Deep neck infections – case reports

Overview

Introduction: Deep neck infections represent severe inflammatory involvement of defined fascial spaces of the neck and are potentially life-threatening diseases. The etiology is most commonly odontogenic or tonsillogenic. The main complications are mediastinitis, septic shock and upper airway obstruction. Treatment is based on the administration of intravenous antibiotics and, in indicated cases, surgical drainage of abscess sites.

Case report 1: A 7-year-old girl was treated by a general practitioner for acute tonsil­litis. CT scan with contrast medium was indicated due to worsening of the condition and neck movement. A large retropharyngeal abscess was not reliably found from the external approach, so the procedure was extended to tonsillectomy and transoral drain­age. The cause was probably a multilocular abscess with rigid membranous septa.

Case report 2: A 65-year-old man with diabetes mellitus presents with odynophagia and infiltrate of the left side of the neck. CT scan showed a phlegmon in the left carotid space. Surgery was indicated after 24 hrs of ineffective conservative treatment. During the operation, extensive formed abscess lesions were found and drained.

Case report 3: A 60-year-old woman was treated as an outpatient for tonsillitis, then at the regional ENT department with an incipient epiglottitis, and finally at a tertiary department with a diagnosis of deep neck infection extending from the epiglottis to the hyoid according to imaging examinations. Peroperative findings revealed even larger extent of abscess that extended down to the jugulum.

Case report 4: A 57-year-old patient with peritonsillar abscess treated by incision and antibiotics in the regional ENT department. Despite the treatment instituted, the condition progressed and a parapharyngeal abscess developed, which had to be managed by tonsillectomy and external incision at a tertiary department, including postoperative intubation and several days of hospitalization in an ICU ward.

Conclusion: Medical history, otorhinolaryngological examination and early head and neck contrast enhanced CT are essential in the diagnosis of deep cervical inflamma­tion. Modern therapeutic algorithms including a multidisciplinary approach, repeated CT scans and surgical revisions lead to reduced mortality, including patients with mediastinitis.

Keywords:

case report – deep neck infections – parapharyngeal abscess – retropharyngeal abscess