Deep Neck Infection

Deep Neck Infection: Analysis of 185 cases Authors: Tung-Tsun Huang, MD,1 Tien-Chen Liu, MD,2 Peir-Rong Chen, MD,1 Fen-Yu Tseng, MD,3 Te-Huei Yeh, MD,2 Yuh-Shyang Chen, MD2Department of Otolaryngology, National Taiwan University Hospital

Publishing: Accepted 6 January 2004 Published online 3 June 2004 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.20014Journal ClubObjectivesTo review the experience the National Hospital in Taiwan with Deep Neck InfectionsTo identify the predisposing factors of lifer-threatening complications Methodology Retrospective studyHard and electrical medical records of patient diagnosed with deep neck infections in the department of ORL at the national Taiwan University HospitalTime-Frame: 1997-2002 Exclusion Criteria:Superficial Cellulites/abscessLimited intra-oral abscess Peri-tonsilar AbscessCervical Necrotizing Fasciitis Cervical infections secondary to penetrating/iatrogenic neck traumaPatient who did NOT complete the treatment within the hospital

Methodology Sample Size: 185 patients DemographyEtiologyUnderlying systemic illnessesBacteriologyRadiologyTreatmentHospitalization durationComplicationsOut-come of treatmentMethodology Results-Demography185 patients: 109 males vs. 76 females

Results Space involvedCT Neck with contrast was done to all patientsAbscess: 76.8 % Cellulites: 23.2%

Results - EtiologyThe cause of infection was identified in 79 patients

Results Underlying Medical Illness63 patients has an underlying systemic illness38 males25 femalesIllness:DM Type IIChronic Renal DiseaseLiver Cirrhosis Gastric related malignancy on chemotherapyResults Bacteriology Sample obtained either through needle aspiration or surgeryOnly 127 patients112 patients had bacterial growth Polymicrobial Results Bacteriology

Results - TreatmentAll patients received antimicrobial therapyAbscess Group: 142 patients103 underwent surgical drainage19 multiple needle aspiration1 Teeth extraction19 only IV anti-microbial therapyResults- Complications16.2 % of patients had complications and some were multi-complicated

Results- ComplicationsResults - MortalityAll patient with both abscess and cellulites were discharged in a stable medical conditionExcept 3 deathsAge mean >55 yearsHad underlying medical illnessDeveloped complications Results Hospital Stay2 -72 daysDiabetic patients had longest stay followed by patient who had tracheotomy done DiscussionAge and underlying medical illness are the most important predisposing factors in deep neck infectionsMore complications Longer hospital stay Death Why? Lower defense mechanism and lower rate of recovery Odontogenic infection is the commonest cause of infectionFollowed by IV drug abuse and neck traumaHar-El and Sethi reportBut.. URTI was the commonest in this studyWhy? resolves fast, disappears at the time of presentationOdontogenic and URTI both causes cervical lymph adenopathy and so lymph nodes abscessDiscussionBacteriology:Polymicrobial growthS. viridans followed by Beta-Hemolytics streptococci and StaphylococcusThen.. K. pneumonia and Peptostreptococcus Not much different and can be explained by # of diabetic patients as K. Pneumonia is the commonest pathogen in diabetic patientsDiscussionBlood culture was not of a value in this study and direct pus culture was used CT scan was done for allTo differentiate abscess from cellulitesTo locate the extend of the infectionSurgical approach applicability DiscussionTreatment:All received antimicrobial therapyDid it delay the surgical management?Surgical drainage is preferredConfirmed abscess in CT scanImpending complicationsHistory of previous poor respond to antimicrobial therapy Long course of antibiotics DiscussionAirway obstruction is a well known complication for neck infectionsLudwings angina and retro-pharyngeal abscess Tracheostomised Unlike the reviewed the literatureWhy? Early diagnosis and treatment DiscussionDiabetic is the commonest systemic illness in all literatureOptimization is essentialChange from Oral Hypoglycemic agent to insulin DiscussionConclusion Red Flags: Old Age, DM and Systemic Illness DM may be a precipitating factor in deep neck infection, therefore, any treatment without diabetic control is sub-optimalWhenever applicable, early surgical drainage is the ultimate treatment Retrophargeal space abscess and Ludwigs angina are impending airway! Critical Appraisal Yes No? QuestionsThank you.