A Clinical Study of Deep Neck Abscesses

Background: Deep neck space infection is common clinical entity seen in ENT practice. Early diagnosis and adequate treatment can help in reducing the morbidity and mortality associated with the disease. Methods: This study was conducted in the department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College Jammu for a period of 2 years w. e.f August 2017 to August 2019. 50 patients presenting with symptoms of throat pain, dysphagia, odynophagia, fever, neck swelling, trismus, halitosis and change in voice were included. Only clinically and radiologically confirmed cases of deep neck space infections of all age groups and both the sexes were included in the study. Needle aspiration or incision and drainage was done at the earliest stage in majority of patients. Pus was sent for culture and sensitivity analysis. All the patients were started on antibiotics, supportive therapy in the form of intravenous fluids, analgesics, antipyretics, mouthwashes were given. Results: Out of 50 patients, highest incidence was noted in 31-40 years age group accounting for 24% patients with male: female ratio of 1.27: 1. In the present study the most common presenting complaint was painful swallowing (odynophagia) seen in 48(96%) patients followed by fever seen in 46(92%) patients, trismus, pain throat, neck swelling, neck pain, difficulty in breathing., dental pain, bad breath. The most common cause was dental infection in 24(48%) patients followed by salivary gland infection in 11(22%) patients, recurrent tonsillitis was seen in 9(18%) patients. The most common infection was ludwig’s angina seen in 28 patients (56%) patients followed by peritonsillar abscess seen in 10(20%) patients. Conclusion: Since most of the infections are dental in origin, patient education regarding oral and dental hygiene needs to be stressed

​Clinical Profile and Outcome of Ludwig’s Angina in Tertiary Care Hospital in Tamil Nadu

Background: Ludwig’s angina is a lethal infectious cellulitis of the submandibular space, which always makes a difficult situationfor treating surgeons.Objectives: The objective of this study was to study about the presentation, management, and clinical outcome of Ludwig’sangina.Materials and Methods: A study made in the Department of ENT - Head and Neck Surgery, Tirunelveli Medical College,Tirunelveli, for a period of 1 year from July 2016 to July 2017, a total of 41 patients - 33 males and 8 females were includedin the study.Results: Majority of the patients were having a dental infection before the episode - 85%. Pseudomonas aeruginosa is the mostcommon among the isolated pathogens. Six patients presented with stridor and needed tracheostomy. With early incision anddrainage, proper antibiotics and supportive measures, 37 patients survived without any morbidities. Despite all of our greatestefforts, four patients expired. Although comorbidities such as diabetes and chronic kidney disease are seen in few, majoritywere not having any other systemic illness.Conclusion: Prompt diagnosis and surgical drainage with broad-spectrum antibiotics and if needed tracheostomy often givemuch better results in the treatment of Ludwig’s angina. An early intervention of dental infection in early stages may be helpfulin avoiding progression into Ludwig’s angina.

Deep Neck Space Infections: A Profile of Fifty Nine Cases.

The present study was undertaken to analyse our experience with deep neck space infections and emphasize the importance of patient presentation, radiologic evaluation and early diagnosis and appropriate management. The records of 59 patients treated for deep neck space infections were evaluated. Odontogenic infections (35.59%) were found to be the most common cause of deep neck space infections followed by tonsillar infections (20.33%). Pain, fever, neck swelling and odynophgia were the most common clinical presentations. Radiological investigations were performed in all the patients (100%) while contrast enhanced CT - scan was performed in 35 patients (59.32%). The most commonly involved sites were the submandibular space and the parapharyngeal space, involving 14 patients and 11 patients respectively. All the patients (100%) were on intravenous antibiotics and fluids. Surgical intervention was done in 47 patients (79.66%) whereas 12 patients (20.33%) improved with conservative medical management alone. Despite the wide use of antibiotics, deep neck space infections are commonly seen. Early clinical and radiological diagnosis and appropriate management help to prevent the development of life threatening complications. Surgical drainage forms the mainstay of treatment, conservative medical therapy is also effective in selective cases.

A Case of Cryptococcal Abscess Involving Deep Neck Space in an Immunocompetent Patient / 대한이비인후과학회지

The encapsulated yeast, Cryptococcus, has rapidly risen to a worldwide major opportunistic fungal pathogen. Infection with Cryptococcus neoformans usually occurs in immunocompromised host and but may occur also occur in immunocompetent patients. Cryptococccal infection commonly involves the lung or central nervous system; it can disseminate to any organ. However, Cryptococcal abscess in deep neck space is rare. We report an immunocompe-tent patient, who was 60-years-old with cryptococcal abscess in deep neck space. Incisional biopsy of the involved soft tissue revealed the presence of Cryptococcus neoformans. Abscess culture also yielded Cryptococcus. Surgical debriment and antifungal therapy resulted in cure.

Deep Neck Space Infection Along with Tuberculous Cervical Lymphadenitis in an HIV Patient / 대한이비인후과학회지

Recent literature indicates that the incidence of deep neck space infection is on the decline because of the availability of better antibiotics used for upper respiratory infection, but cases of deep neck space infection that do not respond to conventional antibiotic therapy are on the rise. This may be due to reduced immunity, debility, human immunodeficiency virus (HIV) infection, and improper or inadequate treatment. With the emergence of the HIV, the incidence of deep neck space infections and life threatening complications has been on the rise. We describe a case of tuberculous cervical lymphadenitis in an HIV infected patient who developed deep neck space infection and was treated by incision and drainage.

Lipoma of the Deep Neck Space / 대한이비인후과학회지

Lipoma is a common tumor throughout the body, but occurrence in the deep neck space is very rare, and only some cases have been reported by otolaryngologist and pathologist for the last century. In head and neck area, as elsewhere, the lipoma is mainly originated from the subcutaneum. But in deeper tissues, its characteristics are different from those of other sites of lipoma. Submucosal lipoma in the head and neck area usually occur in oral cavity and hypopharynx. Recently we hae experienced 3 cases of deep neck space lipoma, so we report our clinical experiences with brief review of literature.

Clinical Study of Deep Neck Infection: Clinical Analysis of a Hundred Cases / 대한이비인후과학회지

BACKGROUND: Due to the antibiotic therapy and the appropriate treatment, the incidence of the infections of the neck decreased. But during last 5 years in the Red Cross hospital, there were the hundred cases. And a few significant complications were still experienced. OBJECTIVES: For the early treatment and the prevention of the infection of the neck, it is necessary to study the characteristics, the diagnosis, and the treatment. MATERIALS AND METHODS: The hundred cases of the infections of the neck in the Red Cross hospital from January in 1992 to December in 1996 were analyzed about the age and sex distribution related to spaces involved, the location of cellulitis and abscess, the side of lesion, the symptoms and signs, the etiologic events, the associated conditions, the results of culture, the special diagnostic methods, the treatments, and the complications. RESULTS: In the infections of the neck, the following contents were more frequent: male(sex), the third decade(age), pain and fever(symptoms and signs), acute tonsillitis and odontogenic origin(etiologic events), Diabetes Mellitus(associated condition), hemolytic Streptococcus and Bacteroides(the results of culture), and Computerized Tomography(the special diagnostic methods). There was no significant difference in the side of lesion. The useful treatment in the peritonsillar space infection was the incision and drainage and then tonsillectomy two or three weeks after the recovery of the infection, and in the deep neck space infection, only antibiotic therapy or the incision and drainage with the antibiotic therapy were useful. The complications were four cases with two cases of sepsis, one cases of mediastinitis, and one cases of internal jugular vein thrombosis. CONCLUSION: In spite of the antibiotic therapy and the appropriate treatment, there were some complications experieced. So, we must know the characteristics of the infection of the neck well, and the systemic and active attitude is necessary.