Deep Neck Infections as a Complication of Pharyngeal Inflammation
Authors:
Jana Krtičková 1
; J. Haviger 2; Lenka Ryšková 3
; Jana Šatanková 1
; Viktor Chrobok 1
; L. Školoudík 1
Authors‘ workplace:
Klinika otorinolaryngologie a chirurgie hlavy a krku LF UK a FN Hradec Králové
1; Katedra informatiky a kvantitativních metod, Fakulta informatiky a managementu, Univerzita Hradec Králové
2; Ústav klinické mikrobiologie, Fakultní nemocnice Hradec Králové
3
Published in:
Otorinolaryngol Foniatr, 66, 2017, No. 1, pp. 7-11.
Category:
Original Article
Overview
Introduction:
In our study, we analyzed data from patients hospitalized with deep neck infection over the period from 2003 to 2012.
Results:
A total of 654 patients were hospitalized during the study period for complications of acute inflammation of pharynx, of which 587 patients for peritonsillar complication, in 67 patients experienced the development of deep neck inflammation. Men are affected 3 times more often than women. By comparing inflammatory parameters, we found lower values in the group of patients with abscess-forming lymphadenitis compared to those with involvement of the parapharyngeal and retropharyngeal areas. When comparing the values of inflammatory markers with patients suffering from peritonsillar complications during the same period, we have confirmed the hypothesis that the values of inflammatory markers in children cannot be used to distinguish whether they have a peritonsillar involvement or already a deep neck infection. In adults, the increase in inflammatory markers was significantly higher (p=0.002) in patients with deep neck infections. When comparing surgical approaches in the treatment of parapharyngeal and retropharyngeal abscesses, we found a higher number of reoperations in patients with transoral approach (64 %) compared to those with external approach (7 %). In the group of patients with involvement of the parapharyngeal and retropharyngeal area, fibroscopic intubation was needed in 28% of adult patients and tracheostomy was performed in 2 adults. ).
Conclusion:
Deep neck inflammation is always an indication for surgical drainage. We believe the safest procedure is revision surgery using a wide external approach. Special attention is required to manage the patient’s airways. Interdisciplinary cooperation is required for comprehensive treatment of deep neck inflammation.
Keywords:
abscess, retropharyngeal abscess, cellulitis, deep neck infection
Sources
1. Bakir, S., Tanriverdi, M. H., Gün, R.,Yorgancilar, A. E., Yildirim, M., Tekbaş, G., Palanci, Y., Meriç, K., Topçu, I.: Deep neck space infections: a retrospective review of 173 cases. Am. J. Otolaryngol., 33, 2012, 1, s. 56-63.
2. Beneš, J.: Infekční lékařství. Praha, Galén, 2009, s. 492-500. ISBN 978-80-7262-64-1.
3. Bolton, M., Wang, W., Hahn, A., Ramilo, O., Mejias, A., Jaggi, P.: Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone. Pediatr. Infect. Dis. J., 32, 2013, 9, s. 1034-1036.
4. Brook, I.: Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Journal of Oral and Maxillofacial Surgery, 62, 2004, 12, s. 1545-1550.
5. Cotichia, J. M., Getnick, G. S., Yun, R. D., Arnold, J. E.: Age-,time-,side- specific differences in pediatric deep neck abscesses, Arch. Otolaryngol. Head and Neck Surgery, 130, 2004, 2, s. 201-207.
6. Daya, H., LO, S., Papsin, B. C., Zachariasova, A., Murray, H., Pierie, J., Laughlin, S., Blaser, S.: Retropharyngeal and parapharyngeal infections in children: the Toronto Experience. Int. J. Pediatr. Otorhinolaryngol., 69, 2005, 1, s. 81-86.
7. Dytrych, P., Kabelka, Z., Katra, R., Marková, M., Kynčl, M., Jurovčík, M.: Parafaryngeální a retrofaryngeální absces u dětí, Otorinolaryng. a Foniat. /Prague/, 58, 2009, 2, s. 79-82.
8. Grisaru-Soen, G., Komisar, O., Aizenstein, O., Soudack, M., Schwartz, D., Paret, G.: Retropharyngeal and parapharyngeal abscess in children - epidemiology, clinical features and treatment. Int., 74, 2010, 9, s. 1016-1020.
9. Hasegawa, J., Hidaka, H., Tateda, M., Kudo, T., Sagai, S., Miyazaki, M., Katagiri, K., Nakanome, A., Ishida, E., Ozawa, D., Kobayashi, T.: Ananalysis of clinical risk factors of deep neck infection. Auris Nasus Larynx, 38, 2011, 1, s: 101-107.
10. Hasegawa, J., Tateda, M., Hidaka, H., Sagai, S., Nakanome, A., Katagiri, K., Seki, M., Katori, Y., Kobayashi, T.: Retropharyngeal abscess complicated with torticollis: case report and review of the literature. Tohoku J. Exp. Med., 213, 2007, 1, s. 99-104.
11. Huang, T. T., Liu, T. C., Chen, P. R., Tseng, F. Y., Yeh, T. H., Chen, Y. S.: Deep neck infection: analysis of 185 cases. Head Neck, 26, 2004, 10, s. 854-860.
12. Chrobok, V., Mejzlík, J., Spitzer, D., Plášilová, I.: Klinické poznámky k patologii retrofaryngeálního prostoru. Otorinolaryng. a Foniat. /Prague/, 50, 2001, 2, s. 115-120.
13. Klug, T. E., Fischer, A. S., Antonsen, C., Rusan, M., Eskildsen, H., Ovesen, T.: Parapharyngeal abscess is frequently associated with concomitant peritonsillar abscess. Eur. Arch. Otorhinolaryngol., 271, 2014, 6, s. 1701-1707.
14. Krtičková, J., Haviger, J., Ryšková, L., Smatanová, K., Chrobok, V., Školoudík, L.: Peritonzilární komplikace akutních zánětů patrových tonzil (retrospektivní studie). Otorinolaryng. a Foniat. /Prague/, 65, 2016, č. 1, s. 24-29.
15. Lin, C., Yeh, F. L., Lin, J. T., Ma, H., Hwang, C. H., Shen, B. H., Fang, R. H.: Necrotizing fasciitis of the head and neck: analysis of 47 cases. Plast., 107, 200, 7, s. 1684-1693.
16. Marioni, G., Staffieri, A., Parisi, S., Marchese-Ragona, R., Zuccon, A., Staffieri, C., Sari, M., Speranzoni, C., de Filippis, C., Rinaldi, R.: Rational diagnostic and therapeutic management of deep neck infections: analysis of 233 consecutive cases. Ann. Otol. Rhinol. Laryngol., 119, 2010, 3, s. 181-187.
17. Marioni, G., Castegnaro, E., Staffieri, C., Rinaldi, R., Giacomelli, L., Boninsegna, M., Bertolin, A., Staffieri, A.: Deep neck infection in elderly patients. A single institution experience (2000-2004). Aging Clin. Exp. Res., 18, 2006, 2, s. 127-132.
18. Mc Clay, J. E., Murray, A. D., Booth, T.: Intravenous antibiotik therapy for deep neck abscesses defined by computed tomography. Arch. Otolaryngol. Head Neck Surg., 129, 2003, 11, s. 1207-1212.
19. Mihál, V., Michálková, M., Mikulášová, J., Vidura, R., Wiedermann, J., Reitinger, J., Tenora, J., Tichá, V., Kazdová, H.: Tortikolis jako projev retrofaryngeálního abscesu, Pediatrie pro praxi, 2002, 1, s. 27-28.
20. Monobe, H, Suzuki, S, Nakashima, M, Tojima, H, Kaga, K.: Peritonsillar abscess with parapharyngeal and retropharyngeal involvement: incidence and intraoral approach., Acta Otolaryngol. Suppl., 599, 2007, s. 91-94.
21. Parhiscar, A., Har, E. G.: Deep neck absces. Ann. Otol. Rhinol. Laryngol., 110, 2001, 11, s. 1051-1054.
22. Ryšková, O.: Základy lékařské mikrobiologie a imunologie. Karolinum, 2000, s. 87-114, ISBN 80-246-0135-4.
23. Saluja, S., Brietzke, S. E., Egan, K. K., Klavon, S., Robson, C. D., Waltzman, M. L., Roberson, D. W.: A prospective study of 113 deep neck infections managed using a clinical practice guideline. Laryngoscope., 132, 2013, 12, s. 3211-3218.
24. Sláma, K. jun., Mrázková, L.: Retrofaryngeální absces lební baze u dítěte. Otorinolaryng. a Foniat. /Prague/, 56, 2, 2007, s. 115-118.
25. Suehara, B. A., Goncalves, A. J., Alcadipani, F. A., Kavabata, N. K.: Deep neck infection- analysis of 80 cases. Revista Brasileira de Otorhinolaryngologia, 74, 2008, 2, s. 253-259.
26. Wong, D. K., Brown, C., Mills, N., Spielmann, P., Neeff, M.: To drain or not to drain - management of pediatric deep neck abscesses: a case-control study. Int. J. Pediatr. Otorhinolaryngol., 76, 2012, 12, s. 1810-1813.
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