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How to avoid life-threatening complications following head and neck space infections: an algorithm-based approach to apply during times of emergency. When and why to hospitalise a neck infection patient

  • O Gallo (a1), G Mannelli (a1), M S Lazio (a1) and R Santoro (a1)
Abstract
Abstract Background:

Head and neck space infections present with a potential mortality rate of 40–50 per cent. This paper proposes an algorithm-based management of head and neck space infection to prevent life-threatening events.

Methods:

A total of 225 patients with head and neck space infection were prospectively analysed at our institution. An experimental scoring system determined the level of clinical risk for the development of major complications. Accordingly, patients were classified into three risk groups: low-, intermediate- and high-risk.

Results:

Only intermediate- and high-risk patients were hospitalised. Intermediate-risk patients received intravenous medical therapy with daily re-evaluation; 18 of them required delayed surgery. Of the high-risk patients, three required immediate surgical treatment and five received delayed surgery, while in five cases medical therapy was the only treatment received. Low-risk patients were treated in an out-patient setting.

Conclusion:

The algorithm-based management of head and neck space infection was successful in enabling the avoidance of lethal complications onset.

Copyright
Corresponding author
Address for correspondence: Dr Giuditta Mannelli, Clinic of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Azienda Ospedaliera Universitaria Careggi, Via Largo Brambilla 3, Florence 50134, Italy E-mail: mannelli.giuditta@gmail.com
References
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1 Sakarya EU, Kulduk E, Gundogan O, Soy FK, Dundar R, Kilavuz AE et al. Clinical features of deep neck infection: analysis of 77 patients. Kulak Burun Bogaz Ihtis Derg 2015;25:102–8
2 Ovassapian A, Tuncbilek M, Wentzel EK, Joshi CW. Airway management in adult patients with deep neck infections: a case series and review of the literature. Anesth Analg 2005;100:585–9
3 Miller B, Khalifa Y, Feldon SE, Friedman DI. Lemierre syndrome causing bilateral cavernous sinus thrombosis. J Neuroophthalmol 2012;32:341–4
4 Colmenero Ruiz CC, Labajo AD, Yanez Vilas IY, Paniagua J. Thoracic complications of deeply situated serious neck infections. J Craniomaxillofac Surg 1993;21:7681
5 Levine TM, Wurster CF, Krespi YP. Mediastinitis occurring as a complication of odontogenic infection. Laryngoscope 1986;94:747–50
6 Huang TT, Tseng FY, Yeh TH, Hsu CJ, Cen YS. Factors affecting the bacteriology of deep neck infection: a retrospective study of 128 patients. Acta Otolaryngol 2006;126:396401
7 Brito TP, Hazboun IM, Fernandes FL, Bento LR, Zappelini CE, Chone CT et al. Deep neck abscesses: study of 101 cases. Braz J Otorhinolaryngol 2017;83:341–8
8 Meher R, Jain A, Sabharwal A, Gupta B, Singh I, Agarwal AK. Deep neck abscess: a prospective study of 54 cases. J Laryngol Otol 2005;119:299302
9 Reynolds SC, Chow AW. Life-threatening infections of the parapharyngeal and deep fascial spaces of the head and neck. Infect Dis Clin North Am 2007;21:557–76
10 Beck HJ, Salassa JR, McCaffey T, Hermans PE. Life-threatening soft tissue infections of the neck. Laryngoscope 1984;94:354–61
11 Uluibau IC, Jaunay T, Goss AN. Severe odontogenic infections. Aust Dent J 2005;50:S7481
12 Lee YQ, Kanagalingam J. Bacteriology of deep neck abscesses: a retrospective review of 96 consecutive cases. Singapore Med J 2011;52:351–5
13 Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am 2008;41:459–83
14 Lin HT, Tsai CS, Chen YL, Liang JG. Influence of diabetes mellitus on deep neck infection. J Laryngol Otol 2006;120:650–4
15 Oliver ER, Boyd Gillespie M. Deep neck space infections. In: Cummings Flint PW, Haughey BH et al. , eds. Otolaryngology – Head and Neck Surgery, 5th edn. St Louis: Mosby, 2010;201–8
16 Wang LF, Tai CF, Kuo WR, Chien CY. Predisposing factors of complicated deep neck infections: 12-year experience at a single institution. J Otolaryngol Head Neck Surg 2010;39:335–41
17 Yellon RF. Head and neck space infections. In: Bluestone CD, Casselbrant ML, Stool SE et al. , eds. Pediatric Otolaryngology, volume 2, 4th edn. Philadelphia: Saunders, 2003;1681–701
18 Sueara AB, Gonçalves AJ, Alcadipani FA, Kavabata NK, Menezes MB. Deep neck infection: analysis of 80 cases. Braz J Otorhinolaryngol 2008;74:253–9
19 Bartlett JG, Gorbach SL. Anaerobic infections of the head and neck. Otolaryngol Clin North Am 1976;9:655–78
20 Brook I. Microbiology and management of peritonsillar, retropharyngeal and parapharyngeal abscesses. J Oral Maxillofac Surg 2004;62:1545–50
21 Boscolo-Rizzo P, Marchiori C, Zanetti F, Vaglia A, Da Mosto MC. Conservative management of deep neck abscesses in adults: the importance of CECT findings. Otolaryngol Head Neck Surg 2006;135:894–9
22 Daramola OO, Flanagan CE, Maisel RH, Orland RM. Diagnosis and treatment of deep neck space abscesses. Otolaryngol Head Neck Surg 2009;141:123–30
23 Nagy M, Backstrom J. Comparison of the sensitivity of lateral neck radiographs and computed tomography scanning in pediatric deep-neck infections. Laryngoscope 1999;109:775–9
24 Crespo AN, Chone CT, Fonseca AS. Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection. Sao Paulo Med J 2004;122:259–63
25 Boscolo-Rizzo P, Stellin M, Muzzi E, Mantovani M, Fuson R, Lupato V et al. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol 2012;269:1241–9
26 Gallo O, Deganello A, Meccariello G, Spina R, Peris A. Vacuum-assisted closure for managing neck abscesses involving the mediastinum. Laryngoscope 2012;122:785–8
27 Yuen H, Loy A, Johari S. Urgent awake tracheotomy for impending airway obstruction. Otolaryngol Head Neck Surg 2007;136:838–42
28 Boscolo-Rizzo P, Da Mosto MC. Submandibular space infection: a potentially lethal infection. Int J Infect Dis 2009;13:327–33
29 Boscolo-Rizzo P, Marchiori C, Montolli F, Vaglia A, Da Mosto MC. Deep neck infections: a constant challenge. ORL J Otorhinolaryngol Relat Spec 2006;68:259–65
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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