney, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Andrew H. Murr, Professor of Clinical Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, Chief of Service San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Publisher: Cambridge University Press
  • DOI: https://doi.org/10.1017/CBO9780511547454.011
  • pp 47-50

Summary

INTRODUCTION – AGENTS

The head and neck contain a variety of fascial planes forming potential spaces for the spread of infection. If these spaces are seeded, infection may travel to vital structures such as the carotid artery, jugular vein, or mediastinum. Deep neck spaces include the submandibular, peritonsillar, parapharyngeal, retropharyngeal, and prevertebral spaces.

The majority of deep neck space infections are caused by the organisms that frequently infect or colonize the upper aerodigestive tract. These include Streptococcus and Staphylococcus species, as well as bacteria commonly found in the oral cavity such as Bacteroides species, Klebsiella, Escherichia coli, Enterobacter, Actinomyces, and Eikenella corrodens. Often these infections involve mixed flora.

EPIDEMIOLOGY

Both adults and young children can develop deep neck space infections. Teenagers and young adults present with peritonsillar space abscesses more commonly than other age groups. A recent dental infection or procedure may be a predisposing factor for a submental or submandibular space infection (see Chapter 3, Dental and Odontogenic Infections). Intravenous or subcutaneous injection of illicit substances into neck veins or tissue also predisposes to neck infections.

CLINICAL FEATURES

The clinical features of a particular deep neck space infection will reflect the anatomic characteristics of the deep neck space involved (Table 10.1). A submandibular space infection may reveal a concomitant infection of the submandibular duct. Odontogenic infections can progress to submental or sublingual infections, and therefore a through dental examination is always indicated.

REFERENCES
Fairbanks, D N F. Pocket guide to antimicrobial therapy in otolaryngology – head and neck surgery, 12th ed. Washington, DC: American Academy of Otolaryngology, 2005.
Herzon, F S. Peritonsillar abscess: incidence, current management practices and a proposal for treatment guidelines. Laryngoscope 1995;105(8):1–17.
Herzon, F S, Martin, A D. Medical and surgical treatment of peritonsillar, retropharyngeal and parapharyngeal abscesses. Curr Infect Dis Rep 2006;8(3):196–202.
Lin, D, Reeck, J B, Murr, A H. Internal jugular vein thrombosis and deep neck infection from intravenous drug use: management strategy. Laryngoscope 2004;114(1):56–60.
Myers, E N. Deep neck abscesses. In: Operative otolaryngology head and neck surgery. 1997:667–75., Saunders; 1st edition. http://www.amazon.com/Operative-Otolaryngology-Head-Surgery-Two/dp/0721638414.