Evaluation of diagnosis, complications and management of Head and Neck space infections: A study on 50 patients

To carry out a prospective study to study and evaluate the aetiology, clinical presentation, bacteriology, management and complications of neck abscesses.

The study was carried out at Topiwala National Medical College and B.Y.L. Nair Hospital, Mumbai. Fifty patients with abscesses in various neck spaces were selected and informed consent was taken for the study. All the patients were investigated for routine blood examinations. Radiological examinations i.e. X-ray chest PA view and X-ray neck AP view and lateral view were done. Our diagnosis was confirmed by Ultrasonography or Computed Tomography (CT) of the neck. Computed Tomography (CT) of the neck was done in all cases to differentiate between abscess and cellulitis. In cases of retropharyngeal, prevertebral, parapharyngeal or visceral vascular space CT scan was carried out to study the exact extent of the abscess and the condition of surrounding structures. In cases where presence of pus was ascertained,the abscess was incised and drained under suitable anaesthesia. Pus was sent for Smear culture and antibiotic sensitivity test for both aerobic and anaerobic microorganisms. All measurements and findings were compared and statistically analyzed. RESULTS Neck abscesses were common in the third to fourth decade of life (24%) with a male preponderance (64%), male to female ratio being 01.78:01. The most common site of neck abscess was found to be in the submandibular space (52.05%), commonly secondary to dental caries followed by submental abscess (23.28%). Lateral pharyngeal abscess was seen in 09.58% cases and retropharyngeal abscess in 04.10% cases. Pain in the neck was the most common symptom (100%) followed by swelling in the neck and odynophagia (96%). The most common aetiological factor for abscesses of the deep neck spaces was dental infection (76.27%), followed by pharyngotonsillitis (22.03%). Uncontrolled Diabetes mellitus is the commonest coexisting systemic disease seen in 13 cases (76%) followed by HIV positive status found in 04 patients (24%). Streptococci species and Enterococcus species were the most common organism (33.33%), followed by Staphylococcus (16.66%).

Computed tomography is an important tool which not only helps in differentiating cellulitis from the presence of pus but also in mapping the extent of disease. It also helps in identifying the complications early and thus in planning the most appropriate line of management. Airway management should be the top priority in treatment of deep neck abscesses. Airway management may require intubation or tracheostomy to overcome the obstruction especially seen in submandibular abscess, retropharyngeal abscess and parapaharyngeal abscess. Although the optimal timing for incision and drainage may be difficult to ascertain,early incision and drainage of all abscesses is advocated.