Deep Neck Space Infections: A Study of 76 Cases

Document Type: Original


1 Department of Otorhinolaryngology, SGRDIMSR, Amritsar, Punjab, India.

2 Department of Pathology, GMC, Amritsar, Punjab, India.

3 Department of Otorhinolaryngology, GMC, Patiala, Punjab, India.


Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. The common primary sources of DNSI are dental infections, tonsillar and salivary gland infections, malignancies, and foreign bodies. With widespread use of antibiotics, the prevalence of DNSI has been reduced. Common complications of DNSI include airway obstruction, jugular vein thrombosis, and sepsis. Treatment principally comprises airway management, antibiotic therapy, and surgical intervention. This study was conducted to investigate the age and sex distribution of patients, symptoms, presentation, sites involved, bacteriology, and management and complications of DNSI.
Materials and Methods:
This retrospective study was performed from October 2010 to January 2013, and included 76 patients with DNSI. Patients of all age groups and gender were included. All parameters including age, gender, co-morbidities, presentation, site, bacteriology, complications, and required interventions were studied.
In our study, the majority of patients were in the 31–50-year age group. Males accounted for 55.26% of the sample and females for 44.74%, with a male:female ratio of 1.23. Most of the patients were from a rural background. Diabetes was found as a co-morbid condition in 10.52% cases. Neck pain was the most common symptom, identified in 89.47% cases. The most common etiological factor was odontogenic infection (34.21%), followed by tonsillar and pharyngeal infection (27.63%). The most common presentation was Ludwig’s angina (28.94%), followed by peritonsillar abscess and submandibular abscess. In 50% of cases, Streptococcus and Staphylococcus were found in the culture. Surgical intervention was carried out in 89.47% cases. Emergency tracheotomy was required in 5.26% cases.
DNSI can be life-threatening in diabetic patients, the immunocompromised, and elderly patients, and special attention should therefore be given to these groups. Early diagnosis and treatment is essential to prevent complications. All patients must be treated initially with intravenous antibiotics, with treatment subsequently updated based on a culture and sensitivity report. Due to poor oral hygiene, lack of nutrition, smoking and chewing of beetle nut and tobacco, odontogenic infections are the most common cause of DNSI. Thus, DNSI could be prevented by making the population aware of dental and oral hygiene and offering regular check-ups for dental infections.


Main Subjects

1. Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life threatening deep cervical space infections: A review of one hundred ninety six cases. Am J Otolaryngol 2003;24(2):111–7.

2. Vieira F, Allen SM, Stocks RSM, Thompson JW. Deep neck infections. Otolaryngol Clin N Am 2008;12:459–83.

3.  Durazzo M, Pinto F, Loures M, Volpi E, Nishio S, Brandao L, et al. Deep neck space infections. Rev Ass Med Brasil 1997;43:119–26.

4. Wong TY. A nationwide survey of deaths from oral and maxillofacial infections: the Taiwanese experience. J Oral Maxillofac Surg 1999;57:       1297–99.

5. Weed H, Forest L. Deep neck infection. J Otolaryngol Head Neck Surg 1998;3:2515–24.

6. Parhiscar A, Harel G. Deep neck abscess: A retrospective review of 210 cases. Ann Otolo Rhinol Laryngol 2001;110(11): 1051–54.

7. Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, Gonzalez VH, Bluestone CD. Head and neck space infections in infant and children. Otolaryngol Head Neck Surg 1995; 112(3):375–82.

8. Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: Analysis of 185 cases. J Otolaryngol Head Neck Surg 2004; 26(10):854–60.

9.  Hasegawa J, Hidaka H, Tateda M, Kudo T, Sagai S, Miyazaki M, et al. An analysis of clinical risk factors of deep neck infection. Auris Nasus Larynx 2011; 38(1):101–7.

10. Bakir S, Tanriverdi MH, Gun R, Yorgancilar AE, Yildirim M, Tekbas G, et al. Deep neck space infections: A retrospective review of 173 cases. Am J Otolaryngol 2012; 33(1):56–63.

11. Boscolo RP, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V, et al. Deep neck space infections: A study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol 2012; 269(4): 1241–49.

12. Wills PI, Vernon RP. Complications of space infections of the head and neck. Laryngoscope 1981; 91(7):1129–36.

13. Mayor GP, Millan JMS, Martinez VA. Is conservative treatment of deep neck space infections appropriate? J Head and Neck 2001; 23(2): 126–33.

14.  Meher R, Jain A, Sabharwal A, Gupta B, Singh I, Agarwal I. Deep neck abscess: A prospective study of 54 cases. J Laryngol Otol 2005;119(04): 299–302.

15. Sethi DS, Stanley RE. Deep neck abscesses: Challenging trends. J Laryngol Otol 1994;108:  138–43.

16. Anil S, Al-Ghamdi HS. The impact of periodontal infections on systemic diseases. An update for medical practitioners. Saudi Med J 2006; 27(6):767–76.

17. Marioni G, Staffieri A, Parisi S, Marchese RR, Zuccon A. Rational diagnostic and therapeutic management of deep neck infections: Analysis of 233 consecutive cases. Ann Otol Rhinol Laryngol 2010(3); 119: 181–87.

18. Tschiassny K. Ludwig’s angina: An anatomic study of the role of the lower molar teeth in its pathogenesis. Arch Otolaryngol.1943; 38(5):485–96.

19. Bottin R, Marioni G, Rinaldi R, Boninsegna M, Salvadori L, Staffieri A. Deep neck infection: A present day complication. A retrospective review of 83 cases. Eur Arch Otorhinolaryngol 2003; 260: 576–79.

20. Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N. Deep neck infections: A retrospective review of 112 cases. Eur Arch Otorhinolaryngol 2009; 266:273–77.

21. Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess: A retrospective study of 110 patients. Oral Surg Med 1994; 77(5):446–50.

22. Parhiscar A, Har-EL G. Deep neck abscess: A retrospective review of 210 cases. Ann Otol Rhinol Laryngol 2001;110:1051–4.

23. Khode SR, Bhat P, Rane S, Dasguota KS. Retrospective analysis of 298 cases of deep neck infections: Its diagnosis and management. Sci J Med Clin Trials 2013;103:1–3.

24. Stalfor J, Adielsson A, Ebenfelt A, Nethander G, Westin T. Deep neck space infections remain a surgical challenge: A study of 72 patients. Acta Otolaryngologica. 2004;124:1191–6.

25. Ridder GJ, Technau IK, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: 8 year experience of 234 cases. J Otolaryngol Head Neck Surg 2005;133:709–14.

26. Mumtaz RM, Arain AA, Suhail A, Rajput SA, Mohammad A, Nabeel H. Deep neck space infections: Retrospective review of 46 patients. J Cranio Max Dis 2014;3(1):21–5.

27. Gidley PW, Ghorayeb BY, Stiernberg CM. Contemporary management of deep neck space infections. J Otolaryngology Head Neck Surg 1997; 116:16–22.

28. Smith JL, Hsu JM, Chang J. Predicting deep neck space abscess using computed tomography. Am J Otolaryngology 2006; 27:244–7.

29. Osborn TM, Assael LA, Bell RB. Deep space neck infection: Principles of surgical management. Oral Maxillofacial Surg Clin N Am 2008;20:   353–65.