Deep Neck Space

Infections

Fascial Planes of the

Neck
Superficial

cervical fascia

Envelopes; Boundaries; Significance

Deep

cervical fascia

Superficial layer (investing layer)

Envelopes; Boundaries; Significance
Middle layer (visceral fascia)
Envelopes; Boundaries; Significance
Deep layer (prevertebral fascia)
Envelopes; Boundaries; Significance

Carotid

sheath fascia

Envelopes; Boundaries; Significance

Neck Spaces
(Boundaries & Contents)
Parapharyngeal

space
Pterygopalatine (pterygomaxillary) fossa
Masticator space
Temporal fossa
Infratemporal fossa
Parotid space
Peritonsillar space
Submandibular space
Carotid sheath space
Visceral (pretracheal) space
Retropharyngeal (retrovisceral) space
Danger space
Prevertebral space

Etiology
Dental

infections (most common in adults)

Acute pharyngitis of Waldeyers ring (most common
in children)
Cervical lymphadenitis (r/o cancer in adult)
Acute rhinosinusitis (retropharyngeal lymphadenitis)
Acute mastoiditis (Bezold abscess)
Iatrogenic (oral surgery; intubation; endoscopic
trauma)
Sialadenitis
Foreign body
Penetrating cervicofacial trauma (including IV drug)
Cellulitis
Congenital cysts (thyroglossal duct; branchial cleft)
Acquired cysts (laryngoceles; saccular cysts)

Microbiology
Mixed

aerobic & anaerobic oropharyngeal flora

(most common)
Strep. viridans
Strep. pyogenes
Peptostreptococcus
Staph. epidermidis
Staph. aureus
MRSA
Bacteroides
Fusobacterium
Neisseria, Pseudomonas, Escherichia, Haemophilus
Actinomyces
Mycobacteria
Baronella henselae

History
Inflammatory

symptoms
Localizing symptoms
Recent infection
Recent trauma
Recent surgery
Immunodeficiency status

Physical Examination
Palpation
Otoscopy
Oral cavity

& Pharynx

Dentition
Trismus
Salivary ducts
Unilateral tonsil swelling

Awake

flexible fiberoptic airway

evaluation

Diagnostic Testing
Blood

tests
Plain x-rays
Lateral neck film
Chest film

CT with IV contrast
MRI
Ultrasound

Treatment
Airway

management
Fluid resuscitation
IV antibiotics
Surgical management
Indications
Goals
Needle aspiration
Transoral incision & drainage (peritonsillar abscess,

buccal space, masticator space, pterygomaxillary

space)
Tonsillectomy
Transcervical incision & drainage
Surgical technique

Complications
Ludwigs

angina
Cavernous sinus thrombosis
Lemierre syndrome
Carotid artery pseudo-aneurysm
or rupture
Mediastinitis
Necrotizing fasciitis