Deep Neck Infections: Signs and Symptoms, Diagnosis, and Treatment

What Are Deep Neck Infections?

Deep neck infections are serious infections that affect the deep neck spaces. They pose a serious threat to life. When the condition receives treatment late, it may even lead to the patient's death. The structure and complexity of the areas affected by this infection make their management difficult. Deep neck space infections can spread rapidly and compromise the patient's breathing. Hence, the priority while treating should be maintaining the airway.

What Is the Pathophysiology of Deep Neck Infections?

These deep neck spaces, by their relationship to the hyoid bone, are divided into three groups that include the following spaces:

Above the Hyoid:

• Peritonsillar Space: This is between the tonsil and the lateral superior pharyngeal constrictor. Tonsillitis is usually the cause of infections.
• Submandibular Space: This is bounded above by the mandible and below by the hyoid. Infections are usually odontogenic in origin (Streptococcus viridans). Infection of this space may lead to Ludwig's angina.
• Parapharyngeal Space: Infections derive from such diseases as tonsillitis and pharyngitis. Masticator, Buccal, and Parotid Spaces: Infections are associated with dental or parotid pathology.

Causing Involvement of the Entire Neck:

• Retropharyngeal, Danger, and Prevertebral Spaces: Infections can exhibit dangerous complications, such as sepsis, especially in children.
• Carotid Space: It encloses major vessels and nerves. Infections here usually extend from surrounding areas.

Below the Hyoid:

• Anterior Visceral Space: It usually presents with infections originating from trauma to the esophagus.

What Are the Signs and Symptoms of Deep Neck Space Infections?

The most common signs and symptoms of deep neck infections are fever, increased WBC (white blood cells), and pain in the neck region. However, the other signs and symptoms will vary depending upon the space infected, and they are as follows:

• Asymmetry of the neck is caused by swelling caused by the infection in the deep neck space.
• Enlarged lymph nodes due to the infection.
• Medial displacement of the tonsil is caused by parapharyngeal space involvement.
• Trismus (restriction to the jaw movements) due to the involvement of the pterygoid muscle.
• Shortness of breath and tachypnea (abnormally rapid breathing) are symptoms of neck swelling, which obstructs the airway.
• Increase in temperature at regular intervals.
• Torticollis, in which the head is tilted to one side, can be caused by inflammation of the muscles around the spinal cord.
• Limited neck movement.
• The patient may have a stridor, which is a high-pitched, musical breathing sound.

How to Diagnose Deep Neck Space Infections?

The health worker will work up the case by taking a detailed medical history. Following this, the doctor will do a physical examination, according to which the doctor will advise for additional tests such as:

• Complete Blood Count: The complete blood count may show leukocytosis (increased white blood cell count), which may also reveal dehydration if the patient is not taking enough fluid due to pain.
• Blood Culture: If there is purulent discharge from the area, a blood culture test is performed to identify the microorganism causing the infection.
• X-ray: Plain radiography of the neck regions is advised to identify the space infected.
• Ultrasound: Ultrasound scanning is useful only when the infection is not very deep and may not be adequate for deep infections.
• Computed Tomography (CT) Scan: A CT scan with contrast is the gold standard in identifying deep neck infections. A CT scan can determine the boundary, location, and relation to the adjacent neurovascular structures.

How Are Deep Neck Space Infections Treated?

The management of this condition should be done immediately as the infection has a rapid progression, and if medical attention is not given at the right time, it may lead to the patient's death. The treatment involves the following:

1. Securing the Airway:

• The first and foremost thing to do in managing a deep neck infection is to see if the airway is getting obstructed because of the infection. In emergencies, securing the airway involves observation, endotracheal or nasotracheal intubation, tracheostomy, or cricothyroidotomy. However, it is challenging to intubate patients with deep neck infections as there are chances of rupture of the abscess, which could lead to aspiration, acute airway obstruction, and death.
• Another factor making the intubation challenging is the difficulty visualizing the larynx because of the swelling, which might cause lateral displacement.
• Patients with significant airway obstruction should be considered for tracheostomy under local anesthesia to secure the airway. Tracheostomy is more conservative, safer, and preferable in case of deep neck infections.

2. Intravenous Antibiotic: An intravenous route of antibiotic administration is given to the patients. Antibiotic therapy can be started before the culture reports are obtained with the antibiotics, covering almost all possible bacteria groups. Once the culture reports are received, the therapy can be modified according to them. Intravenous antibiotics are administered till the patient's condition improves and the patient is febrile for at least two days.

3. Incision and Drainage: Incision and drainage are given for patients in whom intravenous antibiotic therapy has shown no improvement even after 48 to 72 hours of antibiotic treatment. Once the airway is secured, incision and drainage are done. Various approaches to drainage will depend on the infected space. The technique used to drain must ensure adequate exposure and allow drainage without compromising the adjacent structures.

4. Fine Needle Aspiration: Fine needle aspiration is performed in patients whose infections are easily approachable or in patients who are unstable enough to undergo general anesthesia. The procedure requires CT scan assistance or ultrasound guidance in such cases.

What Are the Complications Associated with Deep Neck Infections?

Deep neck infections are associated with many life-threatening complications and may even lead to the patient's death if the treatment is delayed. The complications include the following:

• Airway obstruction occurs when the trachea gets compressed because of swelling.
• Aspiration can occur spontaneously when the pus drains into the airway, which can happen to its owner during endotracheal intubation.
• Cranial nerve dysfunction can happen.
• Infection of the mediastinum due to the spread of the disease from the neck to the chest region.
• Osteomyelitis can occur when the infection spreads to the bones of the spine, mandible, or skull base.
• Necrotizing cervical fasciitis is an infection of the connective tissue.
• Septic shock (a potentially life-threatening condition that occurs when an infection leads to a dangerously low blood pressure level and organ failure).
• Septic emboli (blood clots containing bacteria that have become dislodged and traveled through the bloodstream).

What Are the Outcomes and Prognosis of Deep Neck Infections?

Patients with deep neck infections can fully recover if they receive adequate treatment. When treatment is delayed, many complications can occur that prolong the treatment's duration. Once the infection is fully treated and recovered, there is no chance of recurrence.

Conclusion

Deep neck infections are severe life-threatening conditions requiring immediate medical attention. The symptoms are very particular for this condition. If someone has symptoms of this condition, consult a healthcare provider immediately. Deep neck infections should be diagnosed early to receive the proper treatment and avoid possible complications.