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American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 56 – 63
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Deep neck space infections: a retrospective review of 173 cases☆
Salih Bakir, MDa,⁎, M. Halis Tanriverdi, MDb , Ramazan Gün, MDa ,
A. Ediz Yorgancilar, MDa , Müzeyyen Yildirim, MDa , Güven Tekbaş, MDc ,
Yılmaz Palanci, MDd , Kaan Meriç, MDe , İsmail Topçu, MDa
a

Department of Ear Nose & Throat, Dicle University School of Medicine, Diyarbakir, Turkey
b
Department of Family Medicine, Dicle University School of Medicine, Diyarbakir, Turkey
c
Department of Radiology, Dicle University School of Medicine, Diyarbakir, Turkey
d
Department of Public Health, Dicle University School of Medicine, Diyarbakir, Turkey
e
Department of Radiology, Diyarbakir State Hospital, Diyarbakir, Turkey
Received 25 October 2010

Abstract

Purpose: The purpose of this study is to review our recent experience with deep neck infections and
emphasize the importance of radiologic evaluation and appropriate treatment selection in those patients.
Materials and Methods: The records of 173 patients treated for deep neck infection at the
Department of Otolaryngology and Head and Neck Surgery of Dicle University Hospital during the
period from 2003 to 2010 were retrospectively reviewed. Their demography, symptoms, etiology,
seasonal distribution, bacteriology, radiology, site of deep neck infection, durations of the hospital
admission and hospital stay, treatment, complications, and outcomes were evaluated. The findings
were compared to those in the available literature.
Results: Dental infection was the most common cause of deep neck infection (48.6%). Peritonsillar
infections (19.7%) and tuberculosis (6.9%) were the other most common cause. Pain, odynophagia,
dysphagia, and fever were the most common presenting symptoms. Radiologic evaluation was
performed on almost all of the patients (98.3%) to identify the location, extent, and character (cellulitis
or abscesses) of the infections. Computed tomography was performed in 85.3% of patients. The most
common involved site was the submandibular space (26.1%). In 29.5% of cases, the infection involved
more than one space. All the patients were taken to intravenous antibiotic therapy. Surgical intervention was required in 95 patients (59.5%), whereas 78 patients (40.5%) were treated with intravenous antibiotic therapy alone. Life-threatening complications were developed in 13.8% of cases;
170 patients (98.3%) were discharged in stable condition.
Conclusion: Despite the wide use of antibiotics, deep neck space infections are commonly seen.
Today, complications of deep neck infections are often life threatening. Although surgical drainage
remains the main method of treating deep neck abscesses, conservative medical treatment are
effective in selective cases.
© 2012 Elsevier Inc. All rights reserved.

1. Introduction
Deep neck space infection (DNI) means infection in the
potential spaces and fascial planes of the neck, either with

Declaration of interest: The authors report no conflicts of interest. The
authors alone are responsible for the content and writing of the manuscript.
⁎ Corresponding author. Department of ENT, Dicle University School
of Medicine, 21280, Diyarbakir, Turkey. Tel.: +90 412 2488001/4492.
E-mail address: drsalihbakir@hotmail.com (S. Bakir).
0196-0709/$ – see front matter © 2012 Elsevier Inc. All rights reserved.
doi:10.1016/j.amjoto.2011.01.003

abscess formation or cellulitis [1]. Despite the prevalence
and the complications incidence of DNI has been diminished
with improved diagnostic techniques and widespread availability of antimicrobial therapy, these infections are still
serious and potentially life threatening today as in the past.
The DNIs may arise from several focuses in the head and
neck, including teeth, adenotonsillar tissue, and salivary
glands [1-3]. The origin of DNI is different in many publications. In the preantibiotic era, most of DNIs arose from
tonsillitis or pharyngitis [2,3]. Today, dental infections are

The white blood cell (WBC) count was higher than 10 000 cells/mm3 (cells per cubic millimeter) in 98 cases (56%). Odontogenic causes were diagnosed through dental consultations.7%). 2. mediastinitis. was odontogenic (84 cases.3%). and draining fistulas in the neck (2%). an additional magnetic resonance imaging also was performed. In 26 patients. 48. In the remaining 29 patients (16. The cultures of 20 patients (58. dyspnea (12%). and the anterior visceral space (0. The duration of admission ranged from 2 to 33 days with an average of 6.7%).1 years (±15.5%). In 3 patients. treatment.5].6%). pleural empyema.8%).5%).6%). The findings were compared to those in the available literature. After pain. the abscess was caused by tuberculosis (6. bacteriology. and 23 patients (15%) had a WBC count of more than 20 000 cells/mm3. 98.5%). trismus (27%). Radiologic evaluation was performed almost all of the patients to identify the location.5%). The etiology of deep neck infections is recorded in Fig.4]. computed tomography (CT) was performed (85. seasonal distribution.9%). the other common complaint was neck swelling (66%). and outcomes were evaluated. In 12 patients. surgical and imaging findings. complications. kidney disease or malignancies. 1. In addition. 57 patients (33%) had a WBC count of more than 15 000 cells/mm3. the retropharyngeal space (3. summer (24. ultrasonography was the only imaging procedure.5°C). and septic shock [4. or immunodeficiency. site of deep neck infection. For 145 DNI patients.3%). Neck ultrasonography and magnetic resonance imaging of the neck were performed less relatively to the CT. and in 14 of those. The results of bacterial cultures were available for 34 of the 96 cases who underwent surgical treatment or needle aspiration (35. The main complications include respiratory obstruction.8%) were polymicrobial.8%). Anaerobes account for 5 (14. and hospital stay. orthopantograms of the mandible were indicated. etiology. The seasonal distribution of patients presenting with deep neck infections: autumn (43. caused by thyroiditis (0.6%).2%). Bakir et al. 122 (70. 3. odynophagia (48%). symptoms. 3–69 years) (Fig. Peptostreptococcus spp. Complications can even result in death [4]. abscess was caused by branchial cleft cyst (1. The mean age was 25. extention. and in 10 patients. According to clinical. The most common one involved site was the submandibular space (26.4%). the carotid space (0. Streptococci. the records of 173 patients treated for DNI at the Department of Otolaryngology and Head and Neck Surgery of Dicle University Hospital between January 2003 and August 2010 were retrospectively reviewed. the infection involved . Materials and methods In this study. The most common bacteries were anaerobic Peptostreptococcus (21. The second most common cause of deep neck infection was peritonsillar abscess (34 cases. the causes of deep neck infections were identified in 144 patients (83. the parotid space (2.1%). Pain was present in almost all cases.16/1. Considering clinical and radiological evidence.2%) male and 93 (53. an infected salivary glands were found (5.S. dysphonia (28%). the origin of the DNI remained unclear. 1).4%). 19. radiology. 2.7%). and character (cellulitis or abscesses) of the infections (170 patients.5) (range. durations of the hospital admission.7 days. dysphagia (44%). / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 56–63 the most common causes of DNI [4-6]. In 51 patients (29. trauma.3%). Distribution of age (n = 173). Table 1). lung. Staphylococcus aureus and anaerobes are the organisms most commonly cultured from deep neck abscesses [3.7%) of the positive cultures. and winter (15.3%) with diabetes mellitus (DM) in our study.6%) (Fig. jugular vein thrombosis. fever (35%). Results There were 80 (46.9%).5%). Their demography.5%) had one involved space.4%). with a female-to-male ratio of 1.8%). 3.5%). Orthopantograms of the mandible were obtained in 26 cases. the masseter space (0. The purpose of this study is to review our recent experience with DNI and emphasize the importance of radiologic evaluation and appropriate treatment selection in those patients. There were 4 patients (2. The most common cause of deep neck infection 57 Fig. Anaerobic and aerobic cultures were obtained. and in 1 patient. pericarditis. The advent of modern imaging techniques has made it possible to diagnose these complications earlier and to localize them exactly [5]. and Staphylococcus epidermidis (19. The DNIs are generally polymicrobial. the parapharyngeal space (11. In 28 patients (16. There was no case of known liver.5%).8%) female patients. the submental space (10. Physical examination revealed that 77 patients (45%) had fever (N37. Management of deep neck infections has usually been based on prompt surgical drainage of purulent abscesses through an external approach or nonsurgical treatment with on the basis of appropriate antibiotics [7].6 ± 4. intravenous drug abuse. otalgia (13%). followed by the peritonsillar space (14. spring (16.3%).

4. 2. Supportive medical treatments (analgesics and antipyretics. intravenous fluids.5 g 4 times per day plus metronidazole 500 mg Table 1 The seasonal distribution of patients according to the origin of DNI Origin Seasons Total Spring Summer Autumn Winter No. also considering the rising incidence of polymicrobic infections. The surgical procedures ranged from a simple drainage by a topical anesthesia to a wide incision and drainage with a general anesthesia.3%) were discharged in stable condition.7%) and thrombosis of the internal jugular vein (2 patients. 2–36 days) (Fig.0 31 15 10 14 4 36.9 14 44.7 13.3 0 48. 6 patients (3. 6.7% (3 cases). of % cases No.3 75 . In 11 DNI patients with mediastinitis. and 24 patients (13.5%). of % cases Dental 15 Tonsil 5 Tuberculosis 0 Unknown 7 Salivary 1 gland Thyroid 1 Neck cyst 0 Total 29 17. In our department. Discussion The current study found that the most common cause of DNI was dental infections (48. The other rare but serious complications in our series were sepsis (3 patients. all patients received antimicrobial therapy after admission.1%).4 27 . mouthwashes.0 0 .0 13.5%) were treated with intravenous antibiotic therapy alone.0 0 33. The mean duration of hospital stay was 8.8 . Descending mediastinitis (11 patients.9 24 14. of % cases No.0 1 33. we performed mediastinotomy. the third-generation cephalosporin antibiotics. Empirical intravenous antibiotics (β-lactamase-resistant β-lactam antibiotics. metronidazole.0 5 100.4%) required temporary tracheotomy. We mostly chose ampicillin/ sulbactam 1. 4. Considering the clinical condition and imaging. If 2 or more spaces were concurrently involved in a significant way. Twenty-seven patients (15.6%). more than one space. the distribution of involved spaces and sites is recorded in Fig.0 0 16.8 50.6%) were evaluated as Ludwig's angina.8 days (range.3%) was the most frequently occurring complication in our series. The seasonal distribution of DNI patients (n = 173). All these complications were developed in patients with extended space abscesses and Ludwig's angina abscesses. Most reports indicated a significant prevalence of DNI that were caused by dental .0 2 24.1 4 10. whereas surgical intervention was required in 95 patients (59. 78 patients (40.6 173 3 times per day.0 1 16.0 0 33.8 42 28.8%) who developed lifethreatening complications. Distribution of our treatment approach is shown in Fig. 6).7 23.1 8 83. 5 and Table 2.3 1 24. either as cellulitis or abscesses. According to clinical and imaging findings. / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 56–63 Fig. then the antibiotics regimen was modified based on the culture and sensitivity results. 170 patients (98.6%) had upper airway distress. 1.0 84 34 12 29 10 . Crude mortality was 1.3 4 40.3 3 15.7 6 .5 .9 ± 5. Patients with abscesses caused by dental infection were referred to the Department of Oral and Maxillofacial Surgery for further treatment. The diagnostic criteria of Ludwig's angina are defined as the simultaneous involvement of the sublingual. Of them. Eight patients (4.6 17. 1. intravenous steroids) were performed when required.9%) were evaluated as extended spaces. they were classified as extended spaces. Bakir et al.3 1 43. There were 24 patients (13. and submental spaces. of % cases No.58 S. submylohyoid.6 16. The second most preferred option was ceftriaxone 1 g 2 times per day plus metronidazole 500 mg 3 times per day. The antibiotic regimen has to cover mostly gram-positive aerobes and anaerobes implicated in deep neck infections. clindamycin) were administered before the culture results were available.

Huang et al [4] found (42%) in 2004. Parhiscar and Har-El [2] found 43% in 2001. . We found that the second most common cause of deep neck infection was tonsillar infections (19. whereas nowadays. Distribution of etiology (n = 173). Marioni et al [8] found 38. upper airway infections are still the most common cause of deep neck infections [8-12]. In children. and Eftekharian et al [6] found 49% in 2009 that the most common cause of deep neck infection was odontogenic in DNI.4-6.S. According to some recent reports. Before the widespread use of antibiotics. Bottin et al [5] found (42%) in 2003. 4. 3.6]. infections [2. Distribution of involved spaces and sites (n = 173). a decreased incidence (8–16%) in pharyngotonsillar onset was described [2. / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 56–63 59 Fig.7%) (Fig. 3). several studies showed that most DNI cases (70–80%) resulted from com- plicated tonsillopharyngeal infections [7].8].8% in 2008. the most encountered causes still remain acute tonsillitis and pharyngitis [3]. Causes of deep neck infections may differ in various studies. poor dental hygiene and intravenous drug abuse have become the most common causes of DNI in adults. According to some studies. Bakir et al. followed by foreign body Fig.

Because dental and tonsil infections constituted a large part of the etiology in DNI in our series. intravenous drugs abuse. / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 56–63 Fig. These infections are more frequent in younger ages and middle-aged adults [12]. tuberculosis disease is a still common in our country and the other developing and underdeveloped countries especially east of the world. chemotherapeutic treatments. . ingestion and infections of unknown origin [13.1 years.9 29. Considering the biopsy results. which was supported by the World Health Organization.6 58.7 65.14]. whereas other studies showed a male dominancy or an equal distribution [4-6]. Distribution of our treatment approach (n = 173). of cases % 57 10 5 19 3 0 1 95 67. 80. Today. According to the Saydam et al.4 41.3 59.3 34. Tuberculous involvement of the neck is also possible. The mean age was 25. 1.7 40. tuberculosis was suspected in 12 patients and then confirmed by other investigations.0 33.9% of our patients were under the age of 40 and 95. 5. we performed surgical drainage and mass biopsy. Every organ can be affected by tuberculosis. The age distribution showed that most of our patients were young and middle aged. As shown in Fig.4% of patients were younger than 50 years. In our study. followed by dental and upper faryngeal infections.5 27 24 7 10 7 1 2 78 32. chronic Table 2 Distribution of our treatment approach according to the origin of DNI Origin Treatment Total Antimicrobial therapy Dental Tonsil Tuberculosis Unknown Salivary gland Thyroid Neck cyst TOTAL Surgery and antimicrobial therapy No. 6. of cases % No.60 S. Our report has not shown association with trauma. This result is consistent with our country conditions. Because of deep neck abscess formation seen on CT in all. Tuberculosis disease should be considered in the differential diagnosis in patients with DNI.5 84 34 12 29 10 1 3 173 Fig.5 70.9%) (Fig. [15] report. there was a slight predominance of women.0 100. Unlike other reports. Distribution of mean hospital stay (n = 173).0 66. The prevalence of DNI is comparatively high in young and middle-aged adults in our series. the present study showed that. 3).0 . Bakir et al.5 30.1 70. tuberculosis infection was the third common cause (6. prevalence of caries was higher in women than in men in our country.

our clinic might have yielded the significant rate of negative cultures. Contrast-enhanced CT (CCT) scan is highly sensitive (91%) and very useful to identify the extent of the deep neck infections and distinguish cellulitis from abscesses [3]. whereas in our study. and mouthwashes (in dental and peritonsillar infection) were provided. which has been reported as the most commonly involved site in most past studies [3. neck swelling. the percentage of patients younger than 50 years was 95.7]. The results of pus cultures from either surgery or needle aspiration were available in 35.1 years (±15. have more complications. Bottin et al [5] reported that there was a slight preponderance of cases presenting in the summer season (35%). so that not commonly preferred in imaging deep neck infection [18]. so analgesics and antipyretics. This situation can be explained by age differences. and in 29. Widespread diffusion of empirical broadspectrum antibiotic and anti-inflammatory treatments may cause masked presentations of deep neck infections without pain. Magnetic resonance imaging has similar prognostic value to CCT scanning. and 56% had high white blood cell count of over 10 000 cells/mm3. fever. 78 patients (40. or leukocytosis [5].4%) (Fig. There were 4 patients with DM in our study. Table 1). Developing imaging techniques have made the management of deep neck infections better. the presence of dyspnea may be the sign of serious complications.3%). In patients with . empirical antibiotic therapy should be administered before the culture results are available. Although the frequency of dyspnea is not common relatively than the other symptoms.4% of the patients were older than 50 years. anaerobic. and may require surgical treatment [7]. we considered 61 CCT to be part of the routine investigation in DNI patients (85. in patients with cellulitis. and the mean age was 25.3%). medical treatment did not seem to increase complication rates or mortality [6. In those cases. odynophagia. Medical versus medical and surgical treatment was determined by imaging and clinical progress. Penicillin should be the drug of choice for aerobic bacteria.6.5) years. Odinophagia. which were described in some other reports [4. chronic pulmonary diseases. our study showed a lower incidence when compared (2. dysphagia.5). autoimmune disease.16].20]. surgical procedures were required (Fig.5% of patients. 60 mg) were used (where possible) because of strong antiinflammatory effects for a few days in patients showing important local edema and dyspnea. but in our series. However. Medical treatment could also be considered in selected cases [17]. Neither fever nor leukocytosis are constant findings in deep neck infections [6]. According to our group and most investigators worldwide. and dysphagia.1%). [4] reported that the mean age was 49. which were similar to other series [5-7]. Those cases with radiologic findings of cellulitis are supposed to have better prognosis and respond earlier to medical treatment.S.5. and 52.8% of the positive cultures had polymicrobial growth. there was an apparent preponderance of cases presenting in the autumn season (43. 5 and Table 2). In the remaining 95 patients (59. or HIV infection. the infection can be controlled successfully with IV antibiotics alone in most DNI cases [6. Intravenous steroids (methylprednisolone.17].6. as well as β-lactamaseproducing bacteria [3].7. Plaza Mayor et al. whereas those with abscesses behave more aggressively.5 (±20. The positive cultures in our study were much similar to the latest reports [5.5%). the initial antibiotic therapy was penicillin and metronidazole usually. Contrast-enhanced CT helps to decide whether surgical intervention is indicated [18]. and fever was common. renal insufficiency. intravenous fluids for rehydration. The third-generation cephalosporins were used instead if poor clinical response was noted or when complications had developed [1]. This regimen covers most gram-positive. 2.19. but it is more expensive and requires longer scanning time when compared with CCT. ultrasonography cannot always identify small or deep abscess and cannot provide the specific anatomical information necessary for surgical intervention [18]. / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 56–63 hepatitis. Bakir et al. the most probable focus and the existence of a previous treatment.4.3%. 4). management of deep neck abscess has usually been based on prompt surgical drainage of purulent abscesses through an external approach [1-6]. Huang et al. On the contrary. In our patients. Many of our patients had received antibiotic therapy. If there is a small amount of abscess and no impending complications are noted. The most commonly involved site was the submandibular space (26. In our clinic. Fever was present in 45%. the infection involved one space. [7] suggested broad-spectrum intravenous antibiotics and high-dosed oral or intravenous corticosteroids for almost all patients with any DNI. The most frequent symptoms of our patients were pain.4% of patients. Empirical antibiotic treatments must cover grampositive and gram-negative aerobic and anaerobic pathogens [17]. If required. before admission. the infection involved more than one space (Fig. the antibiotics were modified depending on the result of culture and sensitivity reports. medical therapy may be sufficient [6.17]. We used usually penicillin or third-generation cephalosporin plus metronidazole or clindamycin combination depending on the case severity. The limited number of positive cultures did not allow any conclusions. However. besides antibiotic therapy. Based on the clinic and radiological findings. Whenever a DNI patient is admitted. In our series.5%) were treated successfully with only intravenous antibiotic therapy. Huang et al [4] reported that DM is the most common risk factor among the systemic disease that has been associated with the development of deep neck infections and noted a major incidence (30.13.17]. We preferred clindamycin for severe DNI. 58. supportive medical treatment was required because of complaints. in 70. It has been stated that. Based on this evidence.5% of patients. which provides adequate therapy against anaerobes that were resistant to penicilin [1]. 145 patients).

Aroesty JH. respiratory obstruction. Martinez-Vidal A. The remaining 8 patients with mediastinitis recovered with effective intravenous antibiotics after surgical drainage. Har-El G. Sander A. 5. [14] Lee JK. In 11 DNI patients with mediastinitis. Other complications in our series were airway distress and thrombosis of the internal jugular vein. Deep neck infection with dental origin: analysis of 85 consecutive cases (2000-2006). Despite the decreasing in death rates.8 days (range. Rinaldi R. [22] recommended transthoracic mediastinal drainage routinely. [9] Çağlı S.5. Lim SC.68: 259-65. [11] İynen İ. Deep neck infections: a retrospective review of 112 cases. In three patients with mediastinitis had developed sepsis. Temporary tracheotomy was required for 6 patients. Otolaryngol Head Neck Surg 2005. we performed mediastinotomy. et al. Technau-Ihling K. location and extension of neck infections.23:126-33. In patients with descending mediastinitis.28:211-5. Head and neck space infections in infants and children. Staffieri C. Kim HD. Bakir et al. Eur Arch Otorhinolaryngol 2003. whereas thoracotomy is more invasive and associated with the risk of respiratory complications that may worsen the prognosis [21]. the hospitalization time of patients with dental origin was longer than the other patients (Fig. carotid artery rupture. Conclusion Despite the wide use of antibiotics. jugular vein thrombosis. Changing trends in deep neck abscesses. deep neck space infections are commonly seen. 112:375-82. Derin boyun enfeksiyonlarına klinik yaklaşım.13.266:273-7. Öncel S. 2–36 days). Oktay I. Eur Arch Otorhinolaryngol 2009. Oral Surg Oral Med Oral Pathol 1994. Oral health status analysis.3%). et al. Ann Otol Rhinol Laryngol 2010. Deep neck infection: analysis of 185 cases. and securing of airway are recognized cornerstones of treatment. Our treatment approach to deep neck infections (medical or medical plus surgical treatment) was determined by clinical (presentation. Our series had a mean length of hospitalization of 8. In reviewing those 11 mediastinitis cases. Rinaldi R. Montolli F. Erciyes Med J 2006. Characterizations of lifethreatening deep cervical space infections: a review of one hundred ninety-six cases. et al. Kuo WR. The main life-threatening complications include descending mediastinitis. whereas Wheatley et al.128:201-6. Tsai SM. Head Neck 2004.7%. In our series. Deep neck infections: a constant challenge. Weissman JL. Martinez-San Millan J.9 ± 5. According to our results.110:1051-4. Surgical exploration may also required when there is airway compromise. 1990. we found the origin arose from dental infection. pleural effusion. [8] Marioni G. Chen PR. [5] Bottin R. which was similar to other series [5. Odontogenic infections comprise one of the most dangerous causes of DNI [21]. A retrospective review of 83 cases (1998-2001). complications of DNIs should not be underestimated. the treatment of deep neck infection consists of using only antimicrobial therapy primarily in the absence of abscess and presence of the cellulitis and surgical drainage required primarily in the presence of the abscesses.15.260:576-9. pericarditis. [15] Saydam G. Am J Otolaryngol 2003. we had 3 deaths and 3 of them were related to dental infection. Otolaryngol Head Neck Surg 1995. Surgical treatment is essential in patients with mediastinitis [21]. drainage. [12] Boscolo-Rizzo P.5]. adult respiratory distress syndrome. [16] Har-El G. Yonsei Med J 2007. [13] Ridder GJ. [10] Miman MC. Is conservative treatment of deep neck space infections appropriate? Head Neck 2001. et al. The mortality rate in our study was 1.48:55-62. [4] Huang TT.4%).20]. It is worth emphasizing that airway support is the priority in patients with deep neck infections [17]. Deep neck abscess: a retrospective review of 210 cases. Kalcıoğlu T. et al. Vaezeafshar R. hepatic failure. Ankara: Ankara: WHO European Region-Ministry of Health. Şan İ. In our department. Parisi S. Clinical evidence and early radiologic diagnosis with contrast-enhanced CT provide valuable information in defining the origin. Liu TC. pneumonia. Marchiori C. Although surgical drainage remains the main method of treating deep neck abscesses. which was close to that of some previous reports [1. Staffieri A. Kinzer et al [21] performed collar mediastinotomy. complications. et al.6:25-8. Marioni et al [17] reported that none of their patients died of deep neck infection or its complications.77:446-50. and disseminated intravascular coagulopathy [4. J Harran Univ Med Fac 2009. Our results demonstrate that tuberculosis must be considered as possible causes of DNIs. Three of them died related to septic shock.16]. Deep neck infection: an analysis of 82 patients. Roozbahany NA. Deep neck infections: results of 50 cases. Güney E. the most frequently occurring complication was mediastinitis (11 cases.17]. The combination of appropriate intravenous antibiotic therapy. The mortality rate may reach 40%. ORL J Otorhinolaryngol Relat Spec 2006. Yüce İ.8:206-13. Shaha A. [3] Ungkanont K. The tracheostomy rate was considerably low (3.62 S. et al.24:111-7. Acta Otolaryngol 2008. even now. early open surgical drainage is the most appropriate method of treating a deep neck infection [4]. [17] Marioni G. KBB İhtisas Dergisi 2001.133:709-14. Bozkuş F. while these serious complications occur [4]. Marioni G. response to antibiotics in the first 48 hours) and radiological evidence. Deep neck infection: a presentday complication. Descending mediastinitis is one of the most lifethreatening complications of DNI [14]. et al. conservative medical treatment are effective in selective cases. [7] Plaza Mayor G. clinical signs of sepsis occur or if there is poor response to antimicrobial therapy within the first 48 hours [6. In a recent study.4. [6] Eftekharian A. 6.26:854-60. because in our series. Yellon RF.119:181-7. Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Rational diagnostic and therapeutic management of deep neck infections: analysis of 233 consecutive cases. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases. septic shock. Ann Otol Rhinol Laryngol 2001. Moller I. . [2] Parhiscar A. 6). et al. venous septic emboli. et al. References [1] Wang LF. / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 56–63 significant abscess formation seen on CT. Access by cervical incision has a lower risk than thoracotomy and avoids pleural contamination.

Akkaya A. Am J Otolaryngol 2006.129: 62-70.49:780-4. T Klin J E N T 2001.S. et al. Ann Thorac Surg 1990. [22] Wheatley MJ. . Br J Oral Maxillofac Surg 2007. Role of socioeconomic factors in deep neck abscess: A prospective study of 120 patients. Descending necrotizing mediastinitis: transcervical drainage is not enough. Hsu JM. Acta Otolaryngol 2009. [19] Agarwal AK. Stirling MC. A retrospective study in patients with deep neck infections. Kirsh MM.45:553-5. Chang J. Severe deep neck space infections and mediastinitis of odontogenic origin: clinical relevance and implications for diagnosis and treatment. Sağlam M. 63 [21] Kinzer S.1:134-40.27:244-7. / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 56–63 [18] Smith II JL. Predicting deep neck space abscess using computed tomography. [20] Tosun F. Becker S. et al. Pfeiffer J. Sethi A. Bakir et al. et al. Sethi D.