Deep neck infection

Mantas Žemaitaitis1, Gytis Baranauskas2, Evaldas Padervinskis2

1Lithuanian university of health sciences, Academy of  Medicine, Faculty of medicine1

2Lithuanian university of health sciences, Kaunas clinics, clinic of ear, nose and throat diseases2


Deep neck infection is a topical issue like any other area infection, but their distinctiveness is a quick complication of life-threatening conditions. The breakthrough in the treatment of infectious diseases was caused by the invention of penicillin. Of course, deep neck infection is no exception. Unfortunately, there is a growing tendency for resistant strains of bacteria to cause deep neck infections [10], so they are still common and may be associated with high morbidity and mortality [2]. It is also observed that the incidence of abscesses following upper respiratory tract infections is decreasing, but the number of abscesses caused by dental infections is relatively higher [10]. The complex anatomy of the head and neck complicates the diagnosis of the disease, but the severity of the symptoms allows early suspicion of infection and timely treatment. This helps prevent complications [9]. It is especially important to monitor airway passage to prevent pressure and their obstruction. Low socioeconomic status, comorbidities, immunosuppressive conditions such as diabetes, human immunodeficiency virus infection increase the risk of atypical disease and complications.

Aim: Analyze cases of deep neck infections treated in  Kaunas Clinics Hospital of LUHS in the years 2014 – 2018  and to compare the obtained results with the data of the scientific literature.

Material and methods: a retrospective study was performed in the Kaunas Clinics Hospital of LUHS, analyzing deep neck infection cases in the years 2014-2018. For literature analysis, the PUBMED-EMBASE database has been searched and articles analyzed.

Results: 122 patients were found in the study period – 69 males (56,6 %) and 53 females (43,4 %). The mean age of the patients was 49,69 ± 20,22 (0,7;88) years. The shortest period of treating was (7,75 ± 2,18) days and the longest period was (15,46 ± 11,51) days. Even 96,7 % patients required at least one surgery. Most cases had parapharyngeal abscesses (58,2 %) and the least cases had parotid area abscess (0,8 %). The most common symptoms were fever (87,7 %), neck pain (45,9 %) and painful swallowing (41 %). The mean temperature was 38,08 ± 0,71 ˚C. On average, C reactive protein was elevated to 238,74 ± 131,62 mg/l and leukocyte count to 15,69 ± 6,09. Anaerobes accounted for the largest proportion (19,7 %). The most common antibiotics used to treat the disease were penicillin and metronidazole (45,1 %). The most common complication was mediastinitis (13,9 %). We can predict if the patient‘s age is > 63,5 years the odds ratio for dying is higher 18,205 [3,3669 – 90,318].

Conclusion: Deep neck infection is a condition that requires urgent treatment. According to our study and literature review, most cases require operative treatment. Abscess spreads rapidly, leading to life-threatening complications. Pus can accumulate at any cervical interfacial gap. Infection is more dangerous and difficult to cure for older people and comorbidities.

Keywords: deep neck infections,  odontogenic infections, mediastinitis