Deep neck space infection
Infection tracking through the fascial spaces of the neck, most often from an odontogenic, tonsillar, or salivary source, that threatens the airway and can spread to the mediastinum. Diagnosis rests on contrast-enhanced CT of the neck; treatment is airway protection, intravenous antibiotics, and surgical drainage of any organized collection.
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What this article covers
- Overview
Deep neck space infection is suppuration that has spread beyond a tooth, tonsil, or salivary gland into the fascial compartments dividing the neck, presenting with fever, neck swelling, pain, and…
- Epidemiology
No population incidence is established for this category, so the typical patient is described rather than a rate assigned.
- Risk factors
Poor oral hygiene and dental disease: untreated caries, periodontitis, or a recent extraction, the leading identifiable cause in adults.
- Pathophysiology
The process is polymicrobial, reflecting normal oral and pharyngeal flora: viridans group streptococci, group A Streptococcus, Staphylococcus aureus, including methicillin-resistant Staphylococcus…
- Clinical features
Fever, neck pain, and swelling: the near-universal triad; the site of maximal firmness points to the involved space.
- Differential diagnosis
Epiglottitis: shares fever, muffled voice, drooling, and trismus, but is diagnosed by direct fiberoptic visualization of a cherry-red, swollen epiglottis, or a thumbprint sign on lateral radiograph, rather than by neck swelling.
- Diagnosis
Establishing the diagnosis: deep neck space infection, and its distinction from a non-drainable phlegmon, rests on contrast-enhanced computed tomography (CT) of the neck, the gold standard, showing…
- Management
First, secure the airway if there is any sign of compromise: stridor, drooling, an inability to swallow secretions, or rapidly expanding bilateral submandibular swelling calls for controlled, awake…
- Complications
Airway obstruction: from mechanical compression by an expanding phlegmon or abscess, most classic in Ludwig angina, and the leading cause of death when recognition is delayed.
- Prognosis
With prompt airway management, antibiotics, and drainage of any organized collection, most single-space infections resolve within 2 to 3 weeks with no lasting deficit.
- Prevention
Routine dental care: twice-yearly cleanings and prompt treatment of caries or periodontitis remove the leading source of adult disease before it can spread past the tooth root.
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- Ludwig angina
Ludwig angina is a rapidly progressive, usually odontogenic cellulitis of the submandibular, sublingual, and submental spaces that can cause airway obstruction from posterior tongue displacement. Airway assessment and securing take priority over every other step, followed by broad-spectrum IV antibiotics and drainage of any organized abscess.
- Peritonsillar abscess
Peritonsillar abscess is the most common deep-space neck infection, presenting with unilateral sore throat, trismus, a muffled hot potato voice, and uvula deviation away from the affected side, treated with prompt drainage plus antibiotics covering group A streptococcus, Staphylococcus aureus, and oral anaerobes.
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